School of Social Service Administration, University of Chicago, Chicago, IL, USA.
Professor and Chair of Public Health Studies, Elon University, Elon, NC, USA.
BMC Health Serv Res. 2019 Aug 13;19(1):563. doi: 10.1186/s12913-019-4395-4.
Community health workers, known as Village Health Teams (VHTs) in Uganda, play a central role in increasing access to community-based health services. The objective of this research is to explore tensions that may emerge as VHTs navigate multiple roles as community members and care providers particularly when providing sensitive reproductive health and HIV care.
Twenty-five VHTs from a rural clinic in Uganda completed semi-structured interviews focused on experiences providing services. Interview questions focused on challenges VHTs face providing services and strategies for improving quality care. After translation from Luganda and transcription, interviews were analyzed using content analysis to identify emergent themes.
Most VHTs were female (n = 16). The average age was 46, and average length of VHT work, 11 years. Analyses revealed that all VHTs capitalized upon the duality of their position, shifting roles depending upon context. Three themes emerged around VHTs' perceptions of their roles: community insiders, professional outsiders, and intermediaries. A caregiver "insider" role facilitated rapport and discussion of sensitive issues. As community members, VHTs leveraged existing community structures to educate clients in familiar settings such as "drinking places". However, this role posed challenges as some VHTs felt compelled to share their own resources including food and transport money. Occupying a professional outsider role offered VHTs respect. Their specialized knowledge gave them authority to counsel others on effective forms of family planning. However, some VHTs faced opposition, suspicions about their motives, and violence in this role. In balancing these two roles, the VHTs adopted a third as intermediaries, connecting the community to services in the formalized health care system. Participants suggested that additional training, ongoing supervision, and the opportunity to collaborate with other VHTs would help them better navigate their different roles and, ultimately, improve the quality of service.
As countries scale up family planning and HIV services using VHTs, supportive supervision and ethical dilemma training are recommended so VHTs are prepared for the challenges of assuming multiple roles within communities.
社区卫生工作者，在乌干达被称为乡村卫生团队（VHT），在增加社区为基础的卫生服务获取途径方面发挥着核心作用。本研究旨在探讨 VHT 在作为社区成员和服务提供者（特别是在提供敏感的生殖健康和艾滋病毒护理时）履行多重角色时可能出现的紧张关系。
乌干达一个农村诊所的 25 名 VHT 完成了重点关注提供服务经验的半结构化访谈。访谈问题集中在 VHT 在提供服务时面临的挑战以及提高优质护理的策略。在从卢干达语翻译并转录后，使用内容分析法分析访谈，以确定出现的主题。
大多数 VHT 是女性（n=16）。平均年龄为 46 岁，VHT 工作平均时长为 11 年。分析表明，所有 VHT 都利用了他们的双重身份，根据情境转变角色。围绕 VHT 对其角色的看法出现了三个主题：社区内部人士、专业外部人士和中间人。作为社区成员，VHT 利用现有的社区结构在熟悉的环境中（如“饮酒场所”）为客户提供教育。然而，这种角色带来了挑战，因为一些 VHT 觉得有必要分享自己的资源，包括食物和交通费用。担任专业外部人士的角色使 VHT 获得了尊重。他们的专业知识使他们有权就有效的计划生育形式为他人提供建议。然而，一些 VHT 面临反对、对他们动机的怀疑以及在这种角色中遭受暴力。在平衡这两个角色的同时，VHT 采用了第三个角色作为中间人，将社区与正式医疗保健系统中的服务联系起来。参与者建议，提供额外的培训、持续的监督以及与其他 VHT 合作的机会，将有助于他们更好地应对不同角色，并最终提高服务质量。
随着各国使用 VHT 扩大计划生育和艾滋病毒服务，建议提供支持性监督和道德困境培训，以便 VHT 为应对社区内履行多重角色的挑战做好准备。
