Kruk M E, Pereira C, Vaz F, Bergström S, Galea S
Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA.
BJOG. 2007 Oct;114(10):1253-60. doi: 10.1111/j.1471-0528.2007.01443.x.
To compare the training and deployment costs and surgical productivity of surgically trained assistant medical officers (técnicos de cirurgia) and specialist physicians (surgeons and obstetrician/gynaecologists) in Mozambique in order to inform health human resource planning in a developing country with low availability of obstetric care and severe physician shortages. Técnicos de cirurgia have been previously shown to have quality of care outcomes comparable to physicians.
Economic evaluation of costs and productivity of surgically trained assistant medical officers and specialist physicians.
Hospitals and health science training institutions in Mozambique.
Surgically trained assistants, medical officers, surgeons and obstetrician/gynaecologists in Mozambique.
The costs of training and deploying the two cadres of health workers were derived from a review of budgets, annual expenditure reports, enrolment registers, and accounting statements from training institutions and interviews with directors and administrators. Productivity estimates were based on a hospital survey of physicians and técnicos de cirurgia.
Cost per major obstetric surgical procedure over 30 years in 2006 US dollars.
The 30-year cost per major obstetric surgery was $38.9 for técnicos de cirurgia and $144.1 for surgeons and obstetrician/gynaecologists. Doubling the salaries of técnicos de cirurgia resulted in a smaller but still substantial difference in cost per surgery between the groups ($60.3 versus $144.1 per procedure). One-way sensitivity analysis to test the impact of varying other inputs did not substantially change the magnitude of the cost advantage of técnicos de cirurgia.
Training more mid-level health workers in surgery can be part of the response to the health worker shortage, which today threatens the achievement of the health Millennium Development Goals in developing countries.
比较莫桑比克接受外科培训的助理医务人员（外科技术员）和专科医生（外科医生和妇产科医生）的培训与部署成本以及手术效率，以便为一个产科护理服务供应不足且医生严重短缺的发展中国家提供卫生人力资源规划依据。此前研究表明，外科技术员的护理质量与医生相当。
对接受外科培训的助理医务人员和专科医生的成本及效率进行经济评估。
莫桑比克的医院和卫生科学培训机构。
莫桑比克接受外科培训的助理人员、医务人员、外科医生和妇产科医生。
通过查阅预算、年度支出报告、注册登记册、培训机构的会计报表以及与主任和管理人员进行访谈，得出培训和部署这两类卫生工作者的成本。效率估计基于对医生和外科技术员的医院调查。
以2006年美元计算的30年间每例主要产科手术的成本。
每例主要产科手术的30年成本，外科技术员为38.9美元，外科医生和妇产科医生为144.1美元。将外科技术员的工资提高一倍后，两组之间每例手术的成本差异缩小，但仍然很大（分别为每例60.3美元和144.1美元）。通过单因素敏感性分析来测试其他变量输入的影响，并未显著改变外科技术员成本优势的幅度。
培训更多中级外科卫生工作者可以作为应对卫生工作者短缺问题的一部分，目前这一短缺威胁到发展中国家实现卫生千年发展目标。
