Akinola Olatubosun, Banda Nelia, Silumbwe Adam, Mulubwa Chama, Chavula Malizgani Paul, Shakwelele Hilda, Chila Sylvia, Zulu Joseph Mumba
Clinton Health Access Initiative, Box 51071, Lusaka, Zambia.
Department of Health Policy and Management, School of Public Health, University of Zambia, PO Box 50110, Lusaka, Zambia.
BMC Prim Care. 2025 May 10;26(1):156. doi: 10.1186/s12875-025-02829-7.
Many low-and middle-income countries, including Zambia experience a huge deficit of human resource for health, which affects the delivery of primary health care services such as maternal and child health (MCH), nutrition, HIV and gender-based services. The Clinton Health Access Initiative in collaboration with the Zambian Ministry of Health implemented a community health systems (CHS) strengthening project to enhance the capacity of community health assistants (CHA) to provide MCH services from 2019 to 2021. The project activities included capacity building in supervision, provision of financial incentives and logistics. This study explores how these interventions strengthened the role of the CHAs in delivering MCH services.
This was a qualitative study consisting of 189 KIIs and IDIs as well as 20 FGDs conducted in all the 10 provinces of Zambia with the CHAs, and their supervisors, health workers, neighbourhood health committees and community members. Data were analysed using thematic analysis.
The CHS strengthening interventions including provision of training manuals, streamlined recruitment and deployment policies, capacity building of CHA supervisors, provision of transport and monthly remuneration contributed to improved delivery and acceptability of MCH services. Further, the leveraging of community networks, linkages and partnerships when delivering these services, including the traditional and religious leaders contributed to improved coverage and acceptability of MCH services. Meanwhile, health systems barriers such as limited supplies in some health facilities, shortage of health workers, persistent transportation challenges and failure to fully abide by the CHA recruitment and selection criteria affected delivery and acceptability of MCH services.
This study builds on existing evidence on the importance of building a stronger community-based primary health care to effectively address maternal and child health related issues. We emphasize the need to integrate strategies such as provision of training manuals, enhanced recruitment and deployment policies, capacity building of supervisors, provision of transport and remuneration within the CHA program to enhance the provision and acceptability of health services.
包括赞比亚在内的许多低收入和中等收入国家都面临着巨大的卫生人力资源短缺问题，这影响了孕产妇和儿童健康（MCH）、营养、艾滋病毒及性别相关服务等初级卫生保健服务的提供。克林顿健康获取倡议组织与赞比亚卫生部合作，于2019年至2021年实施了一个社区卫生系统（CHS）强化项目，以提高社区卫生助理（CHA）提供孕产妇和儿童健康服务的能力。该项目活动包括监督方面的能力建设、提供经济激励和后勤保障。本研究探讨了这些干预措施如何加强了社区卫生助理在提供孕产妇和儿童健康服务中的作用。
这是一项定性研究，在赞比亚所有10个省份对社区卫生助理及其 supervisors、卫生工作者、社区卫生委员会和社区成员进行了189次关键信息访谈（KIIs）和深入访谈（IDIs）以及20次焦点小组讨论（FGDs）。使用主题分析法对数据进行了分析。
社区卫生系统强化干预措施，包括提供培训手册、简化招聘和部署政策、社区卫生助理 supervisors 的能力建设、提供交通和月薪酬，有助于提高孕产妇和儿童健康服务的提供和可接受性。此外，在提供这些服务时利用社区网络、联系和伙伴关系，包括传统和宗教领袖，有助于提高孕产妇和儿童健康服务的覆盖范围和可接受性。同时，一些卫生设施供应有限、卫生工作者短缺、持续的交通挑战以及未能完全遵守社区卫生助理招聘和选拔标准等卫生系统障碍，影响了孕产妇和儿童健康服务的提供和可接受性。
本研究基于现有证据，证明了建立更强大的社区初级卫生保健对于有效解决孕产妇和儿童健康相关问题的重要性。我们强调需要在社区卫生助理项目中整合提供培训手册、加强招聘和部署政策、supervisors 的能力建设、提供交通和薪酬等策略，以提高卫生服务的提供和可接受性。
