Department of Surgery, College of Health Sciences, Makerere University, Mulago Hill Road, Kampala, Uganda.
BMC Health Serv Res. 2013 Aug 1;13:292. doi: 10.1186/1472-6963-13-292.
The shortage and mal-distribution of surgical specialists in sub-Saharan African countries is born out of shortage of individuals choosing a surgical career, limited training capacity, inadequate remuneration, and reluctance on the part of professionals to work in rural and remote areas, among other reasons. This study set out to assess the views of clinicians and managers on the use of task shifting as an effective way of alleviating shortages of skilled personnel at a facility level.
37 in-depth interviews with key informants and 24 focus group discussions were held to collect qualitative data, with a total of 80 healthcare managers and frontline health workers at 24 sites in 15 districts. Quantitative and descriptive facility data were also collected, including operating room log sheets to identify the most commonly conducted operations.
Most health facility managers and health workers supported surgical task shifting and some health workers practiced it. The practice is primarily driven by a shortage of human resources for health. Personnel expressed reluctance to engage in surgical task shifting in the absence of a regulatory mechanism or guiding policy. Those in favor of surgical task shifting regarded it as a potential solution to the lack of skilled personnel. Those who opposed it saw it as an approach that could reduce the quality of care and weaken the health system in the long term by opening it to unregulated practice and abuse of privilege. There were enough patient numbers and basic infrastructure to support training across all facilities for surgical task shifting.
Whereas surgical task shifting was viewed as a short-term measure alongside efforts to train and retain adequate numbers of surgical specialists, efforts to upscale its use were widely encouraged.
撒哈拉以南非洲国家外科专家短缺和分布不均的原因包括选择外科职业的人数不足、培训能力有限、薪酬不足以及专业人员不愿意在农村和偏远地区工作等。本研究旨在评估临床医生和管理人员对任务转移作为缓解医疗机构技能人员短缺的有效方法的看法。
在 15 个地区的 24 个地点的 24 个站点，对 80 名医疗保健经理和一线卫生工作者进行了 37 次深入访谈和 24 次焦点小组讨论，以收集定性数据。还收集了定量和描述性设施数据，包括手术室日志表，以确定最常进行的手术。
大多数卫生机构管理人员和卫生工作者支持外科任务转移，并且一些卫生工作者已经在实践这种方法。这种做法主要是由于卫生人力资源短缺所致。在没有监管机制或指导政策的情况下，工作人员不愿意从事外科任务转移。赞成外科任务转移的人认为这是解决技能人员短缺的潜在方法。反对者则认为，这可能会因缺乏监管而降低服务质量，并长期削弱卫生系统，从而滥用特权。所有设施都有足够的患者数量和基本基础设施来支持外科任务转移的培训。
尽管手术任务转移被视为培训和留住足够数量的外科专家的短期措施，但广泛鼓励加大其使用力度。
