Kabanda Richard, Ocaatre Ronald Miria, Atwine Diana, Kim Bounggui, Waiswa Simon Erisa, Kavuma Prichard Denzel, Lee Yeni, Mutoni Loretah, Kim Solyi, Park Yein, Okuga Monica, Tweheyo Raymond
Republic of Uganda Ministry of Health, Kampala, Uganda.
Faculty of Health Sciences, Uganda Martyrs University, Kampala, Uganda.
BMJ Open. 2025 Jan 11;15(1):e082085. doi: 10.1136/bmjopen-2023-082085.
Empowering communities through identifying and unlocking community capacities and capabilities is vital for improving community health systems. This study assessed the community health system's status quo and readiness for implementing a government-led, partner-supported community health worker project.
A mixed methods cross-sectional study.
Two districts and one city in central Uganda.
21 key informants (KIIs) with district leaders, 4 focus group discussions (FGDs) with community health workers (CHWs) termed as village health teams in the Ugandan setting and a survey of 487 CHWs and 419 pregnant women who had childbirth 12 months before.
KIIs and FGDs explored community health system resources using the WHO health systems building blocks and the UNICEF health system strengthening maturation model. However, the surveys explored the work-related attributes and services delivered by the CHWs and to the community, respectively.
A framework analysis was used for qualitative data in NVivo 14. While descriptive and stratified analyses were conducted for quantitative data in Stata I/C 15.0: proportions for the varied geographical entities were compared using the t-test with p values <0.05 considered significant, one-way ANOVA was used to compare means.
Overall, all sites had relatively strong governance of community health only challenged by multiple implementing partners that were weakly coordinated. There was an exclusive paper-based information management system that linked to the national DHIS-2 software. Community reporting rates varied between 20% and 80%. Community health financing was weak, similarly to commodities availability. The mean age of the community health workforce was high at 50.9 (SD 11.9); the majority reported adequate skills in service delivery except for community first aid, Kangaroo mother care and noncommunicable diseases. Households' most received CHW services included home visits, treatment for sick under-five children and child immunisation.
The existing CHW system has governance and reporting strengths but could be enhanced through revitalization, enhanced coordination of stakeholders, providing appropriate training, work tools, supervision and engaging the community for accountability of results.
通过识别和释放社区能力来增强社区权能对于改善社区卫生系统至关重要。本研究评估了社区卫生系统的现状以及实施政府主导、伙伴支持的社区卫生工作者项目的准备情况。
一项混合方法横断面研究。
乌干达中部的两个区和一个市。
21名与 district leaders的关键信息提供者（KIIs），4次与社区卫生工作者（CHWs）的焦点小组讨论（FGDs），在乌干达背景下这些社区卫生工作者被称为乡村卫生团队，以及对487名社区卫生工作者和419名在12个月前分娩的孕妇进行的调查。
KIIs和FGDs使用世界卫生组织的卫生系统构建模块和联合国儿童基金会的卫生系统强化成熟模型来探索社区卫生系统资源。然而，调查分别探索了社区卫生工作者提供给社区的与工作相关的属性和服务。
在NVivo 14中使用框架分析对定性数据进行分析。在Stata I/C 15.0中对定量数据进行描述性和分层分析：使用t检验比较不同地理实体的比例，p值<0.05被认为具有统计学意义，使用单因素方差分析比较均值。
总体而言，所有地点的社区卫生治理相对较强，仅受到多个实施伙伴协调不力的挑战。存在一个与国家DHIS - 2软件相连的独家纸质信息管理系统。社区报告率在20%至80%之间。社区卫生筹资薄弱，物资供应情况类似。社区卫生工作队伍的平均年龄较高，为50.9岁（标准差11.9）；除社区急救、袋鼠式护理和非传染性疾病外，大多数人报告在服务提供方面具备足够的技能。家庭接受最多的社区卫生工作者服务包括家访、为五岁以下患病儿童治疗和儿童免疫接种。
现有的社区卫生工作者系统具有治理和报告方面的优势，但可通过振兴、加强利益相关者协调、提供适当培训、工作工具、监督以及让社区参与结果问责来加以加强。
