Population Council, Washington DC, USA.
Zanmi Lasante, Mirebalais, Haiti.
J Glob Health. 2021 Mar 10;11:07004. doi: 10.7189/jogh.11.07004.
Community health systems (CHS) are integral in promoting well-being in humanitarian settings, like Haiti, a country plagued by disruptive socio-political and environmental shocks over the past two decades. Haiti's community health workers (CHWs) as critical intermediaries have persisted throughout these contextual shocks. This study explores how shocks influence CHS functionality and resilience in Haiti.
We applied an inductive and deductive qualitative approach to understand the lived experience of CHS actors. A desk review of peer-review and grey literature searched 393 and identified 25 relevant documents on community health policies, guidelines, and strategies implemented over the last fifteen years in Haiti. In-depth interviews with policy and program stakeholders (n = 12), CHWs (n = 24), and CHW supervisors and community health auxiliary nurses (n = 15) were conducted.
Various shocks - political transitions, natural disasters, and disease outbreaks - describe Haiti's protracted complex humanitarian setting and reveal distinct influences on CHS functionality (challenges and enablers), resilience, and mediating factors (eg, policy, financing, governance, parallel systems). Consequences of civil unrest and lockdowns (political transitions), internal displacement and infrastructural damage (natural disasters), and livelihood depletion and food insecurity (natural disasters and disease outbreaks) affect CHS functioning. CHW resilience is rooted in their generalized scope of work, intrinsic motivation, history in the community, trusting relationships, self-regulatory capacity, and adaptability. Mental health and safety among CHS actors and communities they serve pose challenges to CHS functionality and resilience, while reinforcing collaborations that promote CHW coverage and support and sustain CHS. Participants recommended government support for CHWs, collaborations stewarded by the government and complemented by partners, sub-national autonomy, and integration of disaster preparedness for all CHWs.
Political transitions, natural disasters, and disease outbreaks in Haiti continue to profoundly influence CHS functioning, despite mitigating policy and programming efforts. This study documents the relevance of CHS in maintaining primary health care for a country in protracted crises and suggests that propositions of CHW resilience can be explored in complex humanitarian settings globally.
社区卫生系统（CHS）在促进人道主义环境中的福祉方面发挥着重要作用，例如海地，这个国家在过去二十年中一直受到破坏性的社会政治和环境冲击的困扰。海地的社区卫生工作者（CHW）作为关键的中间人，在这些背景冲击中一直坚持下来。本研究探讨了冲击如何影响海地的 CHS 功能和弹性。
我们采用了归纳和演绎的定性方法来理解 CHS 行为者的生活经历。对过去十五年中在海地实施的社区卫生政策、指南和战略的同行评议和灰色文献进行了文献回顾，共搜索了 393 篇文献，确定了 25 篇相关文献。对政策和项目利益攸关方（n=12）、CHW（n=24）、CHW 主管和社区卫生辅助护士（n=15）进行了深入访谈。
各种冲击——政治过渡、自然灾害和疾病爆发——描述了海地长期复杂的人道主义环境，并对 CHS 功能（挑战和促进因素）、弹性和中介因素（如政策、融资、治理、平行系统）产生了明显的影响。内乱和封锁的后果（政治过渡）、国内流离失所和基础设施损坏（自然灾害）以及生计枯竭和粮食不安全（自然灾害和疾病爆发）影响了 CHS 的运作。CHW 的弹性源于他们广泛的工作范围、内在动机、在社区中的历史、信任关系、自我监管能力和适应性。CHS 行为者及其服务的社区的心理健康和安全对 CHS 的功能和弹性构成挑战，同时加强了促进 CHW 覆盖范围和支持并维持 CHS 的合作。参与者建议政府支持 CHW、由政府主导并由合作伙伴补充的合作、次国家自主权以及为所有 CHW 做好灾害准备。
尽管海地在政策和方案制定方面做出了缓解努力，但政治过渡、自然灾害和疾病爆发仍继续深刻影响 CHS 的运作。本研究记录了 CHS 在维持一个长期危机国家的基本医疗保健方面的重要性，并表明可以在全球复杂的人道主义环境中探索 CHW 弹性的命题。
