A situational analysis of human resource and non-communicable diseases management for community health workers in Chengdu, China: A cross-sectional study

Abstract

Background Non-communicable diseases (NCDs) pose a major challenge to health economic cost and residents’ health status. Community health workers (CHWs) are the gatekeeper of primary health care. Objective This study aimed to conduct a situational analysis of the current human resource and requirement of NCDs-related training in Chengdu with regard to address to understand the suggestions for improvement of challenges and barriers. Methods A descriptive online cross-sectional survey was conducted among CHWs (doctor and nurse) from 23 districts and counties in Chengdu. Sociodemographic and NCDs-related variables were collected. Univariate analysis and multiple response analysis were used to describe the characteristics of these variables. Results 711 doctors and 637 nurses completely responded. There were significant differences among gender, age, educational levels, professional title, working year, type of institution, urban circle and registration in general practice between doctors and nurses (P < 0.001). The proportions of NCDs’ category, NCDs-related roles and tasks, NCDs-related training contents and forms that CHWs have attend and hoped to gain more were significantly different between doctors and nurses (P < 0.001). In general, the proportions in nurses were much lower than those of doctors (P < 0.05). The top five diseases managed by CHWs were hypertension, diabetes, cerebrovascular disease, chronic respiratory diseases and mental diseases. The five most reported roles performed among doctors included the distribution of health education (91.4%), following up (85.9%), establishing archives (71.3%), medicine adjustment (64.7%) and treatment implementation (27.8%). The top three diseases managed by nurses were same with doctors. The top four and five tasks were contact with patients or health services (39.6%) and referral (16.6%) in nurses. Most CHWs had received primary and common diseases-related trainings, but they had few opportunities to study in a tertiary hospital (40.4% in doctors and 20.9% in nurses, respectively), attend domestic academic conferences (26.9% in doctors vs 9.7% in nurses), and take part in training courses (44.9% in nurses). CHWs hoped that the above-discussed training contents and forms could be provided more in the future. Besides basic skills related trainings, some specific skills related trainings should be strengthened. Conclusion The qualifications in doctors were much better than those of nurses. The roles performed by CHWs in NCDs management are varied form common and frequent disease management to subsequent follow up and supervision. CHWs hope to receive more desired and oriented trainings. There is a need for building capacity of CHWs, optimizing and defining CHWs’ role, facilitating postgraduate medical education support and strengthening multidisciplinary collaboration would be effective in NCDs management.

The role of community health workers in non-communicable diseases in Cape Town, South Africa: descriptive exploratory qualitative study

“…The findings of the study showed that CHWs undertook a wide range of health care activities related to NCDs, but these were somewhat ad hoc and not well defined in policy. Studies elsewhere also highlight the need for clearer and more specific policy and guidelines on the role of CHWs in NCDs [18][19][20].…”