期刊
HEALTH POLICY AND PLANNING
卷 36, 期 4, 页码 384-396出版社
OXFORD UNIV PRESS
DOI: 10.1093/heapol/czaa172
关键词
Community health workers; implementation science; qualitative research; primary health care
资金
- President's Emergency Plan for AIDS Relief (PEPFAR) through USAID [AID-674-A-12-00029, 72067419CA00004]
This study aimed to document the CHW policy implementation landscape across six provinces in South Africa, exploring reasons for local adaptation of CHW models and identifying potential barriers and facilitators to revision framework implementation. The findings highlighted the importance of adaptability in successful implementation under resource constraints, chronicling differences in NGO involvement, common facilitators in CHWs' work, and barriers and resource limitations they face. The study provided insight into improving the CHW program through recommendations from respondents and aligned with existing research while evaluating previously unexplored districts/provinces.
South Africa has a long history of community health workers (CHWs). It has been a journey that has required balancing constrained resources and competing priorities. CHWs form a bridge between communities and healthcare service provision within health facilities and act as the cornerstone of South Africa's Ward-Based Primary Healthcare Outreach Teams. This study aimed to document the CHW policy implementation landscape across six provinces in South Africa and explore the reasons for local adaptation of CHW models and to identify potential barriers and facilitators to implementation of the revised framework to help guide and inform future planning. We conducted a qualitative study among a sample of Department of Health Managers at the National, Provincial and District level, healthcare providers, implementing partners [including non-governmental organizations (NGOs) who worked with CHWs] and CHWs themselves. Data were collected between April 2018 and December 2018. We conducted 65 in-depth interviews (IDIs) with healthcare providers, managers and experts familiar with CHW work and nine focus group discussions (FGDs) with 101 CHWs. We present (i) current models of CHW policy implementation across South Africa, (ii) facilitators, (iii) barriers to CHW programme implementation and (iv) respondents' recommendations on how the CHW programme can be improved. We chronicled the differences in NGO involvement, the common facilitators of purpose and passion in the CHWs' work and the multitude of barriers and resource limitations CHWs must work under. We found that models of implementation vary greatly and that adaptability is an important aspect of successful implementation under resource constraints. Our findings largely aligned to existing research but included an evaluation of districts/provinces that had not previously been explored together. CHWs continue to promote health and link their communities to healthcare facilities, in spite of lack of permanent employment, limited resources, such as uniforms, and low wages.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据