Institute of Social Work, Dar es Salaam, Tanzania.
Dar es Salaam University College of Education (DUCE) & Institute of Development Studies (IDS), University of Dar s Salaam, Dar es Salaam, Tanzania.
Int J Health Plann Manage. 2021 May;36(3):703-714. doi: 10.1002/hpm.3114. Epub 2021 Jan 21.
Integration of community health workers (CHWs) into the health systems has become a global concern. Recently, the Government of Tanzania through the then Ministry of Health and Social Welfare initiated different strategies that aimed at integrating CHWs into the health system. This paper discusses the process and factors that influence the integration of CHWs into the health system in Tanzania. The study employed qualitative case study design using in-depth interviews (n = 37). In addition, various documents including health policies, Community-based Health Policy, community health workers guideline and Community health workers training curriculum were reviewed. Data were analysed by using thematic analysis. The findings indicated that potential CHWs were selected based on the National Council for Technical Education standards that required an applicant to have four (4) passes in the ordinary level examination. None of the CHWs who had undergone training had been employed by the government. This differed from what was prescribed in the CHWs guidelines. Integration of CHWs into health system in Tanzania has not been optimal because of inadequate preparations in terms of stakeholders engagement, infrastructure, legal and policy frameworks, technical expertise and financial resources. Effective integration of CHWs into the health system requires working with different actors to communicate objectives, achieve ownership of the stakeholders, manage conflict and cooperation, and sustain changes.
将社区卫生工作者（CHWs）纳入卫生系统已成为全球关注的焦点。最近，坦桑尼亚政府通过当时的卫生和社会福利部发起了旨在将 CHWs 纳入卫生系统的不同战略。本文讨论了坦桑尼亚将 CHWs 纳入卫生系统的过程和影响因素。该研究采用定性案例研究设计，使用深度访谈（n=37）。此外，还审查了各种文件，包括卫生政策、基于社区的卫生政策、社区卫生工作者指南和社区卫生工作者培训课程。数据采用主题分析进行分析。研究结果表明，根据国家技术教育委员会的标准，对潜在的 CHWs 进行了选择，该标准要求申请人在普通水平考试中获得四个（4）及格。没有一名经过培训的 CHWs 被政府雇用。这与 CHWs 指南中的规定不同。由于在利益攸关方参与、基础设施、法律和政策框架、技术专长和财政资源方面准备不足，坦桑尼亚将 CHWs 纳入卫生系统的工作并不理想。要使 CHWs 有效地融入卫生系统，需要与不同的利益相关者合作，以沟通目标、实现利益相关者的所有权、管理冲突与合作，以及维持变革。
