Independent Consultant, Washington, DC, USA.
Department of Global Health, KIT Royal Tropical Institute, Amsterdam, The Netherlands.
Health Res Policy Syst. 2021 Oct 12;19(Suppl 3):116. doi: 10.1186/s12961-021-00756-4.
This is the ninth paper in our series, "Community Health Workers at the Dawn of a New Era". Community health workers (CHWs) are in an intermediary position between the health system and the community. While this position provides CHWs with a good platform to improve community health, a major challenge in large-scale CHW programmes is the need for CHWs to establish and maintain beneficial relationships with both sets of actors, who may have different expectations and needs. This paper focuses on the quality of CHW relationships with actors at the local level of the national health system and with communities.
The authors conducted a selective review of journal articles and the grey literature, including case study findings in the 2020 book Health for the People: National CHW Programs from Afghanistan to Zimbabwe. They also drew upon their experience working with CHW programmes.
The space where CHWs form relationships with the health system and the community has various inherent strengths and tensions that can enable or constrain the quality of these relationships. Important elements are role clarity for all actors, working referral systems, and functioning supply chains. CHWs need good interpersonal communication skills, good community engagement skills, and the opportunity to participate in community-based organizations. Communities need to have a realistic understanding of the CHW programme, to be involved in a transparent process for selecting CHWs, and to have the opportunity to participate in the CHW programme. Support and interaction between CHWs and other health workers are essential, as is positive engagement with community members, groups, and leaders.
To be successful, large-scale CHW programmes need well-designed, effective support from the health system, productive interactions between CHWs and health system staff, and support and engagement of the community. This requires health sector leadership from national to local levels, support from local government, and partnerships with community organizations. Large-scale CHW programmes should be designed to enable local flexibility in adjusting to the local community context.
这是我们系列文章中的第九篇，题为“新时代的社区卫生工作者”。社区卫生工作者（CHW）处于卫生系统和社区之间的中间位置。虽然这个位置为 CHW 提供了一个改善社区健康的良好平台，但在大规模 CHW 计划中，一个主要挑战是 CHW 需要与卫生系统和社区中的两个群体建立和维持有益的关系，这两个群体可能有不同的期望和需求。本文重点关注 CHW 与国家卫生系统的地方一级的行动者以及社区之间关系的质量。
作者对期刊文章和灰色文献进行了选择性审查，包括 2020 年出版的《人民的健康：阿富汗到津巴布韦的国家 CHW 计划》一书中的案例研究结果。他们还借鉴了与 CHW 计划合作的经验。
CHW 与卫生系统和社区建立关系的空间具有各种内在的优势和紧张关系，这些优势和紧张关系可以促进或限制这些关系的质量。重要的因素包括所有行动者的角色明确性、工作转介系统和运作的供应链。CHW 需要良好的人际沟通技巧、良好的社区参与技巧以及参与社区组织的机会。社区需要对 CHW 计划有一个现实的了解，需要参与一个透明的 CHW 计划选拔过程，并且有机会参与 CHW 计划。CHW 与其他卫生工作者之间的支持和互动以及与社区成员、团体和领导人的积极互动是至关重要的。
要取得成功，大规模 CHW 计划需要来自卫生系统的精心设计、有效的支持，CHW 与卫生系统工作人员之间的富有成效的互动，以及社区的支持和参与。这需要从国家到地方各级的卫生部门领导，需要地方政府的支持，并与社区组织建立伙伴关系。大规模 CHW 计划的设计应使其能够在适应当地社区环境方面具有灵活性。
