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Unintended Consequences of Community Health Worker Programs in South Africa

机译：社区卫生工作者计划在南非的意外后果

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Task shifting from trained clinicians to community health workers (CHWs) is a central, primary health care strategy advocated by global health policy planners in resource-poor settings where trained health professionals are scarce. The evidence base for the efficacy of these programs, however, is limited-in particular, research that identifies their potential unintended consequences. Based on sustained ethnographic study of CHWs working for AIDS projects in South Africa at the height of the country's AIDS epidemic, this article identifies how structural and local factors produced unintended consequences for CHW programs. These consequences were (a) CHWs moonlighting for multiple organizations, (b) CHWs freelancing in communities without regulation, and (c) adverse patient outcomes resulting from uncoordinated care. These consequences stemmed from structural elements of a bureaucratically weak health system and from local grassroots dynamics that jeopardized long-term CHW program sustainability and eroded national health goals.
机译：任务从训练有素的临床医生转移到社区卫生工作者（CHWS）是一个中央，主要的医疗保健战略，由全球卫生政策规划者在资源贫困环境中倡导，培训的卫生专业人员稀缺。然而，这些方案效力的证据基础是有限的，特别是确定其潜在意外后果的研究。基于在国家艾滋病流行的高度的南非艾滋病项目工作的CHWS持续的民族教学研究，本文确定了结构性和地方因素如何产生对CHW计划的意外后果。这些后果是（a）对于多个组织的Chws Morexlighting，（b）在没有规则的情况下在社区的FRWS自由职业者，并且（c）不开放的护理造成的不利患者结果。这些后果源于官僚主义弱卫生系统的结构元素，以及当地基层动态，危害长期CHW计划可持续性和侵蚀国家健康目标。

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