University of Parma, Department of Medicine and Surgery, Parma, Italy.
Qualitative Research Unit, Azienda USL - IRCCS, Reggio Emilia, Italy.
J Glob Health. 2022 May 14;12:04035. doi: 10.7189/jogh.12.04035.
Universal Health Coverage (UHC) can be achieved by universal access to a solid and resilient people-centred health care system, with Primary Health Care (PHC) as its foundation and strategy. Increased access to PHC occurs when health care services are available, affordable, accessible, acceptable, and perceived appropriate by users. Many studies highlight that health care workers are critical in helping people access, navigate, and interact with PHC services. How the interventions involving health care staff work and under what circumstance remains unclear.
Through a systematic review and a realist synthesis, we identified and described staff-based interventions impacting UHC through PHC. We conducted the systematic review from inception to June 2021, searching for peer-reviewed studies published in English, using quantitative methods for evaluating interventions.
We identified three Context-Mechanism-Outcome (CMO) configurations: inserting culturally sensitive ad hoc bridge figures, tailoring staff practices to the needs of specified populations, and training as a means for staff reskilling. Inserting ad hoc bridge figures in health care services was successful when they were familiar with the contextual culture and the users' needs. The second configuration entails interventions where the staff was asked to consider the needs of targeted populations and differentiate strategies by the detected conditions. Finally, the third one consists of specific, ad hoc, and context-based training targeting several stakeholders. Central to this intervention was training for health care bridge figures, since they were explicitly trained before performing their duties to cope with the health care and social needs of the specific groups they intended to serve.
The review highlights that the context and contextual factors should be considered for an intervention to be successful. Hence, it provides policymakers with practical indications for designing staff-based interventions for reaching UHC within PHC services in a given context. Healthcare bridge figures, an umbrella term embracing a variety of selected community health workers, often trained and working in the communities from which they come, increase access to PHC services as they respond to local societal and cultural norms and customs, ensuring community acceptance and ownership.
全民健康覆盖 (UHC) 可以通过普及坚实且有弹性的以人民为中心的医疗保健系统来实现，以初级卫生保健 (PHC) 为基础和战略。当医疗保健服务可供、负担得起、可及、可接受且被用户认为合适时，就会增加对 PHC 的获取。许多研究强调，医疗保健工作者在帮助人们获得、导航和与 PHC 服务互动方面至关重要。涉及卫生保健人员的干预措施如何发挥作用以及在什么情况下发挥作用尚不清楚。
通过系统评价和现实主义综合，我们确定并描述了通过 PHC 影响 UHC 的基于员工的干预措施。我们从成立到 2021 年 6 月进行了系统评价，搜索了以英文发表的同行评审研究，使用定量方法评估干预措施。
我们确定了三个情境-机制-结果 (CMO) 配置：插入具有文化敏感性的临时桥梁人物、根据特定人群的需求调整员工实践以及培训作为员工再技能的手段。在医疗保健服务中插入熟悉背景文化和用户需求的临时桥梁人物是成功的。第二种配置涉及到要求员工考虑目标人群的需求并根据检测到的情况区分策略的干预措施。最后，第三个配置包括针对几个利益相关者的具体、临时和基于背景的培训。这种干预的核心是针对医疗保健桥梁人物的培训，因为他们在履行职责之前要接受培训，以应对他们打算服务的特定群体的医疗保健和社会需求。
该综述强调，干预措施应考虑背景和背景因素才能取得成功。因此，它为政策制定者提供了在特定背景下为实现全民健康覆盖而设计基于员工的干预措施的实用指示。医疗保健桥梁人物是一个总称，涵盖了各种经过挑选的社区卫生工作者，他们通常在自己所在的社区接受培训和工作，他们响应当地的社会和文化规范和习俗，增加了对 PHC 服务的获取，确保了社区的接受和所有权。
