Curtale F, Siwakoti B, Lagrosa C, LaRaja M, Guerra R
WHO Collaborating Centre, Istituto Superiore di Sanità, Rome, Italy.
Soc Sci Med. 1995 Apr;40(8):1117-25. doi: 10.1016/0277-9536(94)00172-p.
The study analyses the effects of a Nutrition Education Intervention (NEI), specifically designed to reduce vitamin A deficiency, on skills and utilization of Community Health Volunteers (CHVs) in rural Nepal. The intervention, which included preventive and curative activities, was carried out through the existing Primary Health Care (PHC) structure, utilizing CHVs trained by the Ministry of Health and already working in the villages. At the end of two years implementation, the CHVs associated with the NEI showed an improved ability to detect and treat a range of common diseases (diarrhoea, night blindness, malnutrition and acute respiratory infections) as compared with the CHVs not associated with the intervention program. Community utilization of CHVs increased significantly while the use of traditional healers and consultations at private pharmacies decreased. The utilization of health posts and referral to hospitals remained constant. Coverage for all activities carried out by the CHVs was higher among the population within the NEI area. The intervention did not utilize cash incentives. Its operational input consisted mainly of more frequent training, added supervision and increased and regular drug supply. The inclusion of curative activities among the CHVs' responsibilities seems to be a key factor in increasing motivation of volunteers and their acceptance within the community. This study indicated some possible adjustments to improve productivity and utilization of health volunteers in rural communities of Nepal, with a positive return for all PHC activities.
该研究分析了专门为减少维生素A缺乏症而设计的营养教育干预措施（NEI）对尼泊尔农村社区卫生志愿者（CHV）技能和利用情况的影响。该干预措施包括预防和治疗活动，通过现有的初级卫生保健（PHC）结构实施，利用由卫生部培训并已在村庄工作的社区卫生志愿者。在实施两年结束时，与营养教育干预措施相关的社区卫生志愿者在检测和治疗一系列常见疾病（腹泻、夜盲症、营养不良和急性呼吸道感染）方面的能力有所提高，相比之下，未参与干预项目的社区卫生志愿者则不然。社区对社区卫生志愿者的利用率显著提高，而传统治疗师的使用和在私人药房的咨询次数减少。卫生所的利用率和转诊到医院的情况保持不变。在营养教育干预措施区域内的人群中，社区卫生志愿者开展的所有活动的覆盖率更高。该干预措施未使用现金激励措施。其业务投入主要包括更频繁的培训、增加监督以及增加和定期的药品供应。将治疗活动纳入社区卫生志愿者的职责范围似乎是提高志愿者积极性及其在社区内被接受程度的关键因素。这项研究表明，为提高尼泊尔农村社区卫生志愿者的生产力和利用率可能需要进行一些调整，这将为所有初级卫生保健活动带来积极回报。
