Dodd Warren, Kipp Amy, Nicholson Bethany, Lau Lincoln Leehang, Little Matthew, Walley John, Wei Xiaolin
School of Public Health and Health Systems, University of Waterloo, 200 University Ave. W, Waterloo, Ontario, N2L 3G1, Canada.
International Care Ministries, Manila, Philippines.
BMC Health Serv Res. 2021 May 12;21(1):451. doi: 10.1186/s12913-021-06452-x.
Community health worker (CHW) programs are an important resource in the implementation of universal health coverage (UHC) in many low- and middle-income countries (LMICs). However, in countries with decentralized health systems like the Philippines, the quality and effectiveness of CHW programs may differ across settings due to variations in resource allocation and local politics. In the context of health system decentralization and the push toward UHC in the Philippines, the objective of this study was to explore how the experiences of CHWs across different settings were shaped by the governance and administration of CHW programs.
We conducted 85 semi-structured interviews with CHWs (n = 74) and CHW administrators (n = 11) in six cities across two provinces (Negros Occidental and Negros Oriental) in the Philippines. Thematic analysis was used to analyze the qualitative data with specific attention to how the experiences of participants differed within and across geographic settings.
Health system decentralization contributed to a number of variations across settings including differences in the quality of human resources and the amount of financial resources allocated to CHW programs. In addition, the quality and provider of CHW training differed across settings, with implications for the capacity of CHWs to address specific health needs in their community. Local politics influenced the governance of CHW programs, with CHWs often feeling pressure to align themselves politically with local leaders in order to maintain their employment.
The functioning of CHW programs can be challenged by health system decentralization through the uneven operationalization of national health priorities at the local level. Building capacity within local governments to adequately resource CHWs and CHW programs will enhance the potential of these programs to act as a bridge between the local health needs of communities and the public health system.
在许多低收入和中等收入国家（LMICs），社区卫生工作者（CHW）项目是实现全民健康覆盖（UHC）的一项重要资源。然而，在像菲律宾这样卫生系统分散的国家，由于资源分配和地方政治的差异，CHW项目的质量和有效性在不同地区可能有所不同。在菲律宾卫生系统分权化以及推动全民健康覆盖的背景下，本研究的目的是探讨CHW项目的治理和管理如何塑造不同地区CHW的经历。
我们在菲律宾西内格罗斯省和东内格罗斯省的六个城市对CHW（n = 74）和CHW管理人员（n = 11）进行了85次半结构化访谈。采用主题分析法分析定性数据，特别关注参与者在地理区域内和区域间的经历差异。
卫生系统分权化导致了不同地区的一些差异，包括人力资源质量和分配给CHW项目的财政资源数量的差异。此外，CHW培训的质量和提供者在不同地区也有所不同，这对CHW满足其社区特定健康需求的能力产生了影响。地方政治影响了CHW项目的治理，CHW常常感到有压力在政治上与地方领导人保持一致以保住工作。
卫生系统分权化可能会给CHW项目的运作带来挑战，因为国家卫生重点在地方层面的实施不均衡。建设地方政府的能力，为CHW和CHW项目提供充足资源，将增强这些项目作为社区地方健康需求与公共卫生系统之间桥梁的潜力。
