Agentes comunitarios de salud, formación liderada por enfermería y desarrollo de capacidades en países de ingresos bajos y medios: una revisión panorámica
Agencias de apoyo
- El autor expresa su sincero agradecimiento a LPDP (Lembaga Pengelola Dana Pendidikan) por su apoyo en la financiación de los estudios de doctorado con el número de financiación 202308210846479, lo que hizo posible este trabajo
Resumen
Introducción: Los agentes comunitarios de salud (ACS) prestan atención primaria en países de ingresos bajos y medios (PIBM); las enfermeras lideran cada vez más su formación, influyendo en su desempeño. Sin embargo, la evidencia sigue fragmentada, sin un marco teórico común.
Objetivo: Mapear la evidencia sobre formación, supervisión y desarrollo de capacidades lideradas por enfermería para ACS en PIBM, caracterizar el rol de la enfermera e identificar vacíos que limitan su aplicación en políticas.
Método: Revisión de alcance según Arksey y O'Malley, siguiendo PRISMA-ScR. Se buscó en PubMed, Scopus y Google Scholar; tras cribado en dos etapas, se incluyeron 20 estudios.
Resultados: Surgieron cuatro temas: diseño de la formación; roles de enfermería en supervisión y vigilancia clínica; determinantes contextuales de la efectividad; y resultados de salud en modelos enfermera-ACS. La formación y supervisión lideradas por enfermería mejoraron el desempeño de los ACS en salud mental, VIH, enfermedades no transmisibles y salud materno-infantil.
Discusión: Los estudios varían en método y medidas de resultado, sin marco teórico común para comparación. Proponemos el Sistema Integrado de Desarrollo de Capacidades Enfermera-ACS (IN-CCS), un modelo preliminar para futuras pruebas.
Implicaciones para la práctica: Los sistemas de salud deberían formalizar el rol de las enfermeras en la formación y supervisión de ACS, con tiempo dedicado, marcos de competencias y herramientas tecnológicas, e invertir en enfermeras supervisoras.
Recomendaciones: Investigaciones futuras deberían probar prospectivamente el marco IN-CCS, adoptar instrumentos estandarizados de competencias para ACS y usar diseños longitudinales mixtos que generen evidencia transferible para políticas.
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