问答：从小岛农场到公共卫生教授

戴安娜·纳巴蒂亚·恩苏布加（Diana Nambatya Nsubuga）成为乌干达苏斯群岛“非常小”村庄的第一个大学毕业生后，继续完成了美国公共卫生博士学位。

Now the co-founder of综合健康Kwagala农场Nsubuga是一个促进妇女和年轻人的财务独立性的城市农业基金会，并曾是Makerere University的荣誉教授，是营养，社区健康和计划生育计划的倡导者。

Nsubuga告诉scidev.net为什么社区卫生工作者有权改变非洲的未来。

您拥有多个全球职位，并赢得了许多奖项，并且对健康和农业都充满热情。但是你的热情在哪里更强烈？

正是通过耕种，我的父母能够带我上学，但是除此之外，我们的耕作能够负担得起一顿体面，平衡的饭菜，因此能够经历婴儿期，童年，最少疾病。我一生中了解到，当我们不考虑多部门[方法]时，我们无法结束这种健康对话。作为公共卫生专家和公共卫生教授，我了解到有关键的变革杠杆。

第一是营养。通过营养，您可以避免儿童和母亲死亡1000多人。第二个是免疫。通过免疫，您可以预防许多病态和死亡率。第三个魔术子弹是计划生育。然后所有这些都是社区健康，社区参与和社区所有权。

You are the Africa deputy director in charge of policy and advocacy at thecommunity health non-profit Living Goods。您的工作需要什么？

My job involves working with African governments, and influencing them to invest in community health. Over 80 per cent of diseases that countries in Sub-Saharan Africa face are preventable. If communities are empowered with the right information and education, they can prevent these diseases. I engage policymakers, parliamentarians, ministers of health and finance, and really convince them to invest in community health, because we’ve seen the biggest lever of change is when communities are engaged, and when communities can own their health.

Eighty per cent of community health workers on the continent are women. And so, my role involves … making sure that the community health worker programmes are done in such a way that community health workers are digitally empowered to do their work, they’re equipped, they are supervised, and they are compensated for the work that they do.

通过与这些政府的互动，他们是否正在做您建议他们做的事情？他们在支持社区吗？

社区卫生工作者计划已经存在很长时间了。但是我们看到的一件事是，不同的国家正在以不同的方式动员社区。对于许多国家而言，社区卫生工作者未纳入卫生劳动力。而在其他国家，社区卫生工作者被视为医疗团队的一部分。因此，就其社区卫生工作者计划的发展而言，这取决于国家是什么阶段。

15年来，您一直在担任公共卫生专家。关于撒哈拉以南非洲的孕产妇和儿童健康，您认为乌干达和非洲的表现如何？

我认为乌干达有自己的旅程。我们取得了很大的进步，尤其是在降低儿童死亡率和婴儿死亡率方面。在减少怀孕和分娩期间死亡的女性人数方面，我们也取得了长足的进步。也就是说，我们还能做更多的事情。我看着像英国这样的国家，那里的一位母亲在怀孕和分娩期间死亡是一件巨大的事情，导致[卫生系统]审核。

我看着乌干达……每天（相当于）两辆Matatu出租车（约有14人）在怀孕和分娩期间死亡。我可以告诉你，这不会在非洲大陆上产生新闻。它不会在我的国家乌干达传来新闻。

而且许多因素都在起作用，因为它始于女性，了解她们有机会计划何时生孩子，有多久有孩子的频率，多久和多少人。

Who should bear the biggest responsibility for family planning? Is it the government or the community?

Both stakeholders are important. As long as the health of the communities is not in their hands, we still have a long way to go. Government has a mandate to deliver healthcare for its people. But at the same time, government cannot do that alone. Communities — if well sensitised, if services can reach them — will be able to transfer this knowledge, information and services to the people living in the community. When I look at COVID-19, and the impact it has had on women and girls, COVID-19 has proven to governments that more than ever before, communities need to own their health. And so, it is now time to push and to request countries to continue prioritising community health workers … for transformative health.

This interview has been edited for clarity and brevity.