McGaw Medical Center, Northwestern University, Chicago, Illinois, USA.
Institute for Global Health Sciences, University of California San Francisco, San Francisco, California, USA.
Int J Equity Health. 2023 Feb 28;21(Suppl 2):201. doi: 10.1186/s12939-022-01761-x.
Community-based health interventions have been an integral part of recent health gains globally. An innovative approach to delivering community health care combines the Census-Based, Impact-Oriented (CBIO) Approach with Care Groups and Community Birthing Centers called Casas Maternas Rurales. CBIO+ was adopted by Curamericas/Guatemala in its Maternal and Child Health Project, 2011-2015. Here, we describe the opinions of Project staff and local government health care workers about the strengths and challenges of CBIO+. METHODS: Self-administered questionnaires, key informant interviews, and focus group discussions were used to obtain the views of 21 staff members from Curamericas/Guatemala as well as 15 local government health workers. The evaluation focused on four primary areas: (1) advisability of integrating the CBIO+ Approach into the government's rural health system, (2) staff knowledge of the CBIO+ Approach, (3) advantages, disadvantages and challenges of the CBIO+ Approach, and (4) proposed improvements to the CBIO+ Approach. The data were coded into categories and from these categories themes were derived.
The most commonly mentioned advantage of CBIO+ was the inclusion of the community in program planning, which improved participation. Many respondents noted that the CBIO+ Approach was challenging to implement in communities with internal conflicts. Among other challenges mentioned were coordinating (both among the Project staff and with others in the communities), maintenance of a high level of community participation, and overcoming opposition of men to women's participation in Care Groups. The staff mentioned a number of possible changes, including increasing male involvement, raising salaries for community-level paid staff, providing volunteers with incentives, and improving coordination both internally and externally. There was a strong demand among the local Ministry of Public Health and Social Welfare staff for the Project to continue.
The CBIO+ Approach and its implementation by Curamericas/Guatemala was overall embraced by local staff. By eliciting feedback while the project was ongoing, actionable areas for improvement were identified.
社区为基础的卫生干预措施是全球近期健康成果的重要组成部分。一种提供社区卫生保健的创新方法是将基于人口普查、以影响为导向（CBIO）的方法与护理小组和社区生育中心（称为农村母婴之家）相结合。2011-2015 年，危地马拉的 Curamericas 采用了 CBIO+ 方法来实施其母婴健康项目。在这里，我们描述了项目工作人员和当地政府卫生工作者对 CBIO+ 的优势和挑战的看法。方法：采用自填式问卷、关键知情人访谈和焦点小组讨论的方式，从危地马拉的 Curamericas 获得了 21 名工作人员以及 15 名当地政府卫生工作者的意见。评估重点关注四个主要领域：（1）将 CBIO+ 方法融入政府农村卫生系统的适宜性，（2）工作人员对 CBIO+ 方法的了解，（3）CBIO+ 方法的优点、缺点和挑战，（4）对 CBIO+ 方法的改进建议。数据被编码为类别，并从这些类别中得出主题。
最常提到的 CBIO+ 的优势是将社区纳入项目规划，这提高了参与度。许多受访者指出，在存在内部冲突的社区中，实施 CBIO+ 方法具有挑战性。其他提到的挑战包括协调（包括项目工作人员之间以及社区内其他人之间的协调）、保持高水平的社区参与度以及克服男性对女性参与护理小组的反对。工作人员提到了一些可能的变化，包括增加男性参与度、提高社区一级有偿工作人员的工资、为志愿者提供激励措施以及改善内部和外部的协调。当地公共卫生部和社会福利部的工作人员强烈要求项目继续进行。
CBIO+ 方法及其在危地马拉的实施得到了当地工作人员的总体认可。通过在项目进行时征求反馈意见，确定了可改进的行动领域。
