von Both Claudia, Flessa Steffen, Makuwani Ahmad, Mpembeni Rose, Jahn Albrecht
Department of Tropical Hygiene and Public Health, Ruprecht-Karls-University, Im Neuenheimer Feld 324, 69120 Heidelberg, Germany.
BMC Pregnancy Childbirth. 2006 Jun 23;6:22. doi: 10.1186/1471-2393-6-22.
Antenatal care (ANC) is a widely used strategy to improve the health of pregnant women and to encourage skilled care during childbirth. In 2002, the Ministry of Health of the United Republic of Tanzania developed a national adaptation plan based on the new model of the World Health Organisation (WHO). In this study we assess the time health workers currently spent on providing ANC services and compare it to the requirements anticipated for the new ANC model in order to identify the implications of Focused ANC on health care providers' workload.
Health workers in four dispensaries in Mtwara Urban District, Southern Tanzania, were observed while providing routine ANC. The time used for the overall activity as well as for the different, specific components of 71 ANC service provisions was measured in detail; 28 of these were first visits and 43 revisits. Standard time requirements for the provision of focused ANC were assessed through simulated consultations based on the new guidelines.
The average time health workers currently spend for providing ANC service to a first visit client was found to be 15 minutes; the provision of ANC according to the focused ANC model was assessed to be 46 minutes. For a revisiting client the difference between current practise and the anticipated standard of the new model was 27 minutes (9 vs. 36 min.). The major discrepancy between the two procedures was related to counselling. On average a first visit client was counselled for 1:30 minutes, while counselling in revisiting clients did hardly take place at all. The simulation of focused ANC revealed that proper counselling would take about 15 minutes per visit.
While the introduction of focused ANC has the potential to improve the health of pregnant women and to raise the number of births attended by skilled staff in Tanzania, it may need additional investment in human resources. The generally anticipated saving effect of the new model through the reduction of routine consultations may not materialise because the number of consultations is already low in Tanzania with a median of only 4 visits per pregnancy. Special attention needs to be given to counselling attitudes and skills during the training for Focused ANC as this component is identified as the major difference between old practise and the new model. Our estimated requirement of 46 minutes per first visit consultation matches well with the WHO estimate of 40 minutes.
产前保健（ANC）是一种广泛应用的策略，旨在改善孕妇健康状况并鼓励分娩时获得专业护理。2002年，坦桑尼亚联合共和国卫生部基于世界卫生组织（WHO）的新模式制定了一项国家适应计划。在本研究中，我们评估了卫生工作者目前提供产前保健服务所花费的时间，并将其与新的产前保健模式预期所需时间进行比较，以确定集中式产前保健对医疗服务提供者工作量的影响。
在坦桑尼亚南部姆特瓦拉市区的四个诊疗所观察卫生工作者提供常规产前保健的情况。详细测量了71次产前保健服务的整体活动以及不同具体组成部分所花费的时间；其中28次为首次就诊，43次为复诊。通过基于新指南的模拟咨询评估了提供集中式产前保健的标准时间要求。
发现卫生工作者目前为首次就诊客户提供产前保健服务的平均时间为15分钟；根据集中式产前保健模式提供服务的时间评估为46分钟。对于复诊客户，当前做法与新模式预期标准之间的差异为27分钟（9分钟对36分钟）。两种程序的主要差异与咨询有关。首次就诊客户平均接受咨询1.5分钟，而复诊客户几乎没有接受咨询。集中式产前保健的模拟显示，每次就诊适当的咨询时间约为15分钟。
虽然引入集中式产前保健有可能改善坦桑尼亚孕妇的健康状况并增加由专业人员接生的分娩数量，但可能需要在人力资源方面进行额外投资。新模式通过减少常规咨询通常预期的节省效果可能无法实现，因为坦桑尼亚的咨询次数本来就少，每次怀孕的中位数仅为4次就诊。在集中式产前保健培训期间，需要特别关注咨询态度和技能，因为这一组成部分被确定为旧做法与新模式之间的主要差异。我们估计每次首次就诊咨询需要46分钟，这与世界卫生组织估计的40分钟非常吻合。
