State Health Resource Centre, Chhattisgarh, Raipur, India.
BMC Health Serv Res. 2022 Aug 10;22(1):1018. doi: 10.1186/s12913-022-08424-1.
Community health workers (CHWs) are crucial human resources for health. While specialist CHWs focus on a single disease vertically, the generalist or multipurpose CHWs perform wider functions. The current study was aimed at examining the time multipurpose CHWs spend on performing their different roles. This can help in understanding the importance they attach to each role. Since CHWs in many developing countries are classified as part-time volunteers, this study also aimed to assess the adequacy of CHW payments in relation to their time use.
The study covered a well-established CHW programme in India's Chhattisgarh state. It had 71,000 multipurpose part-time CHWs known as Mitanins. Data collection involved interviews with a representative sample of 660 rural and 406 urban Mitanins. A semi-structured tool was designed and field tested. It included 26 pre-coded activities of CHWs placed under their six purposes or roles. Prompting and triangulation were used during interviews to mitigate the possibility of over-reporting of work by CHWs. The recall period was of one week. Descriptive analysis included comparison of key indicators for rural and urban Mitanins. A multi-variate linear model was used to find the determinants of CHW time-use.
The rural and urban Mitanins respectively spent 25.3 and 34.8 h per week on their CHW work. Apart from location (urban), the total time spent was associated with size of population covered. The time-use was well balanced between roles of service-linkage, providing health education and curative care directly, COVID-19 related work and action on social determinants of health. More than half of their time-use was for unpaid tasks. Most of the cash-incentives were concentrated on service linkage role. The average payment earned by Mitanins was less than 60% of legal minimum wage.
The time-use pattern of Mitanins was not dictated by cash-incentives and their solidarity with community seemed be a key motivator. To allow wide ranging CHW action like Mitanins, the population per CHW should be decided appropriately. The considerable time multipurpose CHWs spend on their work necessitates that developing countries develop policies to comply with World Health Organisation's recommendation to pay them fairly.
社区卫生工作者（CHW）是卫生保健的重要人力资源。虽然专科 CHW 专注于单一疾病，但通才或多用途 CHW 则执行更广泛的职能。本研究旨在检查多用途 CHW 执行其不同角色的时间。这有助于了解他们对每个角色的重视程度。由于许多发展中国家的 CHW 被归类为兼职志愿者，因此本研究还旨在评估 CHW 薪酬与时间使用的相关性。
本研究涵盖了印度恰蒂斯加尔邦一个成熟的 CHW 计划。该计划拥有 71,000 名多用途兼职 CHW，称为 Mitanins。数据收集涉及对 660 名农村和 406 名城市 Mitanins 的代表性样本进行访谈。设计了一个半结构化工具，并进行了实地测试。它包括将 CHW 的 26 项预先编码活动置于他们的六个目的或角色之下。在访谈中使用提示和三角测量来减轻 CHW 工作过度报告的可能性。回忆期为一周。描述性分析包括比较农村和城市 Mitanins 的关键指标。使用多元线性模型来确定 CHW 时间利用的决定因素。
农村和城市 Mitanins 分别每周花费 25.3 和 34.8 小时从事 CHW 工作。除了位置（城市）外，总时间与覆盖的人口规模有关。时间利用在服务联系、直接提供健康教育和治疗护理、与 COVID-19 相关的工作以及对健康的社会决定因素的行动之间平衡良好。他们的时间利用有一半以上用于无偿任务。大部分现金激励都集中在服务联系角色上。Mitanins 获得的平均报酬不到法定最低工资的 60%。
Mitanins 的时间利用模式不是由现金激励决定的，他们与社区的团结似乎是一个关键的激励因素。为了允许像 Mitanins 这样广泛的 CHW 行动，应适当决定每个 CHW 的人口数量。多用途 CHW 花费大量时间工作，这就要求发展中国家制定政策，以符合世界卫生组织公平支付他们薪酬的建议。
