Mailman School of Public Health, Columbia University, New York, NY, USA.
Int J Gynaecol Obstet. 2011 Dec;115(3):322-7. doi: 10.1016/j.ijgo.2011.09.008. Epub 2011 Oct 27.
Policy, regulation, training, and support for cadres adopting tasks and roles outside their historical domain have lagged behind the practical shift in service-delivery on the ground. The Health Systems Strengthening for Equity (HSSE) project sought to assess the alignment between national policy and regulation, preservice training, district level expectations, and clinical practice of cadres providing some or all components of emergency obstetric care (EmOC) in Malawi and Tanzania.
A mixed methods approach was used, including key informant interviews, a survey of District Health Management Teams, and a survey of health providers employed at a representative sample of health facilities.
A lack of alignment between national policy and regulation, training, and clinical practice was observed in both countries, particularly for cadres with less preservice training; a closer alignment was found between district level expectations and reported clinical practice. There is ineffective use of cadres that are trained and authorized to provide EmOC, but who are not delivering care, especially assisted vaginal delivery.
Better alignment between policy and practice, and support and training, and more efficient utilization of clinical staff are needed to achieve the quality health care for which the Malawian and Tanzanian health ministries and governments are accountable.
政策、法规、培训和对干部承担历史领域外任务和角色的支持，落后于实地服务提供的实际转变。卫生系统强化公平（HSSE）项目旨在评估国家政策和法规、职前培训、地区期望以及在马拉维和坦桑尼亚提供部分或全部紧急产科护理（EmOC）的干部的临床实践之间的一致性。
采用混合方法，包括关键知情人访谈、对地区卫生管理团队的调查以及对具有代表性的卫生机构的卫生提供者的调查。
在马拉维和坦桑尼亚两个国家都观察到国家政策和法规、培训和临床实践之间存在不一致，特别是对于接受较少职前培训的干部；地区期望和报告的临床实践之间存在更紧密的一致性。那些接受过培训和授权提供 EmOC 但未提供护理的干部的利用效率低下，特别是辅助阴道分娩。
需要更好地协调政策和实践、支持和培训，并更有效地利用临床工作人员，以实现马拉维和坦桑尼亚卫生部和政府负责的高质量医疗保健。
