Continuing professional development for medical, nursing, and midwifery cadres in Malawi, Tanzania and South Africa: A qualitative evaluation.
Continuing professional development for medical, nursing, and midwifery cadres in Malawi, Tanzania and South Africa: A qualitative evaluation.
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DOI：
10.1371/journal.pone.0186074
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发表时间：
2017
期刊：
影响因子：
3.7
通讯作者：
Kim HN
中科院分区：
文献类型：
--
作者：
Feldacker C;Pintye J;Jacob S;Chung MH;Middleton L;Iliffe J;Kim HN
随着预防和治疗艾滋病毒和结核病的创新取得进展，卫生保健工作者的持续职业发展仍然是一个高度优先事项，特别是在撒哈拉以南非洲，那里的结核病/艾滋病毒双重流行因卫生保健工作者严重短缺而雪上加霜。还需要进一步审查CPD方案，以确定挑战和有效的解决方案，以加强与艾滋病毒/结核病相关的CPD。在马拉维、坦桑尼亚和南非(RSA)进行了定性评估，使用每个国家的关键线人访谈(KIIS)和焦点小组讨论(FGD)，以确定有效的艾滋病毒/结核病相关CPD的障碍和推动因素。关键利益相关者代表CPD实施者、监管机构和开发人员。卫生工作者是从疾病负担高的地区有目的地抽取的；每个卫生工作者都完成了简短的、半结构化的问卷调查，并参加了FGD。利用扎根的理论方法，将KII和FGD结果结合成跨越各国的关键主题。进行了52项KIIS：马拉维17项，坦桑尼亚19项，RSA 16项。89名卫生工作者(马拉维24人、坦桑尼亚38人、RSA 27人)完成了问卷并参加了妇女发展活动。首先，缺乏可持续的财政资源，以及国家方案发展协调方面的局限性，导致对国家方案发展监督的问责不力，降低了国家方案发展的质量保证。医护人员短缺限制了CPD机会，造成了CPD机会的不平等。持续持续发展的无关紧要，以及HCW确定的持续持续发展需求与当前计划之间的不平衡降低了人们对持续持续发展的热情。设施层面的制约因素，包括基础设施差和供应链薄弱，制约了国家方案发展的技能和知识的落实。在农村地区，挑战更为严峻。为了弥补已查明的差距，需要在各级提供可持续的资金、强有力的领导和协作，以加强国家方案文件的监管和认证制度；增加工作场所的国家方案文件的可及性；并为国家方案文件的实施创造有利环境。总而言之，这些改进可能会改善结核病/艾滋病毒CPD质量和患者结局。
As innovations in the prevention and treatment of HIV and TB advance, continuing professional development (CPD) of health care workers (HCWs) remains a high priority, particularly in sub-Saharan Africa where dual TB/HIV epidemics are compounded by severe HCW shortages. There is further need to examine CPD programs to identify challenges and effective solutions to strengthen HIV/TB-related CPD. Qualitative evaluations in Malawi, Tanzania and South Africa (RSA) were conducted using key informant interviews (KIIs) and focus group discussions (FGDs) in each country to identify barriers and enablers of effective HIV/TB-related CPD. Key stakeholders represented CPD implementers, regulators, and developers. HCWs were purposively sampled from high disease burden districts; each HCW completed brief, semi-structured questionnaires and participated in a FGD. KII and FGD results were combined into key themes spanning across countries using a grounded theory approach. Fifty-two KIIs were conducted: 17 in Malawi, 19 in Tanzania and 16 in RSA. Eighty-nine HCWs (24 from Malawi, 38 from Tanzania and 27 from RSA) completed questionnaires and participated in FGDs. Primarily, lack of sustainable financial resources and limitations in coordination of CPD result in poor accountability for CPD oversight and reduce CPD quality assurance. Healthcare worker shortages limit CPD opportunities, creating disparities in CPD access. CPD irrelevance and imbalance between HCW-identified CPD needs and current programs reduce enthusiasm for CPD. Facility-level constraints, including poor infrastructure and weak supply chains, restrict implementation of CPD skills and knowledge. Challenges are more severe in rural settings. To address identified gaps, sustainable funding, strong leadership and collaboration at every level are needed to strengthen CPD regulation and accreditation systems; increase CPD accessibility in the workplace; and create enabling environments for CPD implementation. Together, these improvements may improve TB/HIV CPD quality and patient outcomes.
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