Gouroumourty Revadi, Maheshwari Mukul, Prasad Anamika, Pakhare Abhijit, Joshi Ankur
Department of Community and Family Medicine, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India.
Department of Community Medicine, Sri Manakula Vinayagar Medical College and Hospital, Puducherry, India.
BMC Prim Care. 2025 May 20;26(1):179. doi: 10.1186/s12875-025-02851-9.
Community health workers' (CHWs') performance may be affected by several factors interplaying at the systemic level. There is a need to study those factors in the indigenous context to devise strategies for optimising the CHWs' performance. Hence, this study was conducted to understand the individual, health system and community level drivers of CHWs performance in Maternal and Child Health services and to decipher the interactions between CHWs and their stakeholders.
A qualitative inquiry using pragmatic philosophy in a rural setting of Central India (Madhya Pradesh) was conducted. Firstly, relatively low and high performing CHWs were identified, and their stakeholders were selected through purposive sampling. A total of twenty in-depth interviews of CHWs, including their stakeholders, and two focused group discussions with nineteen participants were conducted. Manual thematic analysis was used to summarise the drivers of CHWs' performance. The 4 Cs subjective realistic model was created. The 4Cs of the model stand for the context of the shared responsibility; the clashes experienced by the CHWs (while working with their peers), complications and subsequent coherent measures from the stakeholders' perspective.
The drivers of CHWs' performance were broadly constituted by three categories: contextual level, health system level and intrinsic contentment. The contextual factors include transport availability, community behaviour and heterogeneity in population. The determinants of health system were irregular incentives, scarcity of drugs, lack of peers' support, patronage and benefaction. The intrinsic contentment was represented with sense of lack of recognition, family issues and natural causes. As per the realistic model, the clashes were related to network and transport availability, concurrent surveys, irregular incentives and peer support. These clashes led to the incompletion of tasks by CHWs which further resulted in supervisory challenges for the peers. The coherent measures suggested includes strengthening of supportive supervision and availability of regular incentives and transport.
The CHWs' performance was a derivation of inherent context, which was bidirectionally influenced by health systems concerns. The stakeholders' interviews led to in depth understanding of the challenges faced by CHWs thereby adding validity to the qualitative inquiry.
社区卫生工作者（CHW）的绩效可能受到系统层面多种因素相互作用的影响。有必要在本土背景下研究这些因素，以制定优化社区卫生工作者绩效的策略。因此，本研究旨在了解妇幼保健服务中社区卫生工作者绩效的个人、卫生系统和社区层面驱动因素，并解读社区卫生工作者与其利益相关者之间的相互作用。
在印度中部（中央邦）的农村地区进行了一项采用实用主义哲学的定性调查。首先，确定了绩效相对较低和较高的社区卫生工作者，并通过目的抽样选择了他们的利益相关者。总共对20名社区卫生工作者及其利益相关者进行了深入访谈，并与19名参与者进行了两次焦点小组讨论。采用手动主题分析来总结社区卫生工作者绩效的驱动因素。创建了4C主观现实模型。该模型的4C代表共同责任的背景；社区卫生工作者（与同行合作时）经历的冲突、并发症以及从利益相关者角度采取的后续连贯措施。
社区卫生工作者绩效的驱动因素大致分为三类：背景层面、卫生系统层面和内在满足感。背景因素包括交通便利性、社区行为和人口异质性。卫生系统的决定因素是激励措施不规律、药品短缺、缺乏同行支持、赞助和捐助。内在满足感表现为缺乏认可感、家庭问题和自然原因。根据现实模型，冲突与网络和交通便利性、同时进行的调查、激励措施不规律和同行支持有关。这些冲突导致社区卫生工作者任务未完成，进而给同行带来监督挑战。建议的连贯措施包括加强支持性监督以及提供定期激励和交通便利。
社区卫生工作者的绩效是内在背景的产物，受到卫生系统相关问题的双向影响。对利益相关者的访谈有助于深入了解社区卫生工作者面临的挑战，从而为定性调查增添了有效性。
