Supporting Use of Research Evidence for Policy (SURE Project), Office of Principal, College of Health Sciences, Makerere University, New Mulago Hospital Complex, P.O. Box 7072, Kampala, Uganda.
Int J Technol Assess Health Care. 2011 Apr;27(2):173-9. doi: 10.1017/S0266462311000055. Epub 2011 Mar 30.
There is a shortage and maldistribution of medically trained health professionals to deliver cost-effective maternal and child health (MCH) services. Hence, cost-effective MCH services are not available to over half the population of Uganda and progress toward the Millennium Development Goals for MCH is slow. Optimizing the roles of less specialized health workers ("task shifting") is one strategy to address the shortage and maldistribution of more specialized health professionals.
(i) Lay health workers (community health workers) may reduce morbidity and mortality in children under five and neonates; and training for traditional birth attendants may improve perinatal outcomes and appropriate referrals. (ii) Nursing assistants in facilities might increase the time available from nurses, midwives, and doctors to provide care that requires more training. (iii) Nurses and midwives to deliver cost-effective MCH interventions in areas where there is a shortage of doctors. (iv) Drug dispensers to promote and deliver cost-effective MCH interventions and improve the quality of the services they provide. The costs and cost-effectiveness of all four options are uncertain. Given the limitations of the currently available evidence, rigorous evaluation and monitoring of resource use and activities is warranted for all four options.
A clear policy on optimizing health worker roles. Community mobilization and reduction of out-of-pocket costs to improve mothers' knowledge and care-seeking behaviors, continuing education, and incentives to ensure health workers are competent and motivated, and community referral and transport schemes for MCH care are needed.
医疗培训专业人员的短缺和分布不均，导致提供具有成本效益的母婴健康（MCH）服务的能力受到限制。因此，乌干达超过一半的人口无法获得具有成本效益的 MCH 服务，母婴健康领域的千年发展目标进展缓慢。优化非专业卫生工作者（“任务转移”）的角色是解决更专业卫生专业人员短缺和分布不均的策略之一。
（一）初级卫生保健工作者（社区卫生工作者）可以降低五岁以下儿童和新生儿的发病率和死亡率；培训传统助产妇可以改善围产期结局和适当转诊。（二）医疗机构中的护理助理可能会增加护士、助产士和医生提供需要更多培训的护理的时间。（三）在医生短缺的地区，护士和助产士提供具有成本效益的 MCH 干预措施。（四）药剂师促进和提供具有成本效益的 MCH 干预措施，并提高他们提供的服务质量。这四种选择的成本和成本效益都不确定。鉴于目前可用证据的局限性，所有四种选择都需要对资源利用和活动进行严格的评估和监测。
制定明确的政策优化卫生工作者的角色。需要社区动员和降低自付费用，以提高母亲的知识和寻求护理的行为，继续教育和激励措施以确保卫生工作者有能力和积极性，以及 MCH 护理的社区转诊和运输计划。
