An exploration of facilitators and challenges in the scale-up of a national, public sector community health worker cadre in Zambia: a qualitative study

Human Resources for Health

Research

Margaret Lippitt Prust¹  Nikhil Wilmink²  Jan Willem van den Broek²  Sydney Chauwa Phiri³  Caroline Phiri Chibawe⁴  Ronald Misapa⁵ 

[1] Clinton Health Access Initiative, Boston, MA, United States of America;Clinton Health Access Initiative, Lusaka, Zambia;Clinton Health Access Initiative, Lusaka, Zambia;175 Kudu Road, Kabulonga, Lusaka, Zambia;Directorate of Public Health, Ministry of Health, Lusaka, Zambia;Office of the President, Public Service Management Division, Lusaka, Zambia;

关键词: Community health workers;    Human resources for health;    Qualitative process evaluation;    Zambia;    Health system strengthening;   

DOI  :  10.1186/s12960-017-0214-3

 received in 2017-02-07, accepted in 2017-06-15,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn 2010 a public sector cadre of community health workers called Community Health Assistants (CHAs) was created in Zambia through the National Community Health Worker Strategy to expand access to health services. This cadre continues to be scaled up to meet the growing demands of Zambia’s rural population. We summarize factors that have facilitated the scale-up of the CHA program into a nationwide CHW cadre and the challenges of introducing and institutionalizing the cadre within the Zambian health system.MethodsSemi-structured, individual interviews were held across 5 districts with 16 CHAs and 6 CHA supervisors, and 10 focus group discussions were held with 93 community members. Audio recordings of interviews and focus group discussions were transcribed and thematically coded using Dedoose web-based software.ResultsThe study showed that the CHAs play a critical role in providing a wide range of services at the community level, as described by supervisors and community members. Some challenges still remain, that may inhibit the CHAs ability to provide health services effectively. In particular, the respondents highlighted infrequent supervision, lack of medical and non-medical supplies for outreach services, and challenges with the mobile data reporting system.ConclusionsThe study shows that in order to optimize the impact of CHAs or other community health workers, key health-system support structures need to be functioning effectively, such as supervision, community surveillance systems, supplies, and reporting. The Ministry of Health with support from partners are currently addressing these challenges through nationwide supervisor and community data trainings, as well as advocating for adding primary health care as a specific focus area in the new National Health Strategy Plan 2017–2021. This study contributes to the evidence base on the introduction of formalized community health worker cadres in developing countries.

【 授权许可】

CC BY   
© The Author(s). 2017