School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.
UNICEF Nepal Country Office, Kathmandu, Nepal.
J Glob Health. 2023 May 12;13:04048. doi: 10.7189/jogh.13.04048.
Key informant interviews and focus group discussions were utilised. Participants included FCHVs, primary healthcare workers, community leaders and mothers, district health managers, representatives from the Ministry of Health and Population, multilateral health organisations, bilateral development partners, local non-governmental organisations, community-based organisations, and international non-governmental organisations. We used thematic content analysis to identify emerging themes.
Seventy-seven people participated in the study in September 2016 from communities (n = 53, 69%), districts (n = 8, 10%), and national levels (n = 16, 21%). Strong coordination, international and national support, and community engagement and participation were reported as successes of the earthquake response. Challenges included a lack of preparedness and supplies, a lack of earthquake-resistant infrastructure, and the centralisation of the response. FCHVs continued to work, despite being victims of the earthquake themselves. Facilitators of the continuation of the FCHVs' duties included their strong ties with the communities and facilities, international support, and the ability to mobilise existing community resources. Barriers included fear, communities' attitudes, high workloads, large geographic distances, and difficult geography. Participants identified the importance of having strong, connected, and supported communities, adaptable funding and policies, and decentralised decision-making within strong health systems.
Building resilience in community-based health systems must start with strong communities that are prepared, trained, equipped, and empowered. Health systems must be decentralised and adaptable, with strong coordination and leadership. Capable community health workers such as FCHVs were an important part of building resilience during the earthquake. These lessons can assist countries in strengthening decentralised health systems to better respond to a multitude of shocks, while still providing essential health services for communities.
利用关键知情人访谈和焦点小组讨论。参与者包括家庭保健员、初级卫生保健工作者、社区领导和母亲、地区卫生管理人员、卫生部和人口部代表、多边卫生组织、双边发展伙伴、地方非政府组织、社区组织和国际非政府组织。我们使用主题内容分析来确定新出现的主题。
2016 年 9 月，来自社区（n=53，69%）、地区（n=8，10%）和国家层面（n=16，21%）的 77 人参与了这项研究。协调有力、国际和国家支持以及社区参与和参与被认为是地震应对的成功之处。挑战包括准备不足和供应短缺、缺乏抗震基础设施以及应对工作的集中化。家庭保健员尽管自己是地震的受害者，仍继续工作。家庭保健员继续履行职责的促进因素包括他们与社区和设施的紧密联系、国际支持以及动员现有社区资源的能力。障碍包括恐惧、社区的态度、高工作量、地理距离大以及地理条件困难。参与者确定了拥有强大、联系紧密和得到支持的社区、适应性强的资金和政策以及在强大的卫生系统内进行权力下放决策的重要性。
在以有准备、受过培训、装备精良和有能力的社区为基础的社区卫生系统中建立复原力必须从强大的社区开始。卫生系统必须权力下放和具有适应性，协调和领导能力要强。有能力的社区卫生工作者，如家庭保健员，是在地震期间建立复原力的重要组成部分。这些经验教训可以帮助各国加强权力下放的卫生系统，以更好地应对多种冲击，同时仍为社区提供基本的卫生服务。
