Department of Community Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
Int J Health Plann Manage. 2010 Jan-Mar;25(1):17-29. doi: 10.1002/hpm.950.
Although the mother-to-child transmission (MTCT) contributes only 5% of transmission of HIV infection, its impact has reversed the decline in infant and child mortality rates. With antenatal service coverage of over 90%, the integration of prevention of MTCT (PMTCT) of HIV infection into the Reproductive and Child Health (RCH) services in Tanzania, this is likely to overstretch the staff capacity and undermine the already compromised quality of health care services. A retrospective study was conducted to assess the impact of integrating and scaling-up PMTCT of HIV infection into routine RCH services, on the magnitude of staff workload in RCH clinics. The study was conducted in 60 health facilities identified from five regions that had participated in the pilot phase of PMTCT implementation in the Mainland Tanzania. The average staff workload was calculated from staff-load obtained from attendance records and activity-time obtained by direct observation; and staff-time from records that were kept at the clinic. The average staff workload was found to be 50.5% (8-147%) for facilities providing PMTCT of HIV infection and 37.8% (11-82%) for facilities without PMTCT services. The average staff workload was computed on the assumption that all clients attending various antenatal clinics received PMTCT services from trained staff only and the result revealed staff workload of 87.2%. This study concludes that services for PMTCT of HIV infection can easily be scaled-up and integrated into RCH services using the already existing staff. In the wake of the human resource crisis in the health sector in developing countries, strategies to address the problem will need to go beyond numbers to address issues of staff productivity and their distribution.
尽管母婴传播（MTCT）仅占 HIV 感染传播的 5%，但其影响却扭转了婴儿和儿童死亡率的下降趋势。随着 90%以上的产前服务覆盖率，将 HIV 感染的预防母婴传播（PMTCT）整合到坦桑尼亚生殖和儿童健康（RCH）服务中，这可能会超出员工的能力范围，并破坏已经受到影响的医疗服务质量。一项回顾性研究评估了将 HIV 感染的 PMTCT 整合和扩大到常规 RCH 服务中对 RCH 诊所员工工作量的影响。该研究在五个地区的 60 个卫生设施中进行，这些地区都参与了坦桑尼亚大陆 PMTCT 实施的试点阶段。平均员工工作量是根据出勤记录和直接观察获得的活动时间计算得出的员工负荷以及在诊所保存的记录中的员工时间计算得出的。发现提供 HIV 感染 PMTCT 的设施的平均员工工作量为 50.5%（8-147%），而没有 PMTCT 服务的设施为 37.8%（11-82%）。假设所有参加各种产前诊所的客户都只接受经过培训的员工提供的 PMTCT 服务，计算出平均员工工作量，结果显示员工工作量为 87.2%。这项研究得出的结论是，使用现有的员工，很容易将 HIV 感染的 PMTCT 服务扩大并整合到 RCH 服务中。在发展中国家卫生部门人力资源危机的背景下，解决问题的策略需要超越数字，解决员工生产力及其分配问题。
