Vindigni Stephen M, Riley Patricia L, Kimani Francis, Willy Rankesh, Warutere Patrick, Sabatier Jennifer F, Kiriinya Rose, Friedman Michael, Osumba Martin, Waudo Agnes N, Rakuom Chris, Rogers Martha
University of Washington School of Medicine, 1959 NE Pacific Street, Box 356421, Seattle, WA 98195-6421, USA.
Hum Resour Health. 2014 Mar 17;12:16. doi: 10.1186/1478-4491-12-16.
To assess the feasibility of utilizing a small-scale, low-cost, pilot evaluation in assessing the short-term impact of Kenya's emergency-hire nursing programme (EHP) on the delivery of health services (outpatient visits and maternal-child health indicators) in two underserved health districts with high HIV/AIDS prevalence.
Six primary outcomes were assessed through the collection of data from facility-level health management forms-total general outpatient visits, vaginal deliveries, caesarean sections, antenatal care (ANC) attendance, ANC clients tested for HIV, and deliveries to HIV-positive women. Data on outcome measures were assessed both pre-and post-emergency-hire nurse placement. Informal discussions were also conducted to obtain supporting qualitative data.
The majority of EHP nurses were placed in Suba (15.5%) and Siaya (13%) districts. At the time of the intervention, we describe an increase in total general outpatient visits, vaginal deliveries and caesarean sections within both districts. Similar significant increases were seen with ANC attendance and deliveries to HIV-positive women. Despite increases in the quantity of health services immediately following nurse placement, these levels were often not sustained. We identify several factors that challenge the long-term sustainability of these staffing enhancements.
There are multiple factors beyond increasing the supply of nurses that affect the delivery of health services. We believe this pilot evaluation sets the foundation for future, larger and more comprehensive studies further elaborating on the interface between interventions to alleviate nursing shortages and promote enhanced health service delivery. We also stress the importance of strong national and local relationships in conducting future studies.
评估利用小规模、低成本的试点评估，来评价肯尼亚紧急聘用护士计划（EHP）对两个艾滋病高发且医疗服务欠缺的健康区的卫生服务提供情况（门诊就诊及母婴健康指标）的短期影响的可行性。
通过收集机构层面卫生管理表格中的数据，评估六个主要结果——普通门诊总就诊次数、阴道分娩、剖宫产、产前检查（ANC）就诊人数、接受HIV检测的ANC患者以及HIV阳性女性的分娩情况。在紧急聘用护士前后均对结果指标数据进行评估。还进行了非正式讨论以获取支持性定性数据。
大多数EHP护士被派往苏巴区（15.5%）和锡亚区（13%）。在干预时，我们发现两个区的普通门诊总就诊次数、阴道分娩和剖宫产数量均有所增加。ANC就诊人数以及HIV阳性女性的分娩数量也出现了类似的显著增加。尽管在护士入职后卫生服务数量立即增加，但这些水平往往无法持续。我们确定了几个对这些人员配置增加的长期可持续性构成挑战的因素。
影响卫生服务提供的因素有多个，不仅仅是增加护士供应。我们认为这项试点评估为未来更大规模、更全面的研究奠定了基础，这些研究将进一步阐述缓解护理短缺与促进改善卫生服务提供之间的相互关系。我们还强调了在开展未来研究中建立强大的国家和地方关系的重要性。
