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Moving from community-based to health centre-based management: impact on urban community health worker performance in Ethiopia.
Ludwick, Teralynn; Endriyas, Misganu; Morgan, Alison; Kane, Sumit; McPake, Barbara.
Afiliación
  • Ludwick T; Nossal Institute for Global Health,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, 333 Exhibition Street, Carlton, Victoria, 3000 Australia.
  • Endriyas M; Health Research and Technology Transfer Office, SNNPR State Health Bureau, Hawassa, Sidama, Ethiopia.
  • Morgan A; Nossal Institute for Global Health,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, 333 Exhibition Street, Carlton, Victoria, 3000 Australia.
  • Kane S; Global Financing Facility, The World Bank Group, Washington, DC, USA.
  • McPake B; Nossal Institute for Global Health,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, 333 Exhibition Street, Carlton, Victoria, 3000 Australia.
Health Policy Plan ; 37(2): 169-188, 2022 Feb 08.
Article en En | MEDLINE | ID: mdl-34519336
Community health worker (CHW) performance is influenced by the way in which management arrangements are configured vis-a-vis the community and health services. While low-/middle-income contexts are changing, the literature provides few examples of country efforts to strategically modify management arrangements to support evolving CHW roles (e.g. chronic disease care) and operating environments (e.g. urbanization). This paper aims to understand the performance implications of changing from community-based to health centre-based management, on Ethiopia's Urban Health Extension Professionals (UHEPs), and the tensions/trade-offs associated with the respective arrangements. We conducted semi-structured interviews/focus groups to gather perspectives and preferences from those involved with the transition (13 managers/administrators, 5 facility-based health workers and 20 UHEPs). Using qualitative content analysis, we deductively coded data to four programme elements impacted by changed management arrangements and known to affect CHW performance (work scope; community legitimacy; supervision/oversight/ownership and facility linkages) and inductively identified tensions/trade-offs. Community-based management was associated with wider work scope, stronger ownership/regular monitoring, weak technical support and weak health centre linkages, with opposite patterns observed for health centre-led management. Practical trade-offs included: heavy UHEP involvement in political/administrative activities under Kebele-based management; resistance to working with UHEPs by facility-based workers and health centre capacity constraints in managing UHEPs. Whereas the Ministry of Health/UHEPs favoured the health centre-led management to capitalize on UHEPs' technical skills, Kebele officials were vested in managing UHEPs and argued for community interests over UHEPs' professional interests; health facility managers/administrators held divided opinions. Management arrangements influence the nature of CHW contributions towards the achievement of health, development and political goals. Decisions about appropriate management arrangements should align with the nature of CHW roles and consider implementation setting, including urbanization, political decentralization and relative capacity of managing institutions.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Agentes Comunitarios de Salud / Instituciones de Salud Tipo de estudio: Prognostic_studies / Qualitative_research Límite: Humans País/Región como asunto: Africa Idioma: En Revista: Health Policy Plan Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2022 Tipo del documento: Article

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Agentes Comunitarios de Salud / Instituciones de Salud Tipo de estudio: Prognostic_studies / Qualitative_research Límite: Humans País/Región como asunto: Africa Idioma: En Revista: Health Policy Plan Asunto de la revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Año: 2022 Tipo del documento: Article