{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T01:32:18Z","timestamp":1788226338172,"version":"build-2803163510"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"7","license":[{"start":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T00:00:00Z","timestamp":1750377600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"},{"start":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T00:00:00Z","timestamp":1750377600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/deed.de"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Bundesgesundheitsbl"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:sec>\n            <jats:title>Introduction<\/jats:title>\n            <jats:p>Community health workers (CHW) are crucial for universal health coverage (UHC) in low- and middle-income countries. Decentralization supports this goal but can cause issues if local actors misunderstand their roles. This study explores how Guinea\u2019s local health system actors understood and executed their responsibilities in delivering community health services from 2017 to 2021.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>This is a\u00a0subanalysis of 168 CHW from a\u00a0larger study of 522 respondents on the implementation of community health policy in Guinea. We used a\u00a0sequential explanatory mixed-methods design to assess the knowledge, involvement, and decision space of national community health policy actors, focusing on CHW and community volunteers (<jats:italic>Relais communautaires<\/jats:italic> [RECO]). This analysis was guided by decision space theory and explored both de\u00a0jure (formal) and de\u00a0facto (actual) decision-making. De\u00a0jure decision space refers to the choices authorized by official strategies, policies, or laws, while de\u00a0facto decision space reflects the choices reported by local actors in practice.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>Across all commune types, CHW and RECO demonstrated high knowledge and implementation levels of their roles in community health. Contrary to the initial hypothesis that fully implemented communes would have the highest decision-making space, commune type was not the primary determinant of decision-making space for CHW and RECO. The presence of CHW was positively associated with greater de\u00a0jure and de\u00a0facto decision-making space and enhanced capacity (<jats:italic>p<\/jats:italic>\u202f=\u20090.050). Univariate analysis showed that increased BCG vaccination coverage (vaccine to protect against tuberculosis) was significantly associated with expanded de\u00a0jure decision-making space (<jats:italic>p<\/jats:italic>\u202f=\u20090.041). Bivariate (<jats:italic>p<\/jats:italic>\u202f=\u20090.014) and multivariate (<jats:italic>p<\/jats:italic>\u202f=\u20090.011) analyses revealed that higher pentavalent vaccination coverage (vaccine to protect against diphtheria, tetanus, pertussis, hepatitis\u00a0B, and <jats:italic>Haemophilus influenzae<\/jats:italic> type\u00a0b) was also significantly associated with a\u00a0larger de\u00a0jure decision-making space.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusion<\/jats:title>\n            <jats:p>In countries with decentralized responsibilities, it is crucial for community health actors to understand their decision-making range to improve health outcomes. Also, ensuring sufficient and consistent capacity and funding is essential to enhance health services.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1007\/s00103-025-04076-8","type":"journal-article","created":{"date-parts":[[2025,6,20]],"date-time":"2025-06-20T08:02:08Z","timestamp":1750406528000},"page":"738-746","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Implementation of the national community health policy in Guinea: a\u00a0decision space analysis of the roles and responsibilities of community health workers"],"prefix":"10.1007","volume":"68","author":[{"given":"Alexandre","family":"Delamou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fassou Mathias","family":"Grovogui","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Facely","family":"Camara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Delphin","family":"Koli\u00e9","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tohaninz\u00e9","family":"Goumou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lior","family":"Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amy","family":"Nye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Bossert","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,6,20]]},"reference":[{"key":"4076_CR1","unstructured":"Programme des Nations Unies pour le VIH\/SIDA (2015) 2 millions d\u2019agents de sant\u00e9 communautaires en Afrique\u2014Tirer pleinement profit du dividende d\u00e9mographique, mettre fin \u00e0\u00a0l\u2019\u00e9pid\u00e9mie de sida et assurer durablement la sant\u00e9 pour tous en Afrique. https:\/\/www.unaids.org\/sites\/default\/files\/media_asset\/African2mCHW_fr.pdf. 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The study protocol was approved by the Guinea National Ethics Committee for Health Research in Guinea (No.\u00a0161\/CNERS\/2021) and the Harvard T.H. Chan School of Public Health (IRB21-1162). Informed consent was obtained from all individual participants included in the study.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}}]}}