Department of Family Medicine, University of Maryland Capital Region Health, Largo, MD, USA.
Department of Anthropology and Archeology, Brooklyn College of the City University of New York, Brooklyn, NY, USA.
Inquiry. 2024 Jan-Dec;61:469580241235059. doi: 10.1177/00469580241235059.
To understand the core aspects of an empowerment-based Community Health Worker (CHW) training program, we studied the model of the Comprehensive Rural Health Project (CRHP) in Jamkhed, India-an organization known for facilitating empowerment of women as Village Health Workers (VHWs) and agents of community change. We define empowerment as a means by which individuals gain health and development-related skills and knowledge to facilitate positive change within their lives and communities. Using VHW training observations and semi-structured interviews with health workers and senior trainers, 6 themes were developed and applied in 4 focus group sessions with 18 multigenerational VHWs trained by the CRHP. Transcripts were qualitatively analyzed under 6 themes-selection, baseline training, continuing education and support, community participation, community empowerment, and commitment and longevity. Empowerment of VHWs was found to be an intentional process involving the creation of safe and supportive environments conducive to long-term participatory and experiential learning with professionals who facilitate and mentor. The impact of the baseline training is maintained through ongoing program-VHW interactions and knowledge reinforcement in both the field and training center. Importantly, these interactions reinforce VHWs' credibility and confidence in communities served. Community participation was found to be of key importance starting at the selection phase. The methods used for selection, training and ongoing support are critical to developing a cadre of competent, effective and motivated VHWs as well as fostering long-lasting self-development and leadership skills. Downstream effectiveness of community empowerment on health outcomes is demonstrated through indicators such as access to safe deliveries, declining child malnutrition rates, high vaccination rates as well as reductions in stigmatization of illness and caste discrimination.
为了理解以赋权为基础的社区卫生工作者（CHW）培训计划的核心方面，我们研究了印度 Jamkhed 的综合农村卫生项目（CRHP）模式——该组织以促进农村妇女作为乡村卫生工作者（VHW）和社区变革推动者的赋权而闻名。我们将赋权定义为个人获得与健康和发展相关的技能和知识的手段，以促进其生活和社区的积极变革。使用 VHW 培训观察和与卫生工作者和高级培训师的半结构化访谈，我们开发了 6 个主题，并在 4 次焦点小组会议中应用了这些主题，共有 18 名接受过 CRHP 培训的多代 VHW 参加了这些会议。在 6 个主题下（选拔、基础培训、继续教育和支持、社区参与、社区赋权以及承诺和持久力）对转录本进行了定性分析。发现 VHW 的赋权是一个有意的过程，涉及创建安全和支持性的环境，有利于与促进和指导的专业人员进行长期参与式和体验式学习。通过持续的项目-VHW 互动和在现场和培训中心加强知识，保持基础培训的影响。重要的是，这些互动增强了 VHW 在服务社区中的信誉和信心。社区参与从选拔阶段开始就显得至关重要。选拔、培训和持续支持所使用的方法对于培养一批有能力、有效率和有积极性的 VHW 以及培养持久的自我发展和领导技能至关重要。通过安全分娩的获得、儿童营养不良率的下降、高疫苗接种率以及减少对疾病的污名化和种姓歧视等指标，展示了社区赋权对健康结果的下游效果。
