Save the Children, Dhaka, Bangladesh.
Independent consultant, Hargeisa, Somalia.
Glob Health Sci Pract. 2021 Mar 15;9(Suppl 1):S179-S189. doi: 10.9745/GHSP-D-20-00466.
Community clinics (CCs) staffed by community health workers (CHWs) represent an effort of the Government of Bangladesh to strengthen the grassroots provision of primary health care services and to accelerate progress in achieving universal health coverage. The Improving Community Health Workers (ICHWs) Project of Save the Children piloted a CC-centered health service (CCHS) model that strengthened community and local government engagement, harmonized the work of different CHW cadres who were working in the same catchment area of each CC, and improved the accountability of CHWs and the CC to the local community.
We describe the process for developing and implementing the CCHS model in 6 unions in Barishal District where the model was piloted and provide some early qualitative and quantitative findings pertaining to the model's effectiveness. Data were collected from CCs in the 6 pilot unions and 6 other unions that served as a control. Qualitative data were collected from the intervention area during the pre-pilot (October 2017-September 2018) and pilot phase (October 2018-September 2019). Document review, key informant interviews, and focus group discussions were also conducted. Maternal and child health service utilization data were extracted from the government health information system in both the intervention and control areas.
Community group meetings ensured engagement with local government authorities and supported resource mobilization. There was greater coordination of work among CHWs and increased motivation of CHWs to better serve their clients. The analysis showed that the increase in maternal health consultations was substantially greater in the intervention area than in the control area, as was the number of referrals for higher-level care.
The CCHS model as applied in this pilot project is effective in engaging local key stakeholders, increasing CHW capacity, and improving client satisfaction. The model demonstrated that a community health system can be strengthened by a comprehensive approach that engages communities and local government officials and that harmonizes the work of CHWs.
由社区卫生工作者（CHWs）组成的社区诊所（CCs）是孟加拉国政府为加强基层初级卫生保健服务并加速实现全民健康覆盖而做出的努力。拯救儿童组织的改善社区卫生工作者（ICHWs）项目试点了以社区为中心的卫生服务（CCHS）模式，该模式加强了社区和地方政府的参与，协调了在每个 CC 同一服务范围内工作的不同 CHW 干部的工作，并提高了 CHWs 和 CC 对当地社区的问责制。
我们描述了在巴里萨尔区 6 个联盟中开发和实施 CCHS 模式的过程，并提供了一些与该模式有效性相关的早期定性和定量发现。数据来自 6 个试点联盟和 6 个作为对照的其他联盟的 CC 收集。在试点前（2017 年 10 月至 2018 年 9 月）和试点阶段（2018 年 10 月至 2019 年 9 月）期间，在干预区收集了定性数据。还进行了文件审查、关键人物访谈和焦点小组讨论。干预和对照地区的孕产妇和儿童卫生服务利用数据均从政府卫生信息系统中提取。
社区小组会议确保了与地方政府当局的接触，并支持资源动员。CHWs 之间的工作协调更加协调，CHWs 为更好地为客户服务的积极性也有所提高。分析表明，干预区的孕产妇保健咨询次数增加幅度明显大于对照组，而接受更高层次护理的转诊人数也有所增加。
在本试点项目中应用的 CCHS 模式在吸引地方主要利益攸关方、增强 CHW 能力和提高客户满意度方面是有效的。该模式表明，通过一种综合方法，即让社区和地方政府官员参与进来，并协调 CHW 的工作，可以加强社区卫生系统。
