International Public Health & Biostatistics Unit and CMDT, WHO Collaborating Centre for Health Workforce Policy and Planning, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal.
Hum Resour Health. 2012 Sep 17;10:34. doi: 10.1186/1478-4491-10-34.
This paper describes the task-shifting taking place in health centres and district hospitals in Mozambique and Zambia. The objectives of this study were to identify the perceived causes and factors facilitating or impeding task-shifting, and to determine both the positive and negative consequences of task-shifting for the service users, for the services and for health workers.
Data collection involved individual and group interviews and focus group discussions with health workers from the civil service.
In both the Republic of Mozambique and the Republic of Zambia, health workers have to practice beyond the traditional scope of their professional practice to cope with their daily tasks. They do so to ensure that their patients receive the level of care that they, the health workers, deem due to them, even in the absence of written instructions.The "out of professional scope" activities consume a significant amount of working time. On occasions, health workers are given on-the-job training to assume new roles, but job titles and rewards do not change, and career progression is unheard of. Ancillary staff and nurses are the two cadres assuming a greater diversity of functions as a result of improvised task-shifting.
Our observations show that the consequences of staff deficits and poor conditions of work include heavier workloads for those on duty, the closure of some services, the inability to release staff for continuing education, loss of quality, conflicts with patients, risks for patients, unsatisfied staff (with the exception of ancillary staff) and hazards for health workers and managers. Task-shifting is openly acknowledged and widespread, informal and carries risks for patients, staff and management.
本文描述了莫桑比克和赞比亚卫生中心和地区医院的任务转移情况。本研究的目的是确定人们认为的导致任务转移的原因和因素，以及确定任务转移对服务使用者、服务和卫生工作者带来的积极和消极影响。
数据收集涉及与公务员中的卫生工作者进行个人和小组访谈以及焦点小组讨论。
在莫桑比克共和国和赞比亚共和国，卫生工作者都必须超越传统的专业实践范围，以应对日常任务。他们这样做是为了确保他们的病人得到他们认为应得的护理水平，即使没有书面指示。“超出专业范围”的活动会消耗大量的工作时间。有时，卫生工作者会接受在职培训以承担新角色，但职称和薪酬不会改变，职业发展也闻所未闻。由于临时的任务转移，辅助人员和护士是承担更多多样化职能的两个干部。
我们的观察表明，人员短缺和工作条件差的后果包括值班人员的工作量增加、一些服务关闭、无法为继续教育释放工作人员、质量下降、与患者发生冲突、对患者的风险、对工作人员和管理人员的不满（除了辅助人员）和卫生工作者和管理人员的危险。任务转移是公开承认和广泛存在的，非正式的，对患者、工作人员和管理人员都存在风险。
