Division of Women and Child Health, Aga Khan University, PO Box 3500, Karachi 74550, Pakistan .
Global Health Workforce Alliance Secretariat, World Health Organization, Geneva, Switzerland .
Bull World Health Organ. 2013 Nov 1;91(11):824-833I. doi: 10.2471/BLT.13.118786.
To assess the effectiveness of care provided by mid-level health workers.
Experimental and observational studies comparing mid-level health workers and higher level health workers were identified by a systematic review of the scientific literature. The quality of the evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation criteria and data were analysed using Review Manager.
Fifty-three studies, mostly from high-income countries and conducted at tertiary care facilities, were identified. In general, there was no difference between the effectiveness of care provided by mid-level health workers in the areas of maternal and child health and communicable and noncommunicable diseases and that provided by higher level health workers. However, the rates of episiotomy and analgesia use were significantly lower in women giving birth who received care from midwives alone than in those who received care from doctors working in teams with midwives, and women were significantly more satisfied with care from midwives. Overall, the quality of the evidence was low or very low. The search also identified six observational studies, all from Africa, that compared care from clinical officers, surgical technicians or non-physician clinicians with care from doctors. Outcomes were generally similar.
No difference between the effectiveness of care provided by mid-level health workers and that provided by higher level health workers was found. However, the quality of the evidence was low. There is a need for studies with a high methodological quality, particularly in Africa - the region with the greatest shortage of health workers.
评估中级卫生工作者提供的护理效果。
通过系统综述科学文献，确定了比较中级和高级卫生工作者的实验和观察性研究。使用推荐评估、制定和评估标准评估证据质量，并使用 Review Manager 分析数据。
确定了 53 项研究，这些研究主要来自高收入国家，在三级保健机构进行。总的来说，中级卫生工作者在母婴健康、传染病和非传染病领域提供的护理效果与高级卫生工作者提供的护理效果没有差异。然而，与接受医生团队中助产士护理的产妇相比，单独接受助产士护理的产妇的会阴切开术和镇痛使用率显著降低，并且对助产士护理的满意度更高。总体而言，证据质量较低或极低。搜索还确定了 6 项来自非洲的观察性研究，这些研究比较了临床医生、外科技术员或非医师临床医生与医生提供的护理。结果通常相似。
未发现中级卫生工作者提供的护理效果与高级卫生工作者提供的护理效果之间存在差异。然而，证据质量较低。需要进行具有较高方法学质量的研究，特别是在卫生工作者最短缺的非洲地区。
