Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania.
Antenatal care in practice: an exploratory study in antenatal care clinics in the Kilombero Valley, south-eastern Tanzania.
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DOI：
10.1186/1471-2393-11-36
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发表时间：
2011-05-20
影响因子：
3.1
通讯作者：
Obrist B
中科院分区：
文献类型：
--
作者：
Gross K;Armstrong Schellenberg J;Kessy F;Pfeiffer C;Obrist B
产前护理在降低产妇发病率和改善新生儿存活率和健康方面的潜力已得到广泛承认。然而，在坦桑尼亚提供的产前护理质量方面存在着令人担忧的知识差距。特别是，保健工作者业绩的决定因素尚未得到充分了解。本文采用民族志的方法来记录卫生工作者的产前保健实践，参考国家重点产前保健指南，并确定影响卫生工作者的绩效的因素。潜在的影响，改善产前保健提供坦桑尼亚进行了讨论。结合不同的定性技术，我们研究了卫生工作者的产前保健做法在四个公共产前保健诊所在基隆贝罗山谷，坦桑尼亚东南部。共观察了36次产前保健咨询，并与重点产前保健指南进行了比较。参与者的观察，非正式讨论和深入采访的工作人员帮助确定和解释卫生工作者的做法和影响产前保健提供的背景因素。在选定的产前保健诊所向孕妇提供的产前保健服务差别很大。向所有妇女提供了《重点产前护理指南》建议的一些服务，而其他服务则根本没有提供。影响卫生工作者做法的因素包括：《重点产前护理准则》执行不力、缺乏训练有素的工作人员和缺勤、供应短缺以及使用与《重点产前护理准则》不一致的工作工具。卫生工作者对困难的工作条件作出反应，发展非正式做法作为应对战略或“街头官僚机构”。改善产前保健的努力应通过扩大培训机会，包括几乎没有接受过职前培训的保健工作人员骨干，解决训练有素的工作人员短缺的问题。应注意查明个人应对战略和“基层官僚机构”造成的非正式做法，以便在问题成为组织文化的一部分之前加以解决。
The potential of antenatal care for reducing maternal morbidity and improving newborn survival and health is widely acknowledged. Yet there are worrying gaps in knowledge of the quality of antenatal care provided in Tanzania. In particular, determinants of health workers' performance have not yet been fully understood. This paper uses ethnographic methods to document health workers' antenatal care practices with reference to the national Focused Antenatal Care guidelines and identifies factors influencing health workers' performance. Potential implications for improving antenatal care provision in Tanzania are discussed. Combining different qualitative techniques, we studied health workers' antenatal care practices in four public antenatal care clinics in the Kilombero Valley, south-eastern Tanzania. A total of 36 antenatal care consultations were observed and compared with the Focused Antenatal Care guidelines. Participant observation, informal discussions and in-depth interviews with the staff helped to identify and explain health workers' practices and contextual factors influencing antenatal care provision. The delivery of antenatal care services to pregnant women at the selected antenatal care clinics varied widely. Some services that are recommended by the Focused Antenatal Care guidelines were given to all women while other services were not delivered at all. Factors influencing health workers' practices were poor implementation of the Focused Antenatal Care guidelines, lack of trained staff and absenteeism, supply shortages and use of working tools that are not consistent with the Focused Antenatal Care guidelines. Health workers react to difficult working conditions by developing informal practices as coping strategies or "street-level bureaucracy". Efforts to improve antenatal care should address shortages of trained staff through expanding training opportunities, including health worker cadres with little pre-service training. Attention should be paid to the identification of informal practices resulting from individual coping strategies and "street-level bureaucracy" in order to tackle problems before they become part of the organizational culture.
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影响因子：
4.2
作者：
Akinsola, HA
通讯作者：
Akinsola, HA
影响因子：
3.3
作者：
GILSON, L;KITANGE, H;TEUSCHER, T
通讯作者：
TEUSCHER, T
影响因子：
4.3
作者：
Bergsjo, P;Villar, J
通讯作者：
Villar, J
影响因子：
3
作者：
Dillip, Angel;Hetzel, Manuel W.;Obrist, Brigit
通讯作者：
Obrist, Brigit
DOI：
10.1186/1472-6874-2-7
发表时间：
2002-07-19
期刊：
BMC women's health
影响因子：
--
作者：
Langer, Ana;Villar, Jose;Berendes, Heinz
通讯作者：
Berendes, Heinz