Andom Afom T, Gilbert Hannah N, Yuen Courtney M, Mokoroane Mapoho, Ndayizigiye Melino, Tsoele Mpopo, Koto Masebeo, Tlali Retsepile, Ratsiu Makena, Mukherjee Joia S
Partners In Health - Lesotho, House No. 233, Cnr. Lancers & Caldwell Rd., Maseru West, Private Bag A391, Maseru, 100, Lesotho.
Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
BMC Health Serv Res. 2025 Jan 23;25(1):124. doi: 10.1186/s12913-025-12259-x.
Community Health Workers locally known as Village Health Workers (VHW) in Lesotho are key members of the primary health workforce, and has been playing a significant role in building primary health systems in many countries and they can fill significant gaps in human resources as low and middle income countries work towards universal health coverage in the era of Sustainable Development Goals (SDGs). The 2014 Lesotho health reform restructured the VHW program to compensate, professionalize, and integrate VHWs into primary care services. We sought to document the ways in which the VHW program changed as a result of the health reform and the perceived impact of those changes.
In 2018, we conducted a qualitative research study with an inductive content analysis approach in the four pilot health reform districts of Lesotho. We conducted 26 in-depth interviews with health workers practicing in the community and in primary health facilities, as well as district health authorities, and Ministry of Health officials.
We found that the Lesotho health reform program was observed that it helped to professionalize the VHW program by introducing clear roles and responsibilities, regular monitoring, and supervision. The initiation of performance-based payment of VHWs and regular monitoring and reporting was thought contribute to overall improvement; in performance, strengthened links between communities and facilities, and promoted uptake of services.
The Lesotho Health Reform program was felt to be highly effective in re-structuring the VHW program in Lesotho, suggesting that when VHWs are well-incentivized, monitored, and supervised they can better fulfil their essential role as the backbone of the primary health workforce.
在莱索托，社区卫生工作者当地称为乡村卫生工作者（VHW），是初级卫生人力的关键成员，在许多国家的初级卫生系统建设中发挥了重要作用，并且在中低收入国家朝着可持续发展目标（SDG）时代的全民健康覆盖努力时，他们可以填补人力资源方面的重大缺口。2014年莱索托卫生改革对乡村卫生工作者项目进行了重组，以对乡村卫生工作者进行补偿、使其专业化并将其纳入初级保健服务。我们试图记录乡村卫生工作者项目因卫生改革而发生的变化方式以及这些变化所产生的感知影响。
2018年，我们在莱索托的四个试点卫生改革地区采用归纳性内容分析法进行了一项定性研究。我们对在社区和初级卫生设施工作的卫生工作者、地区卫生当局以及卫生部官员进行了26次深入访谈。
我们发现，莱索托卫生改革项目通过引入明确的角色和职责、定期监测和监督，有助于使乡村卫生工作者项目专业化。乡村卫生工作者基于绩效的薪酬发放以及定期监测和报告的启动被认为有助于整体改善；在绩效方面，加强了社区与设施之间的联系，并促进了服务的利用。
人们认为莱索托卫生改革项目在重组莱索托的乡村卫生工作者项目方面非常有效，这表明当乡村卫生工作者得到良好激励、监测和监督时，他们能够更好地履行其作为初级卫生人力骨干的基本职责。
