School of Public Health, The University of Queensland, Brisbane, Australia.
Health Social Science and Development Research Institute, Kathmandu, Nepal.
BMC Prim Care. 2024 Oct 29;25(1):385. doi: 10.1186/s12875-024-02629-5.
Community health programs (CHPs) are integral components of primary health care (PHC) systems and support the delivery of primary care and allied health and nursing care services. CHPs are necessary platforms for delivering health services toward universal health coverage (UHC). There are limited prior studies on comprehensive evidence synthesis on how CHPs strengthen community health systems for the demand and supply of PHC services. Therefore, this scoping review synthesized existing evidence on the interlinkage between CHPs and the community health system and beyond for delivering and utilising PHC services toward UHC.
We conducted a scoping review of research articles on CHPs. We identified research articles in six databases (PubMed/Medline, CINAHL, Scopus, Cochrane, Web of Science, and Embase) and Google Scholar using search terms under three concepts: CHPs, PHC, and UHC. Of the 3836 records identified, 1407 duplicates were removed, and 2346 were removed based on titles and abstracts. A total of 83 articles were eligible for the full-text review; of them, 18 articles were removed with reasons, and the other 16 were included through hand search. Themes were identified and explained using Sacks and colleagues' "Beyond the Building Block" framework.
A total of 81 studies were included in the final review. Studies described CHPs as foundations for community health system readiness for PHC services, including decentralization in the health sector, community-controlled governance, resource mobilization, ensuring health commodities (e.g., through community pharmacies), and information evidence. These foundational inputs mediate the actions of CHPs by partnership with community organizations and health workforces (e.g., community health workers). CHPs contributed to improved access to health services by providing health services in public health emergencies, affordable and comprehensive care, and modifying social determinants of health.
CHPs are platforms for implementing and delivering PHC services close to communities. They help to modify social determinants of health, promote health and wellbeing, reduce care costs, prevent disease progression, and reduce hospitalisation rates. CHPs are integral parts of community health systems and require investment to improve access to PHC services. Gaps and challenges of CHPs include inadequate funding, limited engagement of the private sector, poor quality of health services, and limited focus on non-communicable diseases (NCDs). Further implementation research is needed to mitigate the burden of NCDs. Health systems efforts focus on increasing resources (e.g., financial and human) required in CHPs to ensure the quality of PHC services provided through CHPs toward better service access, and reaching the unreached and achieve equity and universality of PHC services.
社区卫生服务项目（CHPs）是初级卫生保健（PHC）系统的重要组成部分，支持提供初级保健和相关医疗保健以及护理服务。CHPs 是实现全民健康覆盖（UHC）的必要平台。针对 CHPs 如何加强社区卫生系统以满足和提供 PHC 服务的全面证据综合研究有限。因此，本范围界定综述综合了现有的关于 CHPs 与社区卫生系统及其他方面之间的联系的证据，以实现 UHC 下的 PHC 服务提供和利用。
我们对 CHPs 的研究文章进行了范围界定综述。我们使用三个概念（CHPs、PHC 和 UHC）下的搜索词，在六个数据库（PubMed/Medline、CINAHL、Scopus、Cochrane、Web of Science 和 Embase）和 Google Scholar 中确定了研究文章。在 3836 条记录中，有 1407 条重复记录被删除，有 2346 条基于标题和摘要被删除。共有 83 篇文章符合全文审查标准；其中，有 18 篇因各种原因被排除，其余 16 篇通过手工检索纳入。使用 Sacks 及其同事的“超越构建块”框架确定并解释了主题。
最终综述共纳入 81 项研究。这些研究将 CHPs 描述为 PHC 服务社区卫生系统准备的基础，包括卫生部门的权力下放、社区控制的治理、资源动员、确保卫生商品（例如，通过社区药房）和信息证据。这些基础投入通过与社区组织和卫生工作者（例如，社区卫生工作者）建立伙伴关系来调节 CHPs 的行动。CHPs 通过在公共卫生紧急情况下提供卫生服务、提供负担得起和全面的护理以及调整健康的社会决定因素，有助于改善对卫生服务的获取。
CHPs 是在社区附近实施和提供 PHC 服务的平台。它们有助于调整健康的社会决定因素，促进健康和福祉，降低护理成本，预防疾病进展，降低住院率。CHPs 是社区卫生系统的组成部分，需要投资来改善对 PHC 服务的获取。CHPs 存在的差距和挑战包括资金不足、私营部门参与有限、卫生服务质量差以及对非传染性疾病（NCDs）的关注有限。需要进一步开展实施研究来减轻 NCD 的负担。卫生系统的工作重点是增加 CHPs 所需的资源（例如，财务和人力），以确保通过 CHPs 提供的 PHC 服务的质量，从而改善服务获取，并覆盖未覆盖的人群，实现 PHC 服务的公平性和普遍性。
