Center for One Health, University of Global Health Equity, Kigali, Rwanda.
Department of Infectious Disease and Global Health, Cummings School of Veterinary Medicine, Tufts University, North Grafton, MA, United States of America.
PLoS One. 2020 Sep 3;15(9):e0236255. doi: 10.1371/journal.pone.0236255. eCollection 2020.
Community Health Workers (CHWs) play a vital role delivering health services to vulnerable populations in low resource settings. In Rwanda, CHWs provide village-level care focused on maternal/child health, control of infectious diseases, and health education, but do not receive salaries for these services. CHWs make up the largest single group involved in health delivery in the country; however, limited information is available regarding the socio-economic circumstances and satisfaction levels of this workforce. Such information can support governments aiming to control infectious diseases and alleviate poverty through enhanced healthcare delivery. The objectives of this study were to (1) evaluate CHW opportunity costs, (2) identify drivers for CHW motivation, job satisfaction and care provision, and (3) report CHW ideas for improving retention and service delivery. In this mixed-methods study, our team conducted in-depth interviews with 145 CHWs from three districts (Kirehe, Kayonza, Burera) to collect information on household economics and experiences in delivering healthcare. Across the three districts, CHWs contributed approximately four hours of volunteer work per day (range: 0-12 hrs/day), which translated to 127 684 RWF per year (range: 2 359-2 247 807 RWF/yr) in lost personal income. CHW out-of-pocket expenditures (e.g. patient transportation) were estimated at 36 228 RWF per year (range: 3 600-364 800 RWF/yr). Participants identified many benefits to being CHWs, including free healthcare training, improved social status, and the satisfaction of helping others. They also identified challenges, such as aging equipment, discrepancies in financial reimbursements, poverty, and lack of formal workspaces or working hours. Lastly, CHWs provided perspectives on reasonable and feasible improvements to village-level health programming that could improve conditions and equity for those providing and using the CHW system.
社区卫生工作者（CHWs）在资源匮乏环境中为弱势人群提供卫生服务方面发挥着至关重要的作用。在卢旺达，CHWs 提供以母婴健康、传染病控制和健康教育为重点的村级护理，但不为此类服务获得薪酬。CHWs 构成了该国参与卫生服务提供的最大单一群体；然而，关于这一劳动力的社会经济情况和满意度的信息有限。这些信息可以支持各国政府通过加强医疗保健服务来控制传染病和减轻贫困。本研究的目的是：（1）评估 CHW 的机会成本，（2）确定激励 CHW 动力、工作满意度和提供护理的因素，以及（3）报告 CHW 关于改善留用和服务提供的想法。在这项混合方法研究中，我们的团队对来自三个地区（基里雷、卡扬扎、布鲁拉）的 145 名 CHWs 进行了深入访谈，以收集有关家庭经济状况和提供医疗保健服务经验的信息。在这三个地区，CHWs 每天贡献大约四个小时的志愿者工作（范围：0-12 小时/天），这相当于每年损失 127,684 卢旺达法郎（范围：2359-2247807 卢旺达法郎/年）的个人收入。CHW 的自费支出（例如患者交通费用）估计为每年 36228 卢旺达法郎（范围：3600-364800 卢旺达法郎/年）。参与者认为成为 CHW 有很多好处，包括免费的医疗培训、社会地位的提高以及帮助他人的满足感。他们还指出了一些挑战，例如设备老化、财务报销差异、贫困以及缺乏正式的工作空间或工作时间。最后，CHWs 就改善村级卫生规划提出了合理和可行的观点，这可以改善提供和使用 CHW 系统的人的条件和公平性。
