Zebre Getahun, Gizaw Abraham Tamirat, Tareke Kasahun Girma, Lemu Yohannes Kebede
Department of Epidemiology, Institute of Health, ABH-Jimma University, P.O.BOX 378, Jimma, Ethiopia.
Department of Health, Behavior, and Society, Institute of Health, Jimma University, P.O.BOX 378, Jimma, Ethiopia.
BMC Public Health. 2021 Jan 19;21(1):167. doi: 10.1186/s12889-021-10221-0.
Even though the urban health extension program (HEP) has been implemented since 2009, little was known about its implementation, experience and challenges. Therefore, this study was aimed at exploring the implementation, experience, and challenges of the urban HEP.
A qualitative case study was conducted in Addis Ababa from November 15 to December 29, 2017. The study participants were recruited purposefully. The parent populations were health extension professionals (HEPs). However, health post supervisors, health development army leaders (HDAs), Addis Ababa city HEP administrators, and other community members were also involved in the study. Four focus group discussions and 31 in-depth and key informant interviews were conducted. Data were transcribed verbatim, translated into the English, and analyzed by an inductive thematic analysis approach using Atlas ti7.1 software.
The study found that there were 15 health service packages of the urban HEP delivered to the community based on the need of the households. The strategies for the program implementation were provision of trainings, home visitation, creation of model households, strengthening of HDAs, supervision and reporting, referral and feedback, and social and community mobilization. However, program implementation was challenged by the health system related challenges (health service package and delivery, workload of HEPs, shortage of trained HEPs, lack of regular supervision or monitoring, lack of logistical or motivational support, poor supply chain management, dissatisfaction of HEPs, assigning of more than expected households for HEPs, etc.), multisectoral related and community related challenges (HDAs need of incentives, and lack of graduating model households as per the plan, etc.).
Although the program had a significant contribution to the health of community, it was affected by different challenges that underscore the need to develop different strategies and taking of actions. Therefore, the district health office, health centers and stakeholders from different sectors should have to support and motivate the HEPs and HDAs, and work together with them for successful implementation of the program.
尽管城市卫生推广项目（HEP）自2009年起就已实施，但人们对其实施情况、经验和挑战知之甚少。因此，本研究旨在探索城市卫生推广项目的实施情况、经验和挑战。
2017年11月15日至12月29日在亚的斯亚贝巴进行了一项定性案例研究。研究参与者是有目的地招募的。总体人群是卫生推广专业人员（HEPs）。然而，卫生所主管、健康发展军领导人（HDAs）、亚的斯亚贝巴市卫生推广项目管理人员以及其他社区成员也参与了研究。进行了四次焦点小组讨论和31次深入访谈及关键信息人访谈。数据逐字转录，翻译成英文，并使用Atlas ti7.1软件通过归纳主题分析方法进行分析。
研究发现，城市卫生推广项目根据家庭需求向社区提供了15种卫生服务包。项目实施策略包括提供培训、家访、创建示范家庭、加强健康发展军领导人的能力、监督和报告、转诊和反馈以及社会和社区动员。然而，项目实施面临与卫生系统相关的挑战（卫生服务包及提供、卫生推广专业人员的工作量、训练有素的卫生推广专业人员短缺、缺乏定期监督或监测、缺乏后勤或激励支持、供应链管理不善、卫生推广专业人员不满、给卫生推广专业人员分配的家庭数量超出预期等）、多部门相关和社区相关的挑战（健康发展军领导人需要激励措施，以及缺乏按计划毕业的示范家庭等）。
尽管该项目对社区健康有重大贡献，但它受到不同挑战的影响，这突出表明需要制定不同策略并采取行动。因此，地区卫生办公室、卫生中心和不同部门的利益相关者应支持和激励卫生推广专业人员和健康发展军领导人，并与他们共同努力以成功实施该项目。
