Bradley Susan, Kamwendo Francis, Chipeta Effie, Chimwaza Wanangwa, de Pinho Helen, McAuliffe Eilish
School of Health Sciences, City University London, 1 Myddelton Street, London, EC1R 1UW, UK.
University of Malawi, College of Medicine, Centre for Reproductive Health, Blantyre, Malawi.
BMC Pregnancy Childbirth. 2015 Mar 21;15:65. doi: 10.1186/s12884-015-0492-5.
Shortages of staff have a significant and negative impact on maternal outcomes in low-income countries, but the impact on obstetric care providers in these contexts is less well documented. Despite the government of Malawi's efforts to increase the number of human resources for health, maternal mortality rates remain persistently high. Health workers' perceptions of insufficient staff or time to carry out their work can predict key variables concerning motivation and attrition, while the resulting sub-standard care and poor attitudes towards women dissuade women from facility-based delivery. Understanding the situation from the health worker perspective can inform policy options that may contribute to a better working environment for staff and improved quality of care for Malawi's women.
A qualitative research design, using critical incident interviews, was used to generate a deep and textured understanding of participants' experiences. Eligible participants had performed at least one of the emergency obstetric care signal functions (a) in the previous three months and had experienced a demotivating critical incident within the same timeframe. Data were analysed using NVivo software.
Eighty-four interviews were conducted. Concerns about staff shortages and workload were key factors for over 40% of staff who stated their intention to leave their current post and for nearly two-thirds of the remaining health workers who were interviewed. The main themes emerging were: too few staff, too many patients; lack of clinical officers/doctors; inadequate obstetric skills; undermining performance and professionalism; and physical and psychological consequences for staff. Underlying factors were inflexible scheduling and staff allocations that made it impossible to deliver quality care.
This study revealed the difficult circumstances under which maternity staff are operating and the professional and emotional toll this exacts. Systems failures and inadequate human resource management are key contributors to the gaps in provision of obstetric care and need to be addressed. Thoughtful strategies that match supply to demand, coupled with targeted efforts to support health workers, are necessary to mitigate the effects of working in this context and to improve the quality of obstetric care for women in Malawi.
在低收入国家，人员短缺对孕产妇结局有重大负面影响，但在这些情况下对产科护理提供者的影响记录较少。尽管马拉维政府努力增加卫生人力资源数量，但孕产妇死亡率仍然居高不下。卫生工作者认为人员或开展工作的时间不足，这可能预示着与工作积极性和人员流失相关的关键变量，而由此导致的护理不达标以及对产妇的不良态度会使产妇不愿在医疗机构分娩。从卫生工作者的角度了解情况有助于制定政策选项，这可能有助于为工作人员营造更好的工作环境，并提高为马拉维妇女提供的护理质量。
采用定性研究设计，通过关键事件访谈，深入了解参与者的经历。符合条件的参与者在过去三个月内至少执行过一次紧急产科护理信号功能，并且在同一时间段内经历过一次导致工作积极性受挫的关键事件。使用NVivo软件对数据进行分析。
共进行了84次访谈。对于超过40%表示打算离职的工作人员以及近三分之二接受访谈的其余卫生工作者来说，对人员短缺和工作量的担忧是关键因素。出现的主要主题包括：人员太少，患者太多；临床干事/医生短缺；产科技能不足；影响工作表现和职业素养；以及对工作人员的身心影响。根本因素是排班和人员分配缺乏灵活性，导致无法提供高质量护理。
本研究揭示了产科工作人员所处的艰难工作环境以及由此带来的职业和情感代价。系统故障和人力资源管理不足是产科护理服务存在差距的关键因素，需要加以解决。需要制定合理的供需匹配策略，并针对性地努力支持卫生工作者，以减轻在此环境下工作的影响，并提高马拉维妇女的产科护理质量。
