Brown Andrew N, Gilbert Ben
People that Deliver, UNICEF Supply Division, Copenhagen, Denmark.
Discipline of Pharmacy, Faculty of Health, University of Canberra, Canberra, ACT, Australia.
J Pharm Policy Pract. 2014 May 19;7:5. doi: 10.1186/2052-3211-7-5. eCollection 2014.
Limited human resources are widely recognised as an impediment to achieving the health-related Millennium Development Goals in Pacific Island Countries, with the availability of medical supplies and suitably trained health personnel crucial to ensuring a well-functioning medical supply chain. This paper presents our findings as we seek to answer the research question 'What factors influence the availability of medical supplies within the health facilities of Papua New Guinea?'
We used a qualitative, triangulated strategy using semi-structured interviews, workplace observation and semi-structured focus groups. The parallel use of the interview tool and workplace observation tool allowed identification of 'know-do' gaps between what the interviewee said they did in their work practices, and the actual evidence of these practices. Focus groups provided further opportunities for raising and elaborating issues.
During 2 weeks of data collection we conducted 17 interviews and 15 observational workplace surveys in 15 facilities. Sixteen health personnel participated in 3 focus groups across 2 provinces and one district. An array of medical supply issues across all levels of the medical supply chain were revealed, including standard operating procedures, facilities, transport, emergency medical kits, the cold chain and record keeping. The influence of health worker training and competency was found to be common across all of these issues.
The factors influencing the availability of medical supplies in PNG consist of a range of interrelating issues, consisting of both simple and complex problems involving the different levels and cadres of workers within the medical supply chain. Health systems sustainability theory suggests that a coordinated approach which addresses the inter-related nature of these issues, led by the PNG government and supported by suitable development partners, will be required for sustainable health systems change to occur. These changes are necessary for PNG to meet the health-related Millennium Development Goals.
人力资源有限被广泛认为是太平洋岛国实现与健康相关的千年发展目标的障碍，医疗用品的供应以及训练有素的卫生人员对于确保医疗供应链的正常运转至关重要。本文展示了我们在试图回答研究问题“哪些因素影响巴布亚新几内亚医疗机构内医疗用品的供应？”时的研究结果。
我们采用了定性的、三角互证策略，运用半结构化访谈、工作场所观察和半结构化焦点小组。同时使用访谈工具和工作场所观察工具能够识别受访者在工作实践中所说的与这些实践的实际证据之间的“知行”差距。焦点小组为提出和阐述问题提供了更多机会。
在为期两周的数据收集期间，我们在15个机构进行了17次访谈和15次工作场所观察调查。16名卫生人员参与了2个省和1个地区的3次焦点小组。揭示了医疗供应链各级的一系列医疗用品问题，包括标准操作程序、设施、运输、急救医疗包、冷链和记录保存。发现卫生工作者培训和能力的影响在所有这些问题中都很常见。
影响巴布亚新几内亚医疗用品供应的因素包括一系列相互关联的问题，既有简单问题也有复杂问题，涉及医疗供应链内不同层级和类别的工作人员。卫生系统可持续性理论表明，要实现可持续的卫生系统变革，需要由巴布亚新几内亚政府牵头并得到合适的发展伙伴支持，采取一种协调一致的方法来解决这些问题的相互关联性。这些变革对于巴布亚新几内亚实现与健康相关的千年发展目标是必要的。
