In this guest post, Dr Miriam Taegtmeyer, Senior Clinical Lecturer at the Liverpool School of Tropical Medicine writes for人力资源健康on the need for better evidence on the benefits and implementation of close-to-community health provider programsin low- and middle- income countries.

I am currently a member of theThematic Working Groupon Supporting and Strengthening the Role of Community Health Workers in Health System DevelopmentandtheREACHOUT财团。ReadeOt是在非洲和亚洲的六个国家工作的研究联盟。主题工作组汇集了有兴趣加强对社区卫生工作者使用证据的学者，政策制定者和从业者。

Many countries are rolling out or scaling up the use of community health workers – or close to community providers of health care to try and increase access to health services in line with national and global development goals. These health workers tend to live in the communities that they work in and receive a small amount of training to prevent, diagnose, and treat major illnesses and health conditions.

这些方案有很多承诺，但如果他们能够满足他们的全部潜力，我们需要新的知识，以确保安全，支持，可持续性，质量，可访问性和服务权益。我们还需要与更广泛的卫生系统和近距离靠近社区提供商服务的社区建立联系。鉴于需要更好的信息和指导，我们很高兴合作人力资源健康on a new thematic series.

To write this post, I asked for the views of our Thematic Working Group members to explain why this thematic series is timely and necessary.

为什么近乎社区提供者如此重要？

The composition and roles of close-to-community providers differ according to context. But all around the world they are playing a crucial role in the delivery of health services. The Red Cross has recently completeda set of case studies关于社区志愿者，突出了一些积极影响。

“Trained volunteers, from the local community and working in the local community, are well respected and trusted,” says one of the case studies, Monika Christofori-Khadka. “[They] have an immense impact in health prevention and promotion leading to changing health behavior of the local population, particularly regarding maternal and child health and water, sanitation and hygiene.

在某些环境中，由于我们在埃塞俄比亚的HHA的同事Daniel Gemechu解释：

“由于身体（距离），社会经济和文化（与耻辱相关），卫生设施仍然无法访问。它是通过近距离社区服务，由社区居民或理解文化的成员提供，我们可以达成并确保健康的可达性，并超越这些障碍。“

对近距离提供者的嵌入性和文化理解是印度尼西亚艾基克斯分子生物学研究所的Licia Limato提出的一点：

“近距离的提供者是社区本身，”她说。“作为已经从事社区的人民更加了解社区中的传统和文化价值，这可以被视为政府使人们获得健康信息和保健服务的优势。”

Close-to-community providers can support the health system in ways that go beyond the provision of information. AsRitu Sharmaof the Public Health Foundation of India explains:

“社区health workers form an important link between the community and health system, especially in countries and areas where there is shortage or distribution issues in terms of trained medical staff who do not stay close to the community.”

Why do we need more evidence on close-to-community providers?

There appears to be a resurgence of interest in close-to-community programming. Our colleagueMasuma Mamdani, of Ifakara Health Institute in Tanzania suggests that this is likely to increase:

“鉴于长期慢性疾病的负担越来越多，脆弱和受限制的系统，并且由于对家庭水平的护理负担，社区卫生工作者是该系统在提供医疗保健方面的必要部分。但这只会有效地支持和监督。“

对近社区卫生提供商的重新兴趣需要受到不同背景的强大的全面证据基础的基础。我们仍然不确定加强，维持和扩大近距离服务的最佳方式。

没有单一纸或系统审查将回答所有问题的政策制定者，从业者，捐助者，非政府组织和社区可能有关于如何最好地加强这些服务。作为专题工作组，我们需要有机会支持对话，解释，批评和译文的证据，以及分享不同背景，利益攸关方，衡量和纪律观点的经验和最佳实践。

Although our thematic series is focussed in low- and middle-income countries, it is likely to have relevance and resonance beyond these settings.Sara Javanparast，弗林德斯大学在澳大利亚表明：

“Given the increasing trend of migration, growing problem of chronic disease and issues of access and equity particularly amongst disadvantaged groups and also Indigenous people, more evidence is needed to inform health and human resource policies in developed countries.

“What lessons can we learn from successful close-to-community programmes that are transferable in a different context? What are the existing models of close-to-community programmes in developing countries and factors influencing sustainability of programmes? These are kind of questions that we don’t have enough evidence for in more developed countries.”

您可以提交文件24^钍November 2014to the ‘Close-to-community providers of health care: informing a global agenda’钍ematic series by visiting the人力资源健康website. The Thematic Working Group have a number of activities planned for the coming months, including several sessions at the Global Symposium on Health Systems Research, contact Faye Moody (faye.moody@lstmed.ac.uk.）如果您想了解更多信息。