دانلود رایگان مقاله لاتین توسعه برنامه کارکنان سلامت جامعه از سایت الزویر
عنوان فارسی مقاله:
ذینفعان منظر: توسعه پایدار یک برنامه کارکنان سلامت جامعه در افغانستان
عنوان انگلیسی مقاله:
Stakeholder’s perspective: Sustainability of a community health worker program in Afghanistan
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مقدمه انگلیسی مقاله:
1. Introduction
Sustainability of health projects funded by international agencies is a major challenge both for donors and recipients in developing countries (Edwards & Roelofs, 2006; Sarriot et al., 2004). Sustainability could mean continuation of the project, sustaining the outputs, or maintaining the desired outcomes (Pluye, Potvin, & Denis, 2004). Scheirer and Dearing (2011) define sustainability as “continued use of program components and activities for the continued achievement of the desirable program and population outcomes” (p. 2060). Factors that contribute to sustainability of health projects include community involvement, organizational capacity building, and institutional integration (Sarriot et al., 2004). Empirical studies on sustainability of health projects are growing. Studying Primary Health Care projects implemented by non-governmental organizations (NGOs), Sarriot et al. (2004) found that sustainability occurs through a strategic partnership between local institutions and implementing organizations, capacity building of local institutions, and ensuring financial stability. Studying a health project in China funded by Canadian International Development Agency (CIDA), Edwards and Roelofs (2006) found that strong and transparent partnership with local institutions, adequate organizational support, and preparation of a handover plan atthe beginning were necessary elements to sustain the health project. In a systematic literature review on sustainability of and scaling up CHW programs, Pallas et al. (2013) identified enablers and barriers at multiple levels. At the community level, selection of motivated people from and by the community was an enabler, while lack of community and family support was considered a barrier. At the management level, direct, consistent and standardized supervision was an enabler, while insufficient incentive (a major cause of attrition) and poor supervision were barriers to sustainability. Finally, integration of CHWs into the broader health system and being formally recognized as a human resource for health were enablers, while lack thereof was a barrier to program sustainability Most studies of sustainability have focused on small projects implemented in isolation from the health system. There is little knowledge on sustainability of national health projects within health systems funded, especially when funded primarily by international organizations. In this paper we explore stakeholder perceptions of sustainability in Afghanistan’s national CHW program, which is part of the Basic Package of Health Services (BPHS). In 2014, Afghanistan had a population of approximately 29.8 million people, with 46% below 15 years of age, and 4% above 60 years (Campbell et al., 2013; WHO, 2015). Life expectancy at birth was estimated to be 60 years, an increase from 47 in 2002 (WHO, 2015). Almost 76% of the population lived in rural areas, and over 60% of the population had improved drinking-water sources, but improved sanitation facilities remained as low as 30% (WHO, 2015). Women and children in Afghanistan had one of the lowest health statuses in the world. Maternal mortality ratio was 400 per 100,000 live births, compared with 170 regionally and 210 globally (WHO, 2015). Out of 1000 live births, 36 newborns died before reaching their first month, 73 before reaching their first year, and 101 before reaching their fifth year –i.e., one out of ten dies before reaching their 5th birthday (Campbell et al., 2013). The fertility rate of 5.1 in Afghanistan was double the global average of 2.5 and contributes to both high maternal mortality and under-5 mortality (WHO, 2015). Human resources for health remained scarce in most regions of the country in 2013. Overall, there were 1.9 physicians and 7.5 nurses and midwives per 10,000 people in 2013, most of whom were based in cities and big towns, with as high as 7.2 physicians per 10,000 people in cities, and as low as 0.6 physicians per 10,000 people in rural areas (Campbell et al., 2013). Midwives were also typically based in health clinics where they have the necessary medical equipment for service provision (Bick, 2007). In villages, where 76% of the people lived, CHWs were the first and often the only point of contact of villagers with the formal health system (Najafizada, Labonté, & Bourgeault, 2014). Traditional Unani and Greek medical doctors, religious healers, traditional birth attendants and drug dispensers worked informally both in urban and rural areas (Wilson, 2011). To tackle the discouraging maternal, neonatal and child health concerns and a chronic shortage of human resources for health, the Afghan Ministry of Public Health started deploying volunteer Community Health Workers in rural areas of Afghanistan in 2003. The CHW program, a component of a Basic Package of Health Services, had trained around 26,000 CHWs (8.7 per 10,000 people) until 2014 (Najafizada et al., 2014). Though some studies have looked into the Basic Package of Health Services, in general (Ameli & Newbrander, 2008; Newbrander, Ickx, Feroz, & Stanekzai, 2014); there is a knowledge gap on the CHW program in Afghanistan and especially on sustainability of the Afghan CHW program. As the CHW program is a core component of the Basic Package of Health Services, the two are sometimes discussed interchangeably. The objectives of the study reported on in this paper were twofold: 1) to examine how different stakeholders define program sustainability, and 2) to identify facilitators and challenges to the sustainability of the Afghan CHW program
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