Barriers to and strategies for addressing the availability, accessibility, acceptability and quality of the sexual, reproductive, maternal, newborn and adolescent health workforce: addressing the post-2015 agenda
Barriers to and strategies for addressing the availability, accessibility, acceptability and quality of the sexual, reproductive, maternal, newborn and adolescent health workforce: addressing the post-2015 agenda
复制标题
DOI：
10.1186/s12884-018-1686-4
复制
发表时间：
2018-02-20
影响因子：
3.1
通讯作者：
ten Hoope-Bender, Petra
中科院分区：
文献类型：
--
作者：
Homer, Caroline S. E.;Castro Lopes, Sofia;ten Hoope-Bender, Petra
背景资料：在2015年后发展议程中，实现妇女和新生儿的全民健康覆盖将需要一支适合目的和实践的性、生殖、孕产妇、青少年和新生儿健康工作队伍。本文的目的是探讨SRMNAH服务和劳动力的可用性、可及性、可接受性和质量（AAAQ）方面的障碍、挑战和解决方案。《2014年世界助产状况报告》使用了广泛的助产定义（“支持和照顾妇女和新生儿所需的保健服务和保健工作人员”），并提供了关于多种多样的SRMNAH工作人员的信息，包括医生、助产士、护士和辅助人员。作为数据收集工作的一部分，73个参与的中低收入国家中有36个举办了为期一天的讲习班，涉及各种不同的利益攸关方。与会者被要求讨论SRMNAH工人的AAAQ的障碍，并提出克服所确定的障碍的策略。研讨会使用了讨论指南，一位特别报告员作了详细的记录。使用N-Vivo软件和AAAQ模型作为框架进行了内容分析。结果：在36个国家，约800名参与者参加了研讨会。已查明的SRMNAH工人参加AAAQ的障碍包括：劳动力规模不足和分配不公平，缺乏交通工具，使用费和自付费用。在一些国家，答卷人认为，由于文化差异或对服务使用者的不尊重行为，妇女不信任劳动力，特别是助产士。由于缺乏用品/设备和监管不力，护理质量受到影响。针对这些问题，各国确定了一套解决方案，包括由快速和公平的部署系统支持的充分的劳动力规划，并与UHC原则保持一致。可接受性和质量可以提高与提供尊重的照顾，以及战略，以改善教育和regulation.Conclusions：在这36个国家仍然需要解决的障碍的数量和规模是显着的。适当的规划和政策，以支持发展的SRMNAH劳动力及其公平分配是一个优先事项。必须制定有利的战略，以提高助产士的地位和认可度，因为助产士的作用往往被低估。
Background: In a post-2015 development agenda, achieving Universal Health Coverage (UHC) for women and newborns will require a fit-for-purpose and fit-to-practice sexual, reproductive, maternal, adolescent and newborn health (SRMNAH) workforce. The aim of this paper is to explore barriers, challenges and solutions to the availability, accessibility, acceptability and quality (AAAQ) of SRMNAH services and workforce.Methods: The State of the World's Midwifery report 2014 used a broad definition of midwifery ("the health services and health workforce needed to support and care for women and newborns") and provided information about a wide range of SRMNAH workers, including doctors, midwives, nurses and auxiliaries. As part of the data collection, 36 out of the 73 participating low-and middle-income countries conducted a one-day workshop, involving a range of different stakeholders. Participants were asked to discuss barriers to the AAAQ of SRMNAH workers, and to suggest strategies for overcoming the identified barriers. The workshop was facilitated using a discussion guide, and a rapporteur took detailed notes. A content analysis was undertaken using N-Vivo software and the AAAQ model as a framework.Results: Across the 36 countries, about 800 participants attended a workshop. The identified barriers to AAAQ of SRMNAH workers included: insufficient size of the workforce and inequity in its distribution, lack of transportation, user fees and out of pocket payments. In some countries, respondents felt that women mistrusted the workforce, and particularly midwives, due to cultural differences, or disrespectful behaviour towards service users. Quality of care was undermined by a lack of supplies/equipment and inadequate regulation. Against these, countries identified a set of solutions including adequate workforce planning supported by a fast and equitable deployment system, aligned with the principles of UHC. Acceptability and quality could be improved with the provision of respectful care as well as strategies to improve education and regulation.Conclusions: The number and scale of the barriers still needing to be addressed in these 36 countries was significant. Adequate planning and policies to support the development of the SRMNAH workforce and its equitable distribution are a priority. Enabling strategies need to be put in place to improve the status and recognition of midwives, whose role is often undervalued.