Community health care workers in pursuit of TB: Discourses and dilemmas.

Autor: Onazi O; KNCV/ Challenge TB Project, The Hague, Netherlands., Adejumo AO; Department of Community Health and Primary Health Care, Lagos State University Teaching Hospital, Ikeja Lagos, Nigeria. Electronic address: oluadejum075@gmail.com., Redwood L; University of Sydney, Sydney, Australia., Okorie O; Abia State TB and Leprosy Control Programme, Abia State, Nigeria., Lawal O; Oyo State TB and Leprosy Control Programme Oyo State, Nigeria., Azuogu B; Department of Community Medicine, Ebonyi State University, Abakaliki, Nigeria., Gidado M; KNCV/ Challenge TB Project, The Hague, Netherlands., Daniel OJ; Department of Community Medicine and Primary Care, Olabisi Onabanjo University Teaching Hospital Sagamu, Ogun State, Nigeria., Mitchell EMH; Department of Public Health, Institute of Tropical Medicine Antwerp, Belgium.
Jazyk: angličtina
Zdroj: Social science & medicine (1982) [Soc Sci Med] 2020 Feb; Vol. 246, pp. 112756. Date of Electronic Publication: 2019 Dec 19.
DOI: 10.1016/j.socscimed.2019.112756
Abstrakt: Community-led tuberculosis (TB) active case finding is widely promoted, heavily funded, but many efforts fail to meet expectations. The underlying reasons why TB symptom screening programs underperform are poorly understood. This study examines Nigerian stakeholders' insights to characterize the mechanisms, enabling structures and influences that lead programs to succeed or fail. Eight focus group discussions were held with Community Health Workers (CWs) from four models of community-based TB screening and referral. In-depth interviews were conducted with 2 State TB program managers, 8 Community based organizations (CBOs), and 6 state TB and Leprosy Local Government supervisors. Transcripts were coded using Framework Analysis to assess how divergent understandings of CWs' roles, expectations, as well as design, political and structural factors contributed to the observed underperformance. Altruism, religious faith, passion, and commitment to the health and well-being of their communities were reasons CWs gave for starting TB symptom screening and referral. Yet politicized or donor-driven CWs' selection processes at times yielded implementers without a firm grounding in TB or the social, cultural, and physical terrain. CWs encountered suspicion, stigma, and hostility in both health facilities and communities. As the interface between the TB program and communities, CWs often bore the brunt of frustrations with inadequate TB services and CBO/iNGO collaboration. Some CWs expended their own social and financial capital to cover gaps in the active case finding (ACF) programs and public health services or curtailed their screening activities. Effective community-led TB active case finding is challenging to design, implement and sustain. Contrary to conventional wisdom, CWs did not experience it as inherently empowering. Sustainable, supportive models that combine meaningful engagement for communities with effective program stewardship and governance are needed. Crucially effective and successful implementation of community-based TB screening and referral requires a functional public health system to which to refer.
Competing Interests: Declaration of competing interest All authors declares no conflict of interest.
(Copyright © 2019 Elsevier Ltd. All rights reserved.)
Databáze: MEDLINE
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