Scaling-up the medical workforce in Timor-Leste: Challenges of a great leap forward
Scaling-up the medical workforce in Timor-Leste: Challenges of a great leap forward
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DOI：
10.1016/j.socscimed.2013.07.008
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发表时间：
2013-11-01
影响因子：
5.4
通讯作者：
Ferrinho, Paulo
中科院分区：
文献类型：
--
作者：
Cabral, Jorge;Dussault, Gilles;Ferrinho, Paulo
东帝汶卫生服务系统(T-L)将在2010-2011年国家卫生系统雇用的233名医生的基础上，到2015年增加800名医生，其中大部分在古巴接受培训。对更多医生的需求没有在T-L中讨论：糟糕的健康指标、低覆盖和低利用率以及低服务质量在T-L中得到了很好的记录。然而，需要评估这种扩大规模的选择，相对狭窄地聚焦于医务人员，需要评估其与国家健康状况的相关性，以及使其有效所需的其他补充措施的全面性。本文讨论了医疗队伍迅速扩大的潜在影响，以及监测这一过程并最终减轻任何有害后果所需的组织能力。这一分析是基于对现场收集的文件(T-L)的审查以及2011年对关键线人的采访。我们强调，任何劳动力规模的扩大不仅仅是专业人员数量增加的问题，还应结合改善的培训、分配、工作条件、管理和激励，以此作为实现更好的卫生服务系统的一种手段。在组织和管理能力有限、信息系统不发达、培训和研究能力有限以及依赖外国援助和技术援助的背景下，这是一项重大挑战。潜在的风险与为征聘更多人员的额外费用提供资金、基础设施、设备和消耗品的相关支出、对现有工作人员组合的影响以及对服务的预期需求增加有关。我们的结论是，如果不能有效地管理即将到来的“大跃进”，将产生长期影响：迫切需要为卫生人力的均衡发展制定正式政策和计划，并加强机构。(C)2013爱思唯尔有限公司。保留所有权利。
The health services system of Timor-Leste (T-L) will, by 2015, add 800 physicians, most of them trained in Cuba, to the 233 employed by the national health system in 2010-2011. The need for more physicians is not in discussion: poor health indicators, low coverage and utilization of services, and poor quality of services are well documented in T-L However, the choice of this scaling-up, with a relatively narrow focus on the medical workforce, needs to be assessed for its relevance to the health profile of the country, for its comprehensiveness in terms of other complementary measures needed to make it effective. This article discusses the potential effects of the rapid scaling-up of the medical workforce, and the organizational capacity needed to monitor the process and eventually mitigate any deleterious consequences. The analysis is based on a review of documentation collected on site (T-L) and on interviews with key-informants conducted in 2011. We stress that any workforce scaling-up is not simply a matter of increasing numbers of professionals, but should combine improved training, distribution, working conditions, management and motivation, as a means towards better performing health services' systems. This is a major challenge in a context of limited organizational and managerial capacity, underdeveloped information systems, limited training and research capacity, and dependency on foreign aid and technical assistance. Potential risks are associated with funding the additional costs of recruiting more personnel, associated expenditures on infrastructure, equipment and consumables, the impact on current staff mix, and the expected increased demand for services. We conclude that failing to manage effectively the forthcoming "great leap forward" will have long term effects: formal policies and plans for the balanced development of the health workforce, as well as strengthened institutions are urgently needed. (C) 2013 Elsevier Ltd. All rights reserved.