Lutwama George William, Kok Maryse, Jacobs Eelco
Health Pooled Fund, American Embassy Residency Road, Juba, South Sudan.
KIT Health, Royal Tropical Institute, Mauritskade 63, Amsterdam, 1090 HA, The Netherlands.
Confl Health. 2021 Nov 18;15(1):82. doi: 10.1186/s13031-021-00422-0.
Community health workers (CHWs) are crucial for increasing access to health services to communities. Due to decades of conflict and under-funding, access to health care in South Sudan remains severely limited. To improve equitable access to healthcare, the government has introduced "the Boma Health Initiative (BHI)", a strategy to harmonise community health programmes across the country. In order to scale up the BHI, it is necessary to assess the recent CHW programmes and draw lessons for future implementation. This study aimed to explore the characteristics, barriers, and facilitators to the implementation of CHW interventions in South Sudan between 2011 and 2019.
The study used a qualitative approach drawing from 26 key informant interviews and a scoping review of 21 Health Pooled Fund (HPF) programme reports from October 2016 to June 2018 and policy documents from 2011 to 2019. The results were thematically analysed based on a conceptual framework on factors influencing the performance of CHWs.
Funding of CHW programmes has come from international donors, channelled through non-governmental organisations (NGOs) that have implemented a variety of CHW programmes. Communities have been participating in the selection of voluntary CHWs, intervention areas, and occasionally in the supervision of activities performed by CHWs. The coordination mechanisms among stakeholders have been weak, leading to wastage and duplication of resources. Although training of CHWs is done, training duration was short, and refresher-trainings were rare. There were and still are disparities in the type of incentives provided to CHWs. Monitoring and supportive supervision activities have been insufficient; drug misuse and stock-outs were common.
Despite their challenges, CHW programmes can be implemented in conflict-affected South Sudan if the local human capital is leveraged and engaged by NGOs as implementing partners. Robust coordination efforts are required to build synergies among stakeholders for the effective implementation of the BHI strategy.
社区卫生工作者对于增加社区获得卫生服务的机会至关重要。由于数十年的冲突和资金不足，南苏丹获得医疗保健的机会仍然极为有限。为了改善医疗保健的公平可及性，政府推出了“博马卫生倡议（BHI）”，这是一项协调全国社区卫生项目的战略。为了扩大博马卫生倡议的规模，有必要评估近期的社区卫生工作者项目，并为未来的实施吸取经验教训。本研究旨在探讨2011年至2019年期间南苏丹实施社区卫生工作者干预措施的特点、障碍和促进因素。
该研究采用定性方法，进行了26次关键信息人访谈，并对2016年10月至2018年6月的21份卫生统筹基金（HPF）项目报告以及2011年至2019年的政策文件进行了范围界定审查。研究结果基于一个关于影响社区卫生工作者绩效的因素的概念框架进行了主题分析。
社区卫生工作者项目的资金来自国际捐助者，通过实施各种社区卫生工作者项目的非政府组织（NGO）提供。社区参与了志愿社区卫生工作者的选拔、干预领域的确定，偶尔也参与对社区卫生工作者所开展活动的监督。利益相关者之间的协调机制薄弱，导致资源浪费和重复。尽管对社区卫生工作者进行了培训，但培训时间较短，且很少有复训。过去和现在，向社区卫生工作者提供的激励类型都存在差异。监测和支持性监督活动不足；药物滥用和缺货情况很常见。
尽管存在挑战，但如果当地人力资本得到利用并由作为实施伙伴的非政府组织参与，社区卫生工作者项目可以在受冲突影响的南苏丹实施。需要进行强有力的协调努力，以在利益相关者之间建立协同效应，从而有效实施博马卫生倡议战略。
