Connecting communities to primary care: a qualitative study on the roles, motivations and lived experiences of community health workers in the Philippines
Tóm tắt
Community health workers (CHWs) are an important cadre of the primary health care (PHC) workforce in many low- and middle-income countries (LMICs). The Philippines was an early adopter of the CHW model for the delivery of PHC, launching the Barangay (village) Health Worker (BHW) programme in the early 1980s, yet little is known about the factors that motivate and sustain BHWs’ largely voluntary involvement. This study aims to address this gap by examining the lived experiences and roles of BHWs in urban and rural sites in the Philippines. This cross-sectional qualitative study draws on 23 semi-structured interviews held with BHWs from barangays in Valenzuela City (urban) and Quezon province (rural). A mixed inductive/ deductive approach was taken to generate themes, which were interpreted according to a theoretical framework of community mobilisation to understand how characteristics of the social context in which the BHW programme operates act as facilitators or barriers for community members to volunteer as BHWs. Interviewees identified a range of motivating factors to seek and sustain their BHW roles, including a variety of financial and non-financial incentives, gaining technical knowledge and skill, improving the health and wellbeing of community members, and increasing one’s social position. Furthermore, ensuring BHWs have adequate support and resources (e.g. allowances, medicine stocks) to execute their duties, and can contribute to decisions on their role in delivering community health services could increase both community participation and the overall impact of the BHW programme. These findings underscore the importance of the symbolic, material and relational factors that influence community members to participate in CHW programmes. The lessons drawn could help to improve the impact and sustainability of similar programmes in other parts of the Philippines and that are currently being developed or strengthened in other LMICs.
Tài liệu tham khảo
World health organization and UNICEF: primary health care: report of the international conference on primary health care, 6-12 September 1978. Alma-Ata, USSR; 1978.
Scott K, Beckham SW, Gross M, Pariyo G, Rao KD, Cometto G, Perry HB. What do we know about community-based health worker programs? A systematic review of existing reviews on community health workers. Hum Resour Health. 2018;16(1):39.
Pinto RM, da Silva SB, Soriano R. Community health Workers in Brazil’s unified health system: a framework of their praxis and contributions to patient health behaviors. Soc Sci Med. 2012;74(6):940–7.
Olaniran A, Smith H, Unkels R, Bar-Zeev S, van den Broek N. Who is a community health worker? - a systematic review of definitions. Glob Health Action. 2017;10(1):1272223.
Phillips DR. Primary health care in the Philippines: banking on the barangays? Soc Sci Med (1982). 1986;23(10):1105–17.
Boerma T. The viability of the concept of a primary health care team in developing countries. Soc Sci Med (1982). 1987;25(6):747–52.
Lariosa TR. The role of community health workers in malaria control in the Philippines. Southeast Asian J Tropical Med Public Health. 1992;23(Suppl 1):30–5.
Bautista VA: Reconstructing the Functions of Government: The Case of Primary Health Care in the Philippines. Philippine J Public Administration 1996, XL(3 & 4 (July–October)):231–247.
Congress of the Philippines: Republic Act no. 7883: An act granting benefits and incentives to accredit barangay health workers and for other purposes. In. Metro Manila: Republic of the Philippines; 1995.
Bautista VA. Reconstructing the functions of government: the case of primary health Care in the Philippines; 1996.
Ramiro LS, Castillo FA, Tan-Torres T, Torres CE, Tayag JG, Talampas RG, Hawken L. Community participation in local health boards in a decentralized setting: cases from the Philippines. Health Policy Plan. 2001;16(Suppl 2):61–9.
Campbell C, Cornish F. Towards a "fourth generation" of approaches to HIV/AIDS management: creating contexts for effective community mobilisation. AIDS Care. 2010;22(Suppl 2):1569–79.
Marston C, Renedo A, McGowan CR, Portela A. Effects of community participation on improving uptake of skilled care for maternal and newborn health: a systematic review. PLoS One. 2013;8(2):e55012.
World Health Organization. Task shifting: Global recommendations and guidelines. Geneva: World Health Organization; 2008.
Palafox B, Seguin ML, McKee M, Dans AL, Yusoff K, Candari CJ, Idris K, Ismail JR, Krauss SE, Lasco G, et al. Responsive and equitable health systems-partnership on non-communicable diseases (RESPOND) study: a mixed-methods, longitudinal, observational study on treatment seeking for hypertension in Malaysia and the Philippines. BMJ Open. 2018;8(7):e024000.
QSR International. NVivo qualitative data analysis software, version 12. In: QSR International Pty Ltd; 2018.
Attride-Stirling J. Thematic networks: an analytic tool for qualitative research. Qual Res. 2001;1(3):385–405.
Regmi K, Naidoo J, Pilkington P. Understanding the processes of translation and transliteration in qualitative research. Int J Qual Methods. 2010;9(1):16–26.
Bhattacharyya K, Winch P, LeBan K, Tien M: Community health worker incentives and disincentives. In. Arlington, Virginia: USAID-BASICS II; 2001.
Lacuesta MC, Sarangani ST, Amoyen ND. A diagnostic study of the DOH health volunteer workers program. Philipp Popul J. 1993;9(1–4):26–36.
DataBank. https://databank.worldbank.org/home. Accessed 8 July 2020.
Rodriguez LL. Patriarchy and Women's Subordination in the Philippines. Review of Women's Studies. 1990;1(1):15–25.
Philippine Statistical Authority: Gender Statistics on Labor and Employment. In.: Republic of the Philippines - Philippine Statistical Authority; 2017.
Ramirez-Valles J. Promoting health, promoting women: the construction of female and professional identities in the discourse of community health workers. Soc Sci Med. 1998;47(11):1749–62.
Nkonki L, Cliff J, Sanders D. Lay health worker attrition: important but often ignored. Bull World Health Organ. 2011;89(12):919–23.
Langran IV. Decentralization, democratization, and health: the Philippine experiment. J Asian Afr Stud. 2011;46(4):361–74.
David F, Chin F. An analysis of the determinants of family planning volunteer workers' performance in Iloilo City; 1993.
Quitevis RB. Level of acceptability of roles and performance of barangay health Workers in the Delivery of basic health services. UNP Research J. 2011;20(1):1–1.
Daniels K, Sanders D, Daviaud E, Doherty T. Valuing and sustaining (or not) the ability of volunteer community health workers to deliver integrated community case Management in Northern Ghana: a qualitative study. PLoS One. 2015;10(6):e0126322.
Glenton C, Scheel IB, Pradhan S, Lewin S, Hodgins S, Shrestha V. The female community health volunteer programme in Nepal: decision makers' perceptions of volunteerism, payment and other incentives. Soc Sci Med (1982). 2010;70(12):1920–7.
Jeet G, Thakur JS, Prinja S, Singh M. Community health workers for non-communicable diseases prevention and control in developing countries: evidence and implications. PLoS One. 2017;12(7):e0180640.
Javanparast S, Windle A, Freeman T, Baum F. Community health worker programs to improve healthcare access and equity: are they only relevant to low- and middle-income countries? Int J Health Policy Manag. 2018;7(10):943–54.
Congress of the Philippines: Republic Act 11036: The Mental Health Act. In. Metro Manila: Republic of the Philippines; 2015.
Dangerous Drugs Board: Philippine Anti-Illegal Drugs Strategy. In. Edited by Board DD. Manila: Republic of the Philippines; 2019.
Department of Health: Implementing Guidelines on the Institutionalization of Philippine Package of Essential NCD Interventions for the Integrated Management of Hypertension and Diabetes in PHC facilities (Administrative Order 2012–0029). In. Manila: Republic of the Philippines; 2012.
Haines A, Sanders D, Lehmann U, Rowe AK, Lawn JE, Jan S, Walker DG, Bhutta Z: Achieving child survival goals: potential contribution of community health workers. Lancet (London, England) 2007, 369(9579):2121–2131.
Seidman G, Atun R. Does task shifting yield cost savings and improve efficiency for health systems? A systematic review of evidence from low-income and middle-income countries. Hum Resour Health. 2017;15(1):29.
Woolcock M, Narayan D. Social capital: implications for development theory, research, and policy. World Bank Res Obs. 2000;15(2):225–49.
Mohajer N, Singh D. Factors enabling community health workers and volunteers to overcome socio-cultural barriers to behaviour change: meta-synthesis using the concept of social capital. Hum Resour Health. 2018;16(1):63.
Adams C. Toward an institutional perspective on social capital health interventions: lay community health workers as social capital builders. Sociol Health Illness. 2020;42(1):95–110.
Wahl B, Lehtimaki S, Germann S, Schwalbe N. Expanding the use of community health workers in urban settings: a potential strategy for progress towards universal health coverage. Health Policy Plan. 2019.
Liwanag HJ, Wyss K. Optimising decentralisation for the health sector by exploring the synergy of decision space, capacity and accountability: insights from the Philippines. Health Res Policy Syst. 2019;17(1):4.
Congress of the Philippines: Republic Act 11223: The Universal Health Care Act. In. Metro Manila: Republic of the Philippines; 2018.
Department of Health: Implementing Rules and Regulations of the Universal Heatlh Care Act (Republic Act 11223). In. Metro Manila: Republic of the Philippines; 2019.