Champagne Clara, Rajkumar Andrew Sunil, Auxila Paul, Perrone Giulia, Plötz Marvin, Young Alyssa, Bazaz Jazayeri Samuel, Napier Harriet G, Le Menach Arnaud, Battle Katherine, Amratia Punam, Cameron Ewan, Alfred Jean-Patrick, Deslouches Yves-Gaston, Pothin Emilie
Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.
University of Basel, Basel, Switzerland.
PLOS Glob Public Health. 2022 May 10;2(5):e0000167. doi: 10.1371/journal.pgph.0000167. eCollection 2022.
The national deployment of polyvalent community health workers (CHWs) is a constitutive part of the strategy initiated by the Ministry of Health to accelerate efforts towards universal health coverage in Haiti. Its implementation requires the planning of future recruitment and deployment activities for which mathematical modelling tools can provide useful support by exploring optimised placement scenarios based on access to care and population distribution. We combined existing gridded estimates of population and travel times with optimisation methods to derive theoretical CHW geographical placement scenarios including constraints on walking time and the number of people served per CHW. Four national-scale scenarios that align with total numbers of existing CHWs and that ensure that the walking time for each CHW does not exceed a predefined threshold are compared. The first scenario accounts for population distribution in rural and urban areas only, while the other three also incorporate in different ways the proximity of existing health centres. Comparing these scenarios to the current distribution, insufficient number of CHWs is systematically identified in several departments and gaps in access to health care are identified within all departments. These results highlight current suboptimal distribution of CHWs and emphasize the need to consider an optimal (re-)allocation.
在海地全国部署多技能社区卫生工作者（CHW）是卫生部发起的战略的一个组成部分，该战略旨在加快实现全民健康覆盖的努力。其实施需要规划未来的招聘和部署活动，数学建模工具可以通过基于医疗服务可及性和人口分布探索优化的安置方案，为这些活动提供有益支持。我们将现有的网格化人口估计和出行时间与优化方法相结合，得出理论上的社区卫生工作者地理安置方案，包括步行时间限制和每名社区卫生工作者服务的人数限制。比较了四种符合现有社区卫生工作者总数且确保每名社区卫生工作者步行时间不超过预定义阈值的全国规模方案。第一种方案仅考虑农村和城市地区的人口分布，而其他三种方案还以不同方式纳入了现有卫生中心的 proximity 。将这些方案与当前分布进行比较，发现几个部门的社区卫生工作者数量系统不足，并且在所有部门都发现了医疗服务可及性方面的差距。这些结果突出了当前社区卫生工作者分布的次优情况，并强调需要考虑进行优化（重新）分配。 （注：原文中“proximity of existing health centres”这里的“proximity”直接翻译为“接近度”不太好理解，可结合上下文意译为“现有卫生中心的距离因素”之类表述会更通顺，但按照要求未添加解释，保留原文表述。）
