Human resources for maternal health: multi-purpose or specialists?
Human resources for maternal health: multi-purpose or specialists?
复制标题
DOI：
10.1186/1478-4491-6-21
复制
发表时间：
2008-09-30
影响因子：
4.5
通讯作者：
de Bernis L
中科院分区：
文献类型：
--
作者：
Fauveau V;Sherratt DR;de Bernis L
实现千年发展目标5的一个关键问题是，能否通过扩大在社区开展业务的多用途保健人员或扩大在保健机构工作的专业熟练助产士的规模来更快地实现这一目标。大多数关心降低产妇死亡率的顾问都同意，在有专业服务人员的设施中促进分娩是最终战略。然而，对于如何才能在这条道路上取得进展，以及在大多数女性仍在家中分娩的情况下的“临时解决方案”，证据很少。这些问题特别重要，因为我们已是“安全孕产倡议”二十周年，但没有取得太大进展。本文回顾了孕产妇保健人力资源的现状和面临的问题。根据千年发展目标5，我们提出了在规划扩大产妇保健人力资源时必须解决的七个关键工作领域，最后，我们指出了选定国家最近取得的一些进展以及从这些经验中吸取的教训。虽然本文件的重点是产妇健康，但人们认识到，降低产妇死亡率的干预措施也将有助于显著降低新生儿死亡率。根据2006年12月在突尼斯举行的首届‘社区助产’国际论坛的建议，处理七个主要工作领域中的每一个领域，对于任何千年发展目标5方案的成功都是至关重要的。我们假设，产妇保健方案的停滞在很大程度上是混乱和粗心大意的结果，在有限数量的真正熟练的助产士和大量培训较短、技能较少、权威有限且没有职业道路的多功能工人之间进行了扩大。我们从吸取的经验教训中得出结论，如果不作出坚定的政治决定，赋予助产士和其他具有助产技能的人权力，并大力加强保健系统，使他们有能力应对这一挑战，就不可能在降低孕产妇死亡率方面取得重大进展，保健系统的重点是护理质量而不是数字。
A crucial question in the aim to attain MDG5 is whether it can be achieved faster with the scaling up of multi-purpose health workers operating in the community or with the scaling up of professional skilled birth attendants working in health facilities. Most advisers concerned with maternal mortality reduction concur to promote births in facilities with professional attendants as the ultimate strategy. The evidence, however, is scarce on what it takes to progress in this path, and on the 'interim solutions' for situations where the majority of women still deliver at home. These questions are particularly relevant as we have reached the twentieth anniversary of the safe motherhood initiative without much progress made. In this paper we review the current situation of human resources for maternal health as well as the problems that they face. We propose seven key areas of work that must be addressed when planning for scaling up human resources for maternal health in light of MDG5, and finally we indicate some advances recently made in selected countries and the lessons learned from these experiences. Whilst the focus of this paper is on maternal health, it is acknowledged that the interventions to reduce maternal mortality will also contribute to significantly reducing newborn mortality. Addressing each of the seven key areas of work – recommended by the first International Forum on 'Midwifery in the Community', Tunis, December 2006 – is essential for the success of any MDG5 programme. We hypothesize that a great deal of the stagnation of maternal health programmes has been the result of confusion and careless choices in scaling up between a limited number of truly skilled birth attendants and large quantities of multi-purpose workers with short training, fewer skills, limited authority and no career pathways. We conclude from the lessons learnt that no significant progress in maternal mortality reduction can be achieved without a strong political decision to empower midwives and others with midwifery skills, and a substantial strengthening of health systems with a focus on quality of care rather than on numbers, to give them the means to respond to the challenge.
登录
查看更多内容
DOI：
10.1016/j.ijgo.2006.01.031
发表时间：
2006-06-01
影响因子：
3.8
作者：
Fauveau, V.;Donnay, F.
通讯作者：
Donnay, F.
影响因子：
4.5
作者：
Dussault, Gilles;Franceschini, Maria Cristina
通讯作者：
Franceschini, Maria Cristina
影响因子：
5.4
作者：
Andaleeb, SS
通讯作者：
Andaleeb, SS
影响因子：
6.7
作者：
de Bernis, L;Sherratt, DR;Van Lerberghe, W
通讯作者：
Van Lerberghe, W
影响因子：
5.4
作者：
Fako, TT;Forcheh, N;Ncube, E
通讯作者：
Ncube, E