Assessing skilled birth attendants and emergency obstetric care in rural Tanzania: the inadequacy of using global standards and indicators to measure local realities
Assessing skilled birth attendants and emergency obstetric care in rural Tanzania: the inadequacy of using global standards and indicators to measure local realities
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DOI：
10.1016/s0968-8080(12)39603-4
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发表时间：
2012-05-01
影响因子：
--
通讯作者：
Spangler, Sydney A.
中科院分区：
文献类型：
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作者：
Spangler, Sydney A.
目前在低资源环境下为降低孕产妇死亡率和发病率所作的努力往往依赖于全球标准和指标来评估产科护理，特别是熟练助产士和产科急诊护理。本文描述了使用这些标准评估坦桑尼亚基隆贝罗河谷产科服务的挑战。一项卫生设施调查和广泛的参与者观察表明，现有的服务是复杂和流动的，涉及广泛的技能，资源和即兴。根据既定标准和指标衡量这些服务的努力没有成功。护理的某些方面被高估，而其他方面则被低估，严重忽视了环境和质量。本文讨论了这些研究结果的影响，正在进行的孕产妇保健工作在独特和复杂的环境，质疑目前的依赖一般（往往是模糊的）原型的产科护理政策和规划。它表明，目前的指标可能不足以评估低资源环境中的服务，但并不是说这些环境应该满足于较低的护理标准。除了全球基准外，强调护理质量和承认现有资源的评估方法可能更好地考虑到当地的现实情况，从而更有效、更可持续地提供服务。(C)2012年生殖健康事项
Current efforts to reduce maternal mortality and morbidity in low-resource settings often depend on global standards and indicators to assess obstetric care, particularly skilled birth attendants and emergency obstetric care. This paper describes challenges in using these standards to assess obstetric services in the Kilombero Valley of Tanzania. A health facility survey and extensive participant observation showed existing services to be complicated and fluid, involving a wide array of skills, resources, and improvisations. Attempts to measure these services against established standards and indicators were not successful. Some aspects of care were over-valued while others were under-valued, with significant neglect of context and quality. This paper discusses the implications of these findings for ongoing maternal health care efforts in unique and complex settings, questioning the current reliance on generic (and often obscure) archetypes of obstetric care in policy and programming. It suggests that current indicators may be insufficient to assess services in low-resource settings, but not that these settings should settle for lower standards of care. In addition to global benchmarks, assessment approaches that emphasize quality of care and recognize available resources might better account for local realities, leading to more effective, more sustainable service delivery. (C) 2012 Reproductive Health Matters