Health Policy Research Group, University of Nigeria, Enugu, Nigeria.
Health Res Policy Syst. 2024 Sep 5;22(1):124. doi: 10.1186/s12961-024-01204-9.
Sub-optimal community health service delivery (CHSD) has been a challenge constraining community health systems (CHS) globally, especially in developing countries such as Nigeria. This paper examined the key factors that either enhance or constrain CHSD in Nigeria at the individual, community/facility and governmental levels while recommending evidence-based solutions for sustaining and improving CHSD within the framework of CHS.
Data were collected through a qualitative study undertaken in three states (Anambra, Akwa-Ibom and Kano) in Nigeria. Respondents were formal/informal health providers, community leaders and representatives of civil society organizations all purposively sampled. There were 90 in-depth interviews and 12 focus group discussions, which were audio-recorded, transcribed verbatim and analysed thematically using codes to identify key themes.
Factors constraining community health service delivery at the individual level were poor health-seeking behaviour, preference for quacks and male dominance of service delivery; at the community/facility level were superstitious/cultural beliefs and poor attitude of facility workers; at the governmental level were inadequate financial support, embezzlement of funds and inadequate social amenities. Conversely, the enabling factors at the individual level were community members' participation and the compassionate attitude of informal providers. At the community and facility levels, the factors that enhanced service delivery were synergy between formal and informal providers and support from community-based organizations and structures. At the governmental level, the enhancing factors were the government's support of community-based formal/informal providers and a clear line of communication.
Community health service delivery through a functional community-health system can improve overall health systems strengthening and lead to improved community health. Policy-makers should integrate community health service delivery in all program implementation and ultimately work with the community health system as a veritable platform for effective community health service delivery.
社区卫生服务提供（CHSD）不尽如人意一直是一个挑战，限制了全球的社区卫生系统（CHS），尤其是在尼日利亚等发展中国家。本文研究了在个人、社区/机构和政府各级增强或限制尼日利亚 CHSD 的关键因素，同时为在 CHS 框架内维持和改善 CHSD 提出了基于证据的解决方案。
数据通过在尼日利亚三个州（阿南布拉、阿克瓦-伊博姆和卡诺）进行的定性研究收集。受访者是正规/非正规卫生提供者、社区领导和民间社会组织的代表，均采用目的性抽样。共进行了 90 次深入访谈和 12 次焦点小组讨论，对访谈进行了录音，逐字记录，并使用代码进行主题分析，以确定关键主题。
限制个人层面社区卫生服务提供的因素包括不良的就医行为、对庸医的偏好和男性对服务提供的主导地位；在社区/机构层面的因素包括迷信/文化信仰和工作人员的不良态度；在政府层面的因素包括财政支持不足、资金挪用和社会设施不足。相反，个人层面的有利因素是社区成员的参与和非正规提供者的同情心。在社区和机构层面，增强服务提供的因素是正规和非正规提供者之间的协同作用以及社区组织和结构的支持。在政府层面，增强因素是政府对社区内正规/非正规提供者的支持和明确的沟通渠道。
通过功能齐全的社区卫生系统提供社区卫生服务可以改善整体卫生系统强化，并改善社区卫生。决策者应将社区卫生服务提供纳入所有方案的实施中，并最终与社区卫生系统合作，将其作为有效提供社区卫生服务的可靠平台。
