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Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines

BACKGROUND: Community health worker (CHW) programs are an important resource in the implementation of universal health coverage (UHC) in many low- and middle-income countries (LMICs). However, in countries with decentralized health systems like the Philippines, the quality and effectiveness of CHW p...

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Autores principales: Dodd, Warren, Kipp, Amy, Nicholson, Bethany, Lau, Lincoln Leehang, Little, Matthew, Walley, John, Wei, Xiaolin
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114679/
https://www.ncbi.nlm.nih.gov/pubmed/33980209
http://dx.doi.org/10.1186/s12913-021-06452-x
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author Dodd, Warren
Kipp, Amy
Nicholson, Bethany
Lau, Lincoln Leehang
Little, Matthew
Walley, John
Wei, Xiaolin
author_facet Dodd, Warren
Kipp, Amy
Nicholson, Bethany
Lau, Lincoln Leehang
Little, Matthew
Walley, John
Wei, Xiaolin
author_sort Dodd, Warren
collection PubMed
description BACKGROUND: Community health worker (CHW) programs are an important resource in the implementation of universal health coverage (UHC) in many low- and middle-income countries (LMICs). However, in countries with decentralized health systems like the Philippines, the quality and effectiveness of CHW programs may differ across settings due to variations in resource allocation and local politics. In the context of health system decentralization and the push toward UHC in the Philippines, the objective of this study was to explore how the experiences of CHWs across different settings were shaped by the governance and administration of CHW programs. METHODS: We conducted 85 semi-structured interviews with CHWs (n = 74) and CHW administrators (n = 11) in six cities across two provinces (Negros Occidental and Negros Oriental) in the Philippines. Thematic analysis was used to analyze the qualitative data with specific attention to how the experiences of participants differed within and across geographic settings. RESULTS: Health system decentralization contributed to a number of variations across settings including differences in the quality of human resources and the amount of financial resources allocated to CHW programs. In addition, the quality and provider of CHW training differed across settings, with implications for the capacity of CHWs to address specific health needs in their community. Local politics influenced the governance of CHW programs, with CHWs often feeling pressure to align themselves politically with local leaders in order to maintain their employment. CONCLUSIONS: The functioning of CHW programs can be challenged by health system decentralization through the uneven operationalization of national health priorities at the local level. Building capacity within local governments to adequately resource CHWs and CHW programs will enhance the potential of these programs to act as a bridge between the local health needs of communities and the public health system. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06452-x.
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spelling pubmed-81146792021-05-12 Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines Dodd, Warren Kipp, Amy Nicholson, Bethany Lau, Lincoln Leehang Little, Matthew Walley, John Wei, Xiaolin BMC Health Serv Res Research Article BACKGROUND: Community health worker (CHW) programs are an important resource in the implementation of universal health coverage (UHC) in many low- and middle-income countries (LMICs). However, in countries with decentralized health systems like the Philippines, the quality and effectiveness of CHW programs may differ across settings due to variations in resource allocation and local politics. In the context of health system decentralization and the push toward UHC in the Philippines, the objective of this study was to explore how the experiences of CHWs across different settings were shaped by the governance and administration of CHW programs. METHODS: We conducted 85 semi-structured interviews with CHWs (n = 74) and CHW administrators (n = 11) in six cities across two provinces (Negros Occidental and Negros Oriental) in the Philippines. Thematic analysis was used to analyze the qualitative data with specific attention to how the experiences of participants differed within and across geographic settings. RESULTS: Health system decentralization contributed to a number of variations across settings including differences in the quality of human resources and the amount of financial resources allocated to CHW programs. In addition, the quality and provider of CHW training differed across settings, with implications for the capacity of CHWs to address specific health needs in their community. Local politics influenced the governance of CHW programs, with CHWs often feeling pressure to align themselves politically with local leaders in order to maintain their employment. CONCLUSIONS: The functioning of CHW programs can be challenged by health system decentralization through the uneven operationalization of national health priorities at the local level. Building capacity within local governments to adequately resource CHWs and CHW programs will enhance the potential of these programs to act as a bridge between the local health needs of communities and the public health system. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12913-021-06452-x. BioMed Central 2021-05-12 /pmc/articles/PMC8114679/ /pubmed/33980209 http://dx.doi.org/10.1186/s12913-021-06452-x Text en © The Author(s) 2021 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Dodd, Warren
Kipp, Amy
Nicholson, Bethany
Lau, Lincoln Leehang
Little, Matthew
Walley, John
Wei, Xiaolin
Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines
title Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines
title_full Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines
title_fullStr Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines
title_full_unstemmed Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines
title_short Governance of community health worker programs in a decentralized health system: a qualitative study in the Philippines
title_sort governance of community health worker programs in a decentralized health system: a qualitative study in the philippines
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8114679/
https://www.ncbi.nlm.nih.gov/pubmed/33980209
http://dx.doi.org/10.1186/s12913-021-06452-x
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