WHO Regional Office for Europe, Athens, Greece.
Evidence for Action, University of Southampton, Southampton UK.
Lancet. 2014 Sep 27;384(9949):1215-25. doi: 10.1016/S0140-6736(14)60919-3. Epub 2014 Jun 22.
This paper complements the other papers in the Lancet Series on midwifery by documenting the experience of low-income and middle-income countries that deployed midwives as one of the core constituents of their strategy to improve maternal and newborn health. It examines the constellation of various diverse health-system strengthening interventions deployed by Burkina Faso, Cambodia, Indonesia, and Morocco, among which the scaling up of the pre-service education of midwives was only one element. Efforts in health system strengthening in these countries have been characterised by: expansion of the network of health facilities with increased uptake of facility birthing, scaling up of the production of midwives, reduction of financial barriers, and late attention for improving the quality of care. Overmedicalisation and respectful woman-centred care have received little or no attention.
本文补充了《柳叶刀》系列中关于助产士的其他论文，记录了低收入和中等收入国家的经验，这些国家将助产士作为改善孕产妇和新生儿健康的战略的核心组成部分之一。本文考察了布基纳法索、柬埔寨、印度尼西亚和摩洛哥等国部署的各种不同的卫生系统强化干预措施的组合，其中扩大助产士的职前教育只是其中的一个要素。这些国家在卫生系统强化方面的努力具有以下特点：扩大了卫生设施网络，增加了设施分娩的使用率，扩大了助产士的培养规模，减少了财政障碍，并在后期才关注提高护理质量。过度医疗化和尊重以妇女为中心的护理几乎没有得到关注。
