Zwama Gimenne, Stuttaford Maria Clasina, Haricharan Hanne Jensen, London Leslie
Health and Human Rights Programme, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
Institute for Global Health and Development, School of Health Sciences, Queen Margaret University, Edinburgh, United Kingdom.
Front Sociol. 2019 Apr 30;4:35. doi: 10.3389/fsoc.2019.00035. eCollection 2019.
Community participation, the central principle of the primary health care approach, is widely accepted in the governance of health systems. Health Committees (HCs) are community-based structures that can enable communities to participate in the governance of primary health care. Previous research done in the Cape Town Metropole, South Africa, reports that HCs' potential can, however, be limited by a lack of local health providers' (HPs) understanding of HC roles and functions as well as lack of engagement with HCs. This study was the first to evaluate HPs' responsiveness towards HCs following participation in an interactive rights-based training. Thirty-four HPs, from all Cape Metropole health sub-districts, participated in this qualitative training evaluation. Two training groups were observed and participants completed pre- and post-training questionnaires. Semi-structured interviews were held with 10 participants 3-4 months after training. Following training, HPs understood HCs to play an important role in the communication between the local community and HPs. HPs also perceived HCs as able to assist with and improve the quality and accessibility of PHC, as well as the answerability of services to local community needs. HPs expressed intentions to actively engage with the facility's HC and stressed the importance of setting clear roles and responsibilities for all HC members. This training evaluation reveals HPs' willingness to engage with HCs and their desire for skills to achieve this. Moreover, it confirms that HPs are crucial players for the effective functioning of HCs. This evaluation indicates that HPs' increased responsiveness to HCs following training can contribute to tackling the disconnect between service delivery and community needs. Therefore, the training of HPs on HCs potentially promotes the development of needs-responsive PHC and a people-centred health system. The training requires ongoing evaluation as it is extended to other contexts.
社区参与作为初级卫生保健方法的核心原则，在卫生系统治理中得到广泛认可。卫生委员会（HCs）是基于社区的组织架构，能够促使社区参与初级卫生保健的治理。然而，此前在南非开普敦都会区开展的研究报告指出，卫生委员会的潜力可能会受到当地卫生服务提供者（HPs）对卫生委员会角色和职能缺乏理解以及与卫生委员会缺乏互动的限制。本研究首次评估了卫生服务提供者在参加基于权利的互动式培训后对卫生委员会的反应。来自开普敦都会区所有卫生分区的34名卫生服务提供者参与了此次定性培训评估。观察了两个培训小组，参与者完成了培训前和培训后的问卷。培训3至4个月后，对10名参与者进行了半结构化访谈。培训后，卫生服务提供者认识到卫生委员会在当地社区与卫生服务提供者之间的沟通中发挥着重要作用。卫生服务提供者还认为卫生委员会能够协助并提高初级卫生保健的质量和可及性，以及服务对当地社区需求的响应能力。卫生服务提供者表示打算积极与所在机构的卫生委员会互动，并强调为所有卫生委员会成员明确角色和责任的重要性。此次培训评估揭示了卫生服务提供者与卫生委员会互动的意愿以及他们对实现这一目标所需技能的渴望。此外，它证实了卫生服务提供者是卫生委员会有效运作的关键参与者。该评估表明，培训后卫生服务提供者对卫生委员会反应能力的提高有助于解决服务提供与社区需求之间的脱节问题。因此，对卫生服务提供者进行关于卫生委员会的培训有可能促进响应需求的初级卫生保健和以人为本的卫生系统的发展。随着该培训扩展到其他环境，需要持续进行评估。
