Developing the national community health assistant strategy in Zambia: a policy analysis

Health Research Policy and Systems

Anna-Karin Hurtig²  Charles Michelo¹  John Kinsman²  Joseph Mumba Zulu² 

[1] Department of Public Health, School of Medicine, University of Zambia, P.O. Box 50110, Lusaka, Zambia;Umeå International School of Public Health (UISPH), Umeå University, Umeå SE 90185, Sweden

关键词: Zambia;    Policy analysis;    National community health assistant strategy;    Human resources;   

Others  :  809743
DOI  :  10.1186/1478-4505-11-24

 received in 2012-12-20, accepted in 2013-07-11,  发布年份 2013

【 摘 要 】

Background

In 2010, the Ministry of Health in Zambia developed the National Community Health Assistant strategy, aiming to integrate community health workers (CHWs) into national health plans by creating a new group of workers, called community health assistants (CHAs). The aim of the paper is to analyse the CHA policy development process and the factors that influenced its evolution and content. A policy analysis approach was used to analyse the policy reform process.

Methodology

Data were gathered through review of documents, participant observation and key informant interviews with CHA strategic team members in Lusaka district, and senior officials at the district level in Kapiri Mposhi district where some CHAs have been deployed.

Results

The strategy was developed in order to address the human resources for health shortage and the challenges facing the community-based health workforce in Zambia. However, some actors within the strategic team were more influential than others in informing the policy agenda, determining the process, and shaping the content. These actors negotiated with professional/statutory bodies and health unions on the need to develop the new cadre which resulted in compromises that enabled the policy process to move forward. International agencies also indirectly influenced the course as well as the content of the strategy. Some actors classified the process as both insufficiently consultative and rushed. Due to limited consultation, it was suggested that the policy content did not adequately address key policy content issues such as management of staff attrition, general professional development, and progression matters. Analysis of the process also showed that the strategy might create a new group of workers whose mandate is unclear to the existing group of health workers.

Conclusions

This paper highlights the complex nature of policy-making processes for integrating CHWs into the health system. It reiterates the need for recognising the fact that actors’ power or position in the political hierarchy may, more than their knowledge and understanding of the issue, play a disproportionate role in shaping the process as well as content of health policy reform.

【 授权许可】

   
2013 Zulu et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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