Simmons R, Koenig M A, Huque A A
Department of Population Planning and International Health, School of Public Health, University of Michigan, Ann Arbor 48109-2029.
Stud Fam Plann. 1990 Jul-Aug;21(4):187-96.
This article presents a microanalysis of interactions between female fieldworkers and women in rural Bangladesh, and a discussion of the broader organizational constraints that hamper service delivery. It is argued that the fieldworker, herself a rural woman, is faced with considerable demand for both maternal-child health (MCH) and reproductive health care services, but that operational constraints prevent her from realizing her potential in both of these areas. Qualitative data show that, in the eyes of rural women, contraceptive use and health care are intricately intertwined, and that this association often raises a range of questions that the worker cannot address competently. A number of specific operational barriers--worker densities, staff motivation, supervision, technical competence, supplies--are identified. These barriers reflect a general institutional weakness in the Ministry of Health bureaucracy that prevents it from organizing itself to deliver user-oriented health and family planning services while maintaining adequate and appropriate standards of care.
本文对孟加拉国农村地区女性实地工作者与妇女之间的互动进行了微观分析，并探讨了阻碍服务提供的更广泛的组织制约因素。有人认为，实地工作者本人也是一名农村妇女，面临着对母婴健康（MCH）和生殖保健服务的大量需求，但操作上的限制使她无法在这两个领域发挥自己的潜力。定性数据表明，在农村妇女眼中，避孕措施的使用和医疗保健错综复杂地交织在一起，这种关联常常引发一系列实地工作者无法妥善解决的问题。确定了一些具体的操作障碍——工作人员密度、员工积极性、监督、技术能力、物资供应。这些障碍反映出卫生部官僚机构普遍存在的体制弱点，这使得它无法在维持适当和合适的护理标准的同时，组织自身提供以用户为导向的健康和计划生育服务。
