Murray Susan F, Pearson Stephen C
King's College London, UK.
Soc Sci Med. 2006 May;62(9):2205-15. doi: 10.1016/j.socscimed.2005.10.025. Epub 2005 Dec 5.
A functioning referral system is generally considered to be a necessary element of successful Safe Motherhood programmes. This paper draws on a scoping review of available literature to identify key requisites for successful maternity referral systems in developing countries, to highlight knowledge gaps, and to suggest items for a future research agenda. Key online social science, medical and health system bibliographic databases, and websites were searched in July 2004 for evidence relating to referral systems for maternity care. Documentary evidence on implementation is scarce, but it suggests that many healthcare systems in developing countries are failing to optimise women's rapid access to emergency obstetric care, and that the poor and marginalised are affected disproportionately. Likely requisites for successful maternity referral systems include: a referral strategy informed by the assessment of population needs and health system capabilities; an adequately resourced referral centre; active collaboration between referral levels and across sectors; formalised communication and transport arrangements; agreed setting-specific protocols for referrer and receiver; supervision and accountability for providers' performance; affordable service costs; the capacity to monitor effectiveness; and underpinning all of these, policy support. Theoretically informed social and organisational research is required on the referral care needs of the poor and marginalised, on the maternity workforce and organisation, and on the implications of the mixed economy of healthcare for referral networks. Clinical research is required to determine how maternity referral fits within newborn health priorities and where the needs are different. Finally, research is required to determine how and whether a more integrated approach to emergency care systems may benefit women and their communities.
一个有效的转诊系统通常被认为是成功实施安全孕产计划的必要要素。本文基于对现有文献的范围审查，以确定发展中国家成功的孕产妇转诊系统的关键要求，突出知识空白，并为未来的研究议程提出项目建议。2004年7月，检索了主要的在线社会科学、医学和卫生系统书目数据库及网站，以获取与孕产妇保健转诊系统相关的证据。关于实施情况的文献证据很少，但这表明发展中国家的许多医疗系统未能优化妇女快速获得紧急产科护理的机会，而且穷人和边缘化人群受到的影响尤为严重。成功的孕产妇转诊系统可能需要具备以下条件：基于对人口需求和卫生系统能力评估的转诊策略；资源充足的转诊中心；转诊层级之间以及跨部门的积极协作；正式的通信和交通安排；针对转诊者和接收者的商定的特定环境协议；对提供者绩效的监督和问责；可承受的服务成本；监测有效性的能力；以及支撑所有这些的政策支持。需要开展基于理论的社会和组织研究，以了解穷人和边缘化人群的转诊护理需求、孕产妇劳动力和组织情况，以及医疗保健混合经济对转诊网络的影响。需要开展临床研究，以确定孕产妇转诊如何符合新生儿健康优先事项以及需求不同的地方。最后，需要开展研究，以确定如何以及是否采用更综合的急诊护理系统方法可能使妇女及其社区受益。
