Jhpiego, Baltimore, Maryland, USA.
PLoS Med. 2011 Nov;8(11):e1001129. doi: 10.1371/journal.pmed.1001129. Epub 2011 Nov 29.
Voluntary medical male circumcision (VMMC) reduces female-to-male HIV transmission by approximately 60%; modeling suggests that scaling up VMMC to 80% of men 15- to 49-years-old within five years would avert over 3.3 million new HIV infections in 14 high priority countries/regions in southern and eastern Africa by 2025 and would require 20.33 million circumcisions. However, the shortage of health professionals in these countries must be addressed to reach these proposed coverage levels. To identify human resource approaches that are being used to improve VMMC volume and efficiency, we looked at previous literature and conducted a program review. We identified surgical efficiencies, non-surgical efficiencies, task shifting, task sharing, temporary redeployment of public sector staff during VMMC campaign periods, expansion of the health workforce through recruitment of unemployed, recently retired, newly graduating, or on-leave health care workers, and the use of volunteer medical staff from other countries as approaches that address human resource constraints. Case studies from Kenya, Tanzania, and Swaziland illustrate several innovative responses to human resource challenges. Although the shortage of skilled personnel remains a major challenge to the rapid scale-up of VMMC in the 14 African priority countries/regions, health programs throughout the region may be able to replicate or adapt these approaches to scale up VMMC for public health impact.
自愿男性包皮环切术(VMMC)可使女性向男性传播的 HIV 减少约 60%;建模表明,在五年内将 15 至 49 岁男性的 VMMC 比例提高到 80%,将避免在 2025 年之前在南部和东部非洲的 14 个高重点国家/地区新增 330 多万例 HIV 感染,这需要进行 2033 万例包皮环切术。然而,这些国家必须解决卫生专业人员短缺的问题,以达到这些拟议的覆盖水平。为了确定正在采用哪些人力资源方法来提高 VMMC 的数量和效率,我们查阅了以前的文献并进行了方案审查。我们确定了手术效率、非手术效率、任务转移、任务分担、在 VMMC 运动期间临时重新部署公共部门工作人员、通过招聘失业人员、最近退休人员、新毕业人员或休假中的医疗保健工作者来扩大卫生人力以及利用来自其他国家的志愿医务人员等方法来解决人力资源限制问题。来自肯尼亚、坦桑尼亚和斯威士兰的案例研究说明了应对人力资源挑战的几种创新对策。尽管熟练人员短缺仍然是在 14 个非洲重点国家/地区快速扩大 VMMC 的主要挑战,但该地区的卫生规划者可能能够复制或改编这些方法,以扩大 VMMC 规模,从而对公共卫生产生影响。
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