Perceived Health System Barriers to Tuberculosis Control Among Health Workers in South Africa
Perceived Health System Barriers to Tuberculosis Control Among Health Workers in South Africa
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DOI：
10.5334/aogh.2692
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发表时间：
2020-01-01
影响因子：
2.9
通讯作者：
Spiegel, Jerry M.
中科院分区：
文献类型：
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作者：
Adu, Prince A.;Yassi, Annalee;Spiegel, Jerry M.
背景：在结核病高负担国家，如南非，卫生保健工作人员面临结核病感染和疾病的高风险，对他们的福祉和生产力产生不利影响。尽管有关于保护卫生工作者免受结核病侵害的国际准则，但全球研究的重点是实践中的近端缺陷，而不是卫生系统障碍。目的：本研究旨在引起卫生系统内知情人士对卫生系统保护卫生工作者免受结核病侵害的障碍的看法。方法：对在南非工作场所结核病预防和管理相关领域活跃的18名告密者进行半结构化访谈。访谈录音并逐字抄写，验证和分析得出突发主题。利用世界卫生组织的构建模块作为与保护其卫生人力有关的卫生系统的核心要素，对反应进行了分析。调查结果：举报人确定了以下卫生系统障碍：领导和治理是“自上而下”和分散的；缺乏资金是一个主要障碍；在感染预防和控制以及职业健康方面受过培训的工作人员数量不足；没有全面提供职业保健服务，维持防护技术的能力受到质疑。一个跨领域障碍是，与卫生工作者中结核病病例缺乏准确信息有关的劳动力职业健康缺乏优先考虑。结论：我们的结论是，除非卫生系统障碍得到解决，否则在实施推荐的感染控制和结核病管理措施方面的缺陷不太可能得到纠正。需要卫生系统高级管理层更坚定的领导和更多的资金。制定指标来描述这些障碍的特点和监测进展情况，可以协助这一进程。
Background: The healthcare workforce in high tuberculosis burden countries such as South Africa is at elevated risk of tuberculosis infection and disease with adverse consequences for their well-being and productivity. Despite the availability of international guidelines on protection of health workers from tuberculosis, research globally has focused on proximal deficiencies in practice rather than on health system barriers.Objective: This study sought to elicit perceptions of informed persons within the health system regarding health system barriers to protecting health workers from tuberculosis.Methods: Semi-structured interviews were conducted with 18 informants active in spheres related to workplace tuberculosis prevention and management in South Africa. Interviews were audio recorded and transcribed verbatim, validated and analysed to derive emergent themes. Responses were analysed using the World Health Organization building blocks as core elements of a health system bearing on protection of its health workforce.Findings: The following health system barriers were identified by informants: leadership and governance were "top-down" and fragmented; lack of funding was a major barrier; there were insufficient numbers of staff trained in infection prevention and control and occupational health; occupational health services were not comprehensively available and the ability to sustain protective technologies was questioned. A cross-cutting barrier was lack of priority afforded to workforce occupational health associated with lack of accurate information on cases of TB among health workers.Conclusions: We conclude that deficiencies in implementation of recommended infection control and tuberculosis management practices are unlikely to be corrected until health system barriers are addressed. More committed leadership from senior health system management and greater funding are needed. The process could be assisted by the development of indicators to characterise such barriers and monitor progress.