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首页> 美国卫生研究院文献>International Journal of Health Policy and Management >The Governance of National Community Health Worker Programmes in Low- and Middle-Income Countries: An Empirically Based Framework of Governance Principles Purposes and Tasks
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The Governance of National Community Health Worker Programmes in Low- and Middle-Income Countries: An Empirically Based Framework of Governance Principles Purposes and Tasks

机译：中低收入国家的国家社区卫生工作者计划的治理：基于经验的治理原则宗旨和任务框架

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>Background: National community health worker (CHW) programmes are increasingly regarded as an integral component of primary healthcare (PHC) in low- and middle-income countries (LMICs). At the interface of the formal health system and communities, CHW programmes evolve in context specific ways, with unique cadres and a variety of vertical and horizontal relationships. These programmes need to be appropriately governed if they are to succeed, yet there is little evidence or guidance on what this entails in practice. Based on empirical observations of South Africa’s community-based health sector and informed by theoretical insights on governance, this paper proposes a practical framework for the design and strengthening of CHW programme governance at scale. >Methods: Conceptually, the framework is based on multi-level governance thinking, that is, the distributed, negotiated and iterative nature of decision-making, and the rules, processes and relationships that support this in health systems. The specific purposes and tasks of CHW programme governance outlined in the framework draw from observations and published case study research on the formulation and early implementation of the Ward Based Outreach Team strategy in South Africa. >Results: The framework is presented as a set of principles and a matrix of 5 key governance purposes (or outputs). These purposes are: a negotiated fit between policy mandates and evidence, histories and strategies of community-based services; local organisational and accountability relationships that provide community-based actors with sufficient autonomy and power to act; aligned and integrated programme management systems; processes that enable system learning, adaptation and change; and sustained political support. These purposes are further elaborated into 17 specific tasks, distributed across levels of the health system (national, regional, and local). >Conclusion: In systematising the governance functions in CHW programmes, the paper seeks to shed light on how best to support and strengthen these functions at scale.
机译：>背景：在低收入和中等收入国家（LMIC），国家社区卫生工作者（CHW）计划越来越被视为基本医疗保健（PHC）的组成部分。在正式卫生系统和社区的交界处，CHW计划以特定于上下文的方式发展，具有独特的干部以及各种纵向和横向关系。如果要使这些程序成功，就需要对其进行适当的管理，但是在实践中几乎没有证据或指导。基于对南非社区卫生部门的实证观察，并从对治理的理论见解中获悉，本文提出了一个实用的框架，用于大规模设计和加强CHW计划治理。 >方法：从概念上讲，该框架基于多级治理思想，即决策的分布式，协商和迭代性质，以及在卫生系统中支持该决策的规则，流程和关系。框架中概述的CHW计划治理的特定目的和任务来自对南非基于Ward的外展团队战略的制定和早期实施的观察和已发表的案例研究。 >结果：该框架以一组原则和5个主要治理目的（或输出）的矩阵形式表示。这些目的是：协商确定政策授权与基于社区的服务的证据，历史和策略之间的契合；本地组织和问责关系，为社区参与者提供了足够的自主权和采取行动的权力；统一的综合计划管理系统；使系统学习，适应和改变的过程；和持续的政治支持。将这些目的进一步细化为17个具体任务，这些任务分布在卫生系统的各个级别（国家，区域和地方）。 >结论：在系统化CHW计划中的治理功能时，本文试图阐明如何最好地大规模支持和加强这些功能。

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