Sultan Marium A, Closser Svea, Majidulla Arman, Ahmed Saeed, Naz Farah, Nayyab Sadaf, Zaman Ayesha, Shafique Muhammad, Sohail Ali
Social and Behavioral Interventions Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
Sohail Inc, Peshawar, Pakistan.
PLOS Glob Public Health. 2023 Aug 29;3(8):e0002289. doi: 10.1371/journal.pgph.0002289. eCollection 2023.
Pakistan, along with Afghanistan, is one of two countries where wild poliovirus is still endemic. Frontline workers (FLWs) are the staff most intimately familiar with both implementation challenges and community context. Harnessing their expertise may be a way to improve the community-polio program interface, which has been a persistent and shifting challenge in polio-endemic areas of both countries. From 2020-2022, we engaged frontline workers in 18 Super High-Risk Union Councils (SHRUCs) in Pakistan through a Human-Centered Design ideas competition. In that competition, teams of polio FLWs identified the most significant barriers they faced in conducting their work, and suggested solutions to those problems-a window into the issues the program faces by the people who know it best. The suggestions of FLWs on how to eradicate polio fell into four main categories. First, there were suggestions to tackle community fatigue by reducing touchpoints, particularly visits solely for data collection. Second, there were calls to improve Primary Health Care in SHRUCs, as a way of addressing community frustrations over an intense focus on just one disease in the context of numerous acute needs. Third, there were suggested ways to increase community engagement through locally relevant channels. Finally, many workers suggested improvements to Human Resources processes and workplace dynamics. Across these ideas, one repeated concept is the need for balance between the intensity of polio activities required for eradication and the provision of other government services, including health services. FLWs engaged the process deeply, providing well thought out problem statements and ideas for change. It is our view that there is no one more qualified to speak to the issues on the ground than FLWs. There are critical insights available if we listen to people who are instrumental to the success of health programs, but not commonly involved with creating policy.
巴基斯坦与阿富汗一样，是仍有野生脊髓灰质炎病毒流行的两个国家之一。一线工作者是最熟悉实施挑战和社区情况的工作人员。利用他们的专业知识可能是改善社区与脊髓灰质炎项目接口的一种方式，这在两国脊髓灰质炎流行地区一直是一个持续且不断变化的挑战。2020年至2022年期间，我们通过一场以人为本的设计创意竞赛，让巴基斯坦18个超高风险联合委员会（SHRUCs）的一线工作者参与进来。在那场竞赛中，脊髓灰质炎一线工作者团队确定了他们在开展工作时面临的最重大障碍，并提出了解决这些问题的方案——这是了解该项目面临问题的一扇窗口，而了解情况的正是最熟悉它的人。一线工作者关于如何根除脊髓灰质炎的建议主要分为四类。第一，有人建议通过减少接触点来解决社区疲劳问题，特别是仅为数据收集而进行的走访。第二，有人呼吁改善超高风险联合委员会的初级卫生保健，以此解决社区在众多迫切需求背景下对仅专注于一种疾病的不满。第三，有人提出了通过与当地相关的渠道增加社区参与度的方法。最后，许多工作者建议改进人力资源流程和工作场所动态。在这些想法中，一个反复出现的概念是，在根除脊髓灰质炎所需活动的强度与提供包括卫生服务在内的其他政府服务之间需要取得平衡。一线工作者深入参与了这个过程，提供了经过深思熟虑的问题陈述和变革想法。我们认为，没有谁比一线工作者更有资格谈论实地问题。如果我们倾听那些对卫生项目成功至关重要但通常不参与制定政策的人的意见，就会获得关键的见解。
