Schwarz Dan, Kim June-Ho, Ratcliffe Hannah, Bell Griffith, Awoonor-Williams John Koku, Nimako Belinda, Otupiri Easmon, Lipsitz Stuart, Hirschhorn Lisa, Bitton Asaf
Ariadne Labs, Brigham and Women's Hospital & Harvard T.H. Chan School of Public Health, Boston, MA, 02215, USA.
Division of Global Health Equity, Department of Medicine, Brigham & Women's Hospital, Boston, MA, 02215, USA.
Gates Open Res. 2019 Aug 23;3:1468. doi: 10.12688/gatesopenres.12979.3. eCollection 2019.
Community-based services are a critical component of high-quality primary healthcare. Ghana formally launched the National Community Health Worker (CHW) program in 2014, to augment the pre-existing Community-based Health Planning and Services (CHPS). To date, however, there is scant data about the program's implementation. We describe the current supervision and service delivery status of CHWs throughout the country. Data were collected regarding CHW supervision and service delivery during the 2017 round of the Performance Monitoring and Accountability 2020 survey. Descriptive analyses were performed by facility type, supervisor type, service delivery type, and regional distribution. Over 80% of CHWs had at least monthly supervision interactions, but there was variability in the frequency of interactions. Frequency of supervision interactions did not vary by facility or supervisor type. The types of services delivered by CHWs varied greatly by facility type and region. Community mobilization, health education, and outreach for loss-to-follow-up were delivered by over three quarters of CHWs, while mental health counseling and postnatal care are provided by fewer than one third of CHWs. The Western region and Greater Accra had especially low rates of CHW service provision. Non-communicable disease treatment, which is not included in the national guidelines, was reportedly provided by some CHWs in nine out of ten regions. Overall, this study demonstrates variability in supervision frequency and CHW activities. A high proportion of CHWs already meet the expected frequency of supervision. Meanwhile, there are substantial differences by region of CHW service provision, which requires further research, particularly on novel CHW services such as non-communicable disease treatment. While there are important limitations to these data, these findings can be instructive for Ghanaian policymakers and implementers to target improvement initiatives for community-based services.
基于社区的服务是高质量初级医疗保健的关键组成部分。加纳于2014年正式启动了国家社区卫生工作者（CHW）计划，以加强现有的基于社区的卫生规划与服务（CHPS）。然而，迄今为止，关于该计划实施情况的数据很少。我们描述了全国社区卫生工作者的当前监督和服务提供状况。在2020年绩效监测与问责制调查的2017年一轮中收集了有关社区卫生工作者监督和服务提供的数据。按机构类型、监督者类型、服务提供类型和区域分布进行了描述性分析。超过80%的社区卫生工作者至少每月有一次监督互动，但互动频率存在差异。监督互动的频率不因机构或监督者类型而异。社区卫生工作者提供的服务类型因机构类型和地区而有很大差异。超过四分之三的社区卫生工作者开展社区动员、健康教育和失访追踪外展工作，而提供心理健康咨询和产后护理的社区卫生工作者不到三分之一。西部地区和大阿克拉地区的社区卫生工作者服务提供率尤其低。据报道，十分之九的地区有一些社区卫生工作者提供国家指南未涵盖的非传染性疾病治疗。总体而言，本研究表明监督频率和社区卫生工作者活动存在差异。很大一部分社区卫生工作者已经达到了预期的监督频率。与此同时，社区卫生工作者服务提供在地区上存在很大差异，这需要进一步研究，特别是针对非传染性疾病治疗等新型社区卫生工作者服务。虽然这些数据有重要局限性，但这些发现可为加纳政策制定者和实施者针对基于社区的服务的改进举措提供指导。
