Dawson Angela J, Buchan James, Duffield Christine, Homer Caroline S E, Wijewardena Kumudu
World Health Organization Collaborating Centre in Nursing, Midwifery and Health Development, Faculty of Health, University of Technology, 235-253 Jones Street Broadway, Sydney, NSW 2007, Australia. E-mail:
Health Policy Plan. 2014 May;29(3):396-408. doi: 10.1093/heapol/czt026. Epub 2013 May 8.
Reducing maternal mortality and providing universal access to reproductive health in resource poor settings has been severely constrained by a shortage of health workers required to deliver interventions. The aim of this article is to determine evidence to optimize health worker roles through task shifting/sharing to address Millennium Development Goal 5 and reduce maternal mortality and provide universal access to reproductive health. A narrative synthesis of peer-reviewed literature from 2000 to 2011 was undertaken with retrieved documents assessed using an inclusion/exclusion criterion and quality appraisal guided by critical assessment tools. Concepts were analysed thematically. The analysis identified a focus on clinical tasks (the delivery of obstetric surgery, anaesthesia and abortion) that were shifted to and/or shared with doctors, non-physician clinicians, nurses and midwives. Findings indicate that shifting and sharing these tasks may increase access to and availability of maternal and reproductive health (MRH) services without compromising performance or patient outcomes and may be cost effective. However, a number of issues and barriers were identified with health workers calling for improved in-service training, supervision, career progression and incentive packages to better support their practice. Collaborative approaches involving community members and health workers at all levels have the potential to deliver MRH interventions effectively if accompanied by ongoing investment in the health care system.
在资源匮乏地区，降低孕产妇死亡率以及普及生殖健康服务，因提供干预措施所需的卫生工作者短缺而受到严重制约。本文旨在确定相关证据，以通过任务转移/分担来优化卫生工作者的角色，从而实现千年发展目标5，降低孕产妇死亡率并普及生殖健康服务。对2000年至2011年同行评审文献进行了叙述性综合分析，检索到的文献根据纳入/排除标准进行评估，并采用关键评估工具进行质量评估。对概念进行了主题分析。分析发现重点在于临床任务（产科手术、麻醉和堕胎的实施）已转移至医生、非医师临床医生、护士和助产士并与其分担。研究结果表明，转移和分担这些任务可能会增加孕产妇和生殖健康服务的可及性和可得性，而不会影响服务质量或患者结局，且可能具有成本效益。然而，也发现了一些问题和障碍，卫生工作者呼吁改善在职培训、监督、职业发展和激励措施，以更好地支持他们的工作。如果能持续对卫生保健系统进行投资，涉及社区成员和各级卫生工作者的协作方法有可能有效地提供孕产妇和生殖健康干预措施。
