دانلود رایگان مقاله توسعه پایدار برنامه کارکنان سلامت جامعه

Abstract

Objectives The objectives of this study were two-fold: 1) to examine how different stakeholders define sustainability, and 2) to identify barriers to and facilitators of the sustainability of the Afghan CHW program. Method We interviewed 63 individual key informants, and conducted 11 focus groups [35 people] with policymakers, health managers, community health workers, and community members across Afghanistan. The participants were purposefully selected to provide a wide range of perspectives. Finding Different stakeholders define sustainability differently. Policymakers emphasize financial resources; health managers, organizational operations; and community-level stakeholders, routine frontline activities. The facilitators they identify include integration into the health system, community support, and capable human resources. Barriers they noted include lack of financial resources, poor program design and implementation, and poor quality of services. Measures to ensure sustainability could be national revenue allocation, health-specific taxation, and community financing. Conclusion Sustainability is complicated and has multiple facets. The plurality of understanding of sustainability among stakeholders should be addressed explicitly in the program design. To ensure sustainability, there is a need for a coordinated effort amongst all stakeholders.

6. Conclusion

Ensuring the sustainability of health projects has become a major concern for international donors and governments across the low- and middle-income country spectrum. It is particularly acute in low-income post-conflict countries such as Afghanistan. This paper has examined perspectives of various stakeholders at different levels on Afghan BPHS program sustainability. Community and health manager concerns focused on more on the current state of the program than on its continuation, while only recently have other stakeholders begun to plan for its longer-term financial sustainability. Our findings generally suggest that the sustainability of internationally-funded programs, such as the CHW component of the BPHS, might better be ensured if program stakeholders converge on a shared understanding of this might mean at the outset of program implementation.