Tobi Patrick, George Gavin, Schmidt Elena, Renton Adrian
Institute for Health and Human Development, University of East London, London, UK.
Trop Med Int Health. 2008 Dec;13(12):1452-8. doi: 10.1111/j.1365-3156.2008.02169.x. Epub 2008 Oct 29.
To investigate the effect of scaling up antiretroviral treatment (ART) on the working environment and motivation of health workers in South Africa; and to suggest strategies to minimize negative effects and maximise positive effects.
Exploratory interviews with health managers and senior clinical staff were used to identify locally relevant work environment indicators. A self-reported Likert scale questionnaire was administered to a randomly selected cohort of 269 health professionals at health facilities in KwaZulu Natal and Western Cape provinces of South Africa that included ART delivery sites. The cohort was disaggregated into ART and non-ART groups and differences between the two compared with Fisher's exact test and the non-parametric Mann-Whitney U-test.
The ART sub-cohort reported: (i) a lighter workload (P = 0.013), (ii) higher level of staffing (P = 0.010), (iii) lower sickness absence (P = 0.032), (iv) higher overall job satisfaction (P = 0.010), (v) poorer physical state of their work premises (P = 0.003), and (vi) higher staff turnover (P = 0.036). Conclusion Scale-up affects the work environment in ways that influence workers' motivation both positively and negatively. A net negative balance is likely to drive staff out-migration, undermine the quality of care and compromise the capacity of the programme to achieve significant scale. As health workers are the most important element of the health system, a comprehensive and systematic understanding of scale-up impacts on their working conditions and motivation needs to be an integral part of any delivery strategy.
调查扩大抗逆转录病毒治疗（ART）对南非卫生工作者工作环境和积极性的影响；并提出将负面影响降至最低和将正面影响最大化的策略。
对卫生管理人员和高级临床工作人员进行探索性访谈，以确定与当地相关的工作环境指标。对南非夸祖鲁-纳塔尔省和西开普省包括ART服务点在内的医疗机构中随机抽取的269名卫生专业人员进行了自填式李克特量表问卷调查。该队列被分为ART组和非ART组，两组之间的差异采用Fisher精确检验和非参数曼-惠特尼U检验进行比较。
ART亚队列报告：（i）工作量较轻（P = 0.013），（ii）人员配备水平较高（P = 0.010），（iii）病假缺勤率较低（P = 0.032），（iv）总体工作满意度较高（P = 0.010），（v）工作场所的物理状态较差（P = 0.003），以及（vi）员工流动率较高（P = 0.036）。结论扩大规模以积极和消极两种方式影响工作环境，进而影响工作人员的积极性。净负平衡可能会导致工作人员外流，破坏护理质量，并损害该计划实现显著规模的能力。由于卫生工作者是卫生系统最重要的组成部分，对扩大规模对其工作条件和积极性的影响进行全面系统的了解应成为任何服务提供策略的一个组成部分。
