Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review.
Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review.
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DOI：
10.1186/1478-4491-2-7
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发表时间：
2004-06-18
影响因子：
4.5
通讯作者：
Dovlo, Delanyo
中科院分区：
文献类型：
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作者：
Dovlo, Delanyo
背景技术背景：替代保健工作人员是承担通常由医生、药剂师和护士等国际公认的保健专业人员承担的某些职能和作用的骨干，但他们通常接受较短的职前培训，资格较低。方法：对坦桑尼亚、马拉维、莫桑比克、赞比亚、加纳等国替代保健工作者的教育、管理、业务范围、专业化、命名、保留和成本效益进行了案头审查，利用课程、评估和关键信息提供者问卷。研究结果：使用替代品的成本效益及其在国家和农村社区的相对保留，是其对非洲卫生系统的优势的基础。一些比较临床官员和医生的研究显示，对患者的结果差异很小。专业替代品提供外科、眼科、整形外科、放射科、皮肤科、麻醉科和牙科等学科的服务，表明一般偏向于使用临床服务。结论：调查结果引起了人们对扩大使用替代干部的兴趣，因为扩大获得抗逆转录病毒治疗等服务的需求需要大量的人力资源能力。了解这些干部发挥最佳作用的角色和条件，并管理限制其潜力的怀疑和专业地盘保护，将有助于有效利用替代品。
BACKGROUND: Substitute health workers are cadres who take on some of the functions and roles normally reserved for internationally recognized health professionals such as doctors, pharmacists and nurses but who usually receive shorter pre-service training and possess lower qualifications. METHODS: A desk review is conducted on the education, regulation, scopes of practice, specialization, nomenclature, retention and cost-effectiveness of substitute health workers in terms of their utilization in countries such as Tanzania, Malawi, Mozambique, Zambia, Ghana etc., using curricula, evaluations and key-informant questionnaires. RESULTS: The cost-effectiveness of using substitutes and their relative retention within countries and in rural communities underlies their advantages to African health systems. Some studies comparing clinical officers and doctors show minimal differences in outcomes to patients. Specialized substitutes provide services in disciplines such as surgery, ophthalmology, orthopedics, radiology, dermatology, anesthesiology and dentistry, demonstrating a general bias of use for clinical services. CONCLUSIONS: The findings raise interest in expanding the use of substitute cadres, as the demands of expanding access to services such as antiretroviral treatment requires substantial human resources capacity. Understanding the roles and conditions under which such cadres best function, and managing the skepticism and professional turf protection that restricts their potential, will assist in effective utilization of substitutes.