Poor quality of antenatal care services-Is lack of competence and support the reason? An observational and interview study in rural areas of Lao PDR
Poor quality of antenatal care services-Is lack of competence and support the reason? An observational and interview study in rural areas of Lao PDR
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DOI：
10.1016/j.midw.2011.12.010
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发表时间：
2013-03-01
期刊：
影响因子：
2.7
通讯作者：
Wessel, Hans
中科院分区：
文献类型：
--
作者：
Manithip, Chanthanom;Edin, Kerstin;Wessel, Hans
设计、背景和对象：本次横断面探索性调查于2009年在老挝农村地区坎穆阿内省和尚帕萨克省的4所地区医院和18个卫生中心进行。测量和结果：采用定量和定性相结合的方法：(I)59次非国大会议的观察(所使用的组件和使用的设备)；(Ii)26次对从事非国大服务的卫生保健提供者的半结构化访谈，通过内容分析进行解读。调查结果表明，农村卫生机构的非国大服务质量和绩效总体较差，缺乏例行公事，设备稀缺或不足，提供者的技能有限。医疗保健提供者对他们与非国大合作的能力和动机往往持悲观态度。一些人明确表示，由于缺乏患者的反馈，他们提出辞职，并表示需要医疗保健上级的支持。与地区医院相比，保健中心的设备和用品不那么完善，提供者的工作量更大，因为包括非国大在内的所有活动都是由同一提供者进行的。每名妇女的平均咨询时间为5分钟。结论：老挝农村卫生机构的非国大服务质量较差，原因是缺乏资源，服务提供者技能有限，程序不完善，上级支持不足。实践启示：为了符合国家和国际对非国大服务的建议，我们建议通过提供基本设备、有经验的上级支持和在职培训来提高老挝农村卫生设施的质量。(C)2012爱思唯尔有限公司。保留所有权利。
Objective: to explore the health-care providers' performance and their own perceptions of the ANC services they provide.Design, setting and participants: this cross-sectional exploratory survey was carried out in 2009 at four district hospitals and 18 health centres in Khammouane and Champasack provinces in rural areas of Laos.Measurements and findings: combinations of quantitative and qualitative methods were used: (i) 59 observations of ANC sessions (components performed and equipment used); (ii) 26 semi-structured interviews with health-care providers engaged in ANC services, interpreted through content analysis. The findings indicated an overall poor quality and performance of ANC services in rural health facilities with lack of routines, scarce or insufficient equipment and limited skills among providers. The health-care providers gave an often pessimistic picture of their competence and motivation to work with ANC. Some articulated a resignation due to lack of feedback from the patients and they expressed a need for support from health-care superiors. Compared to the district hospitals, the health centres were less well-equipped and supplied, and the providers had a heavier workload, because all activities including ANC were carried out by the same provider. The average consultation time for each woman was 5 mins.Conclusions: the quality of ANC services in rural health facilities in Laos was poor due to lack of resources, the providers' limited skills concurrent with inadequate routines and insufficient backup from superiors.Implications for practice: to comply with national and international recommendations for ANC services, our suggestion is to improve the quality of the rural health facilities in Laos by providing basic equipment, support from experienced superiors and in-service training. (C) 2012 Elsevier Ltd. All rights reserved.