Laurenzi Christina A, Skeen Sarah, Rabie Stephan, Coetzee Bronwynè J, Notholi Vuyolwethu, Bishop Julia, Chademana Emma, Tomlinson Mark
Institute for Life Course Health Research, Department of Global Health, Stellenbosch University, Stellenbosch, South Africa.
Department of Psychology, Stellenbosch University, Stellenbosch, South Africa.
Health Soc Care Community. 2021 Sep;29(5):1249-1259. doi: 10.1111/hsc.13153. Epub 2020 Sep 4.
As demand for health services grows, task-shifting to lay health workers has become an attractive solution to address shortages in human resources. Community health workers (CHWs), particularly in low-resource settings, play critical roles in promoting equitable healthcare among underserved populations. However, CHWs often shoulder additional burdens as members of the same communities in which they work. We examined the experiences of a group of CHWs called Mentor Mothers (MMs) working in a maternal and child health programme, navigating the crossroads between personal and professional life in the rural Eastern Cape, South Africa. Semi-structured qualitative interviews (n = 10) were conducted by an experienced isiXhosa research assistant, asking MMs questions about their experiences working in their own communities, and documenting benefits and challenges. Interviews were transcribed and translated into English and thematically coded. Emergent themes include balancing roles (positive, affirming aspects of the role) and blurring boundaries (challenges navigating between professional and personal obligations). While many MMs described empowering clients to seek care and drawing strength from being seen as a respected health worker, others spoke about difficulties in adequately addressing clients' needs, and additional burdens they adopted in their personal lives related to the role. We discuss the implications of these findings, on an immediate level (equipping CHWs with self-care and boundary-setting skills), and an intermediate level (introducing opportunities for structured debriefings and emphasising supportive supervision). We also argue that, at a conceptual level, CHW programmes should provide avenues for professionalisation and invest more up-front in their workforce selection, training and support.
随着对卫生服务需求的增长，将任务转移给非专业卫生工作者已成为解决人力资源短缺问题的一个有吸引力的办法。社区卫生工作者（CHWs），特别是在资源匮乏地区，在促进服务不足人群获得公平医疗保健方面发挥着关键作用。然而，社区卫生工作者作为他们工作所在社区的成员，往往承担着额外的负担。我们考察了一组名为“指导母亲”（MMs）的社区卫生工作者在母婴健康项目中的经历，她们在南非东开普省农村地区的个人生活与职业生活之间艰难抉择。由一位经验丰富的科萨语研究助理进行了10次半结构化定性访谈，询问“指导母亲”们在自己社区工作的经历，并记录其中的益处和挑战。访谈内容被转录并翻译成英语，然后进行主题编码。浮现出的主题包括角色平衡（该角色积极、肯定的方面）和界限模糊（在职业义务和个人义务之间艰难抉择的挑战）。虽然许多“指导母亲”描述了如何使客户有能力寻求护理，并从被视为受尊敬的卫生工作者中汲取力量，但其他人谈到了在充分满足客户需求方面的困难，以及她们在个人生活中因该角色而承担的额外负担。我们讨论了这些研究结果的影响，在直接层面（为社区卫生工作者提供自我护理和设定界限的技能）和中间层面（引入结构化汇报的机会并强调支持性监督）。我们还认为，在概念层面，社区卫生工作者项目应提供职业化途径，并在劳动力选拔、培训和支持方面预先投入更多。
