Department of Public Health Medicine, College of Health Sciences, University of KwaZulu-Natal, Durban.
Afr J Prim Health Care Fam Med. 2021 Nov 26;13(1):e1-e14. doi: 10.4102/phcfm.v13i1.2691.
The effectiveness of community health workers (CHWs) in delivering community-based preventive services is often curtailed by inadequate or complete lack of integration of the CHW programmes into national health systems. Although literature has defined the context and guidelines for integrating CHW programmes into health systems, indicators to quantitatively assess the extent of integration are inadequately addressed.
This article presents an integration scale - CHW Programme Integration Scorecard Metrics (CHWP-ISM) - for measuring the extent of CHW programme integration into national health systems.
Literature review and policy documents were focused on sub-Saharan Africa, while interview participants were drawn from six African countries.
A deductive-inductive approach to item and measurement scale development was employed. Information obtained from a combination of diverse literature sources, subject matter expert (SME) interviews and documentary abstraction from publicly available policy documents advised item generation for the proposed CHWP-ISM. The study qualitatively captured the sectoral CHW integration, thematically analysed the data and culminated in the quantitative integration metrics.
Analysis of the responses from six SMEs and abstraction from policy documents resulted in the compilation of metrics with a total of 100 indicators for the CHWP-ISM scale that could be used to assess the level of CHW programmes integration into national health systems. The indicators were categorised along the six World Health Organization's (WHO) health systems building blocks. Subject matter expert responses corresponded well with abstracted results from the 18 country CHW programmes, indicating content validity.
The proposed scorecard metrics can be used to quantitatively rate the extent of CHW programmes integration into health systems, in an attempt to strengthen health systems to improve health outcomes.
社区卫生工作者（CHW）在提供基于社区的预防服务方面的效果往往受到 CHW 项目与国家卫生系统整合不足或完全缺乏整合的限制。尽管文献已经定义了将 CHW 项目纳入卫生系统的背景和指导方针，但用于定量评估整合程度的指标仍未得到充分解决。
本文提出了一个整合规模——CHW 项目整合记分卡指标（CHWP-ISM）——用于衡量 CHW 项目融入国家卫生系统的程度。
文献综述和政策文件集中在撒哈拉以南非洲，而访谈参与者则来自六个非洲国家。
采用演绎-归纳法开发项目和测量量表。从各种文献来源、主题专家（SME）访谈和公开政策文件的文献抽象中获得的信息为拟议的 CHWP-ISM 生成了项目。该研究从定性上捕捉了部门层面的 CHW 整合，对数据进行了主题分析，并最终得出了定量的整合指标。
对六名 SME 的回应分析和政策文件的抽象导致编制了 CHWP-ISM 量表的 100 项指标，这些指标可用于评估 CHW 项目融入国家卫生系统的程度。这些指标沿着世界卫生组织（WHO）的六个卫生系统构建块进行分类。主题专家的回应与从 18 个国家的 CHW 项目中抽象出来的结果非常吻合，表明了内容的有效性。
拟议的记分卡指标可用于定量评估 CHW 项目融入卫生系统的程度，以加强卫生系统，改善健康结果。
