Health Systems, Impact Evaluation and Policy Department, Ifakara Health Institute, Dar es Salaam, Tanzania.
Pact, Dar es Salaam, Tanzania.
PLoS One. 2020 Sep 18;15(9):e0239163. doi: 10.1371/journal.pone.0239163. eCollection 2020.
Trained community workers (CWs) successfully deliver health and social services, especially due to greater community acceptance. Orphans and vulnerable children (OVC) and their caregivers (CG) often need support from several sectors. We identified CW, program and referral characteristics that were associated with success of referrals provided to OVC and their CG in Tanzania in a cross-sectoral bi-directional referral system.
Data for this secondary analysis come from the first two years (2017-2018) of the USAID funded Kizazi Kipya project. Referral success was defined as feedback and service received within 90 days post-referral provision. We analyzed factors that are associated with the referral success of HIV related, education, nutrition, parenting, household economic strengthening, and child protection services among OVC and CG, using generalized estimating equations.
During the study period, 19,502 CWs in 68 councils provided 146,996 referrals to 132,640 beneficiaries. OVC had much lower referral success for HIV related services (48.1%) than CG (81.2%). Adjusted for other covariates, CW age (26-49 versus 18-25 years, for OVC aOR = 0.83, 95%CI (0.78, 0.87) and CW gender (males versus females, for OVC aOR = 1.12, 95%CI (1.08, 1.16); CG aOR = 0.84, 95%CI (0.78, 0.90)) were associated with referral success. CWs who had worked > 1 year in the project (aOR = 1.52, 95%CI 1.46, 1.58) and those with previous work experience as CW (aOR = 1.57, 95%CI (1.42, 1.74) more successfully referred OVC. Referrals provided to OVC for all other services were more successful compared to HIV referrals, with aORs ranging from 2.99 to 7.22. Longer project duration in the district council was associated with increased referral success for OVC (aOR = 1.16 per month 95%CI 1.15,1.17), but decreased for CG (aOR = 0.96, 95%CI 0.94, 0.97). Referral success was higher for OVC and CGs with multiple (versus single) referrals provided within the past 30 days (aOR = 1.28 95%CI 1.21, 1.36) and (aOR = 1.17, 95%CI (1.06, 1.30)) respectively.
CW characteristics, referral type and project maturity had different and often contrasting associations with referral success for OVC versus for CG. These findings could help policymakers decide on the recruitment and allocation of CWs in community based multi-sectoral intervention programs to improve referral successes especially for OVC.
经过培训的社区工作者（CW）成功提供健康和社会服务，尤其是因为他们更能被社区接受。孤儿和弱势儿童（OVC）及其照顾者（CG）通常需要来自多个部门的支持。我们在坦桑尼亚的一个跨部门双向转介系统中确定了与转介给 OVC 和 CG 的成功相关的 CW、项目和转介特征。
本二次分析的数据来自美国国际开发署资助的 Kizazi Kipya 项目的头两年（2017-2018 年）。转介成功被定义为在转介提供后 90 天内收到反馈和服务。我们使用广义估计方程分析了与 OVC 和 CG 的 HIV 相关服务、教育、营养、育儿、家庭经济增强和儿童保护服务的转介成功相关的因素。
在研究期间，68 个理事会的 19502 名 CW 为 132640 名受益人提供了 146996 次转介。OVC 获得 HIV 相关服务的转介成功率（48.1%）远低于 CG（81.2%）。在调整了其他协变量后，CW 年龄（26-49 岁与 18-25 岁相比，OVC 的调整后优势比[aOR]为 0.83，95%CI（0.78，0.87）和 CW 性别（男性与女性相比，OVC 的 aOR 为 1.12，95%CI（1.08，1.16）；CG 的 aOR 为 0.84，95%CI（0.78，0.90））与转介成功相关。在项目中工作>1 年的 CW（aOR=1.52，95%CI 1.46，1.58）和有 CW 工作经验的 CW（aOR=1.57，95%CI（1.42，1.74））更成功地转介了 OVC。与 HIV 转介相比，所有其他服务的 OVC 转介成功率更高，优势比（aOR）范围从 2.99 到 7.22。区议会项目持续时间较长与 OVC 的转介成功率增加（aOR=1.16/月，95%CI 1.15，1.17）相关，但与 CG 减少（aOR=0.96，95%CI 0.94，0.97）相关。在过去 30 天内提供多次（与单次相比）转介的 OVC 和 CG 的转介成功率更高（aOR=1.28，95%CI 1.21，1.36）和（aOR=1.17，95%CI（1.06，1.30））。
CW 特征、转介类型和项目成熟度与 OVC 与 CG 的转介成功率有不同且往往相反的关联。这些发现可以帮助决策者决定在社区为基础的多部门干预计划中招募和分配 CW，以提高转介成功率，尤其是 OVC。
