Dawson Angela, Tran Nguyen-Toan, Westley Elizabeth, Mangiaterra Viviana, Festin Mario
World Health Organization Collaborating Centre for Nursing, Midwifery and Health Development, Faculty of Health, University of Technology, Sydney (UTS), Jones Street, Sydney, NSW, Australia.
School of Public Health and Community Medicine, University of New South Wales, High St, Sydney, 2052, Australia.
BMC Health Serv Res. 2015 Apr 26;15:180. doi: 10.1186/s12913-015-0815-2.
Emergency contraceptive pills (ECP) are one of the 13 essential commodities addressed by the UN Commission on Life-Saving Commodities for Women and Children. Although ECP have been available for 20 years, a number of barriers still limit women's access ECP in low and middle-income countries (LMIC). The workforce who prescribe or dispense ECP are diverse reflecting the varied contexts where ECP are available across the health, commercial and justice sectors and in the community. No reviews currently exist that examine the roles and experiences of the workforce that provide ECP in LMIC.
We present a narrative synthesis of research to: identify provider factors that facilitate and constraint access to ECP; assess the effectiveness of associated interventions and; explore associated health system issues in LMIC. A search of bibliographic databases, meta-indexes and websites was undertaken to retrieve peer reviewed and grey literature. Literature was screened and identified documents examined to appraise quality.
Thirty-seven documents were included in the review. Studies focused on formal health workers revealing knowledge gaps concerning the role of private sector and non-health providers who increasingly provide ECP. Data from the findings section in the documents were coded under 4 themes: provider knowledge; provider attitudes and beliefs; provider practice and provider training. The analysis revealed provider knowledge gaps, less than favourable attitudes and practice issues. The findings provide limited insight into products prescribed and/or dispensed, the frequency of provision, and information and advice offered to consumers. Pre and in-service training needs were noted.
As the provision of ECPs shifts from the clinic-based health sector to increasing provision by the private sector, the limited understanding of provider performance and the practice gaps revealed in this review highlight the need to further examine provider performance to inform the development of appropriate workforce interventions. A standardized approach to assessing performance using agreed outcomes measures may serve to ensure a systematic way forward that is inclusive of the diverse workforce that deliver ECP. Recommendations are outlined to enhance the performance of providers to improve access to ECP. A framework is offered to help guide this process with indicators.
紧急避孕药是联合国妇女和儿童救生用品委员会所关注的13种基本商品之一。尽管紧急避孕药已问世20年，但在低收入和中等收入国家，仍有许多障碍限制了女性获取紧急避孕药。开具或分发紧急避孕药的工作人员多种多样，这反映出在卫生、商业、司法部门及社区等不同环境中都有紧急避孕药的供应。目前尚无综述对低收入和中等收入国家中提供紧急避孕药的工作人员的角色和经历进行研究。
我们对研究进行了叙述性综合分析，以：确定促进和限制获取紧急避孕药的提供者因素；评估相关干预措施的有效性；以及探讨低收入和中等收入国家相关的卫生系统问题。我们检索了书目数据库、元索引和网站，以获取同行评审文献和灰色文献。对文献进行筛选，并对选定的文献进行审查以评估其质量。
该综述纳入了37篇文献。研究聚焦于正规卫生工作者，揭示了在私营部门和非卫生提供者（他们越来越多地提供紧急避孕药）的作用方面存在知识差距。文献中研究结果部分的数据按照4个主题进行编码：提供者知识；提供者态度和信念；提供者实践；以及提供者培训。分析揭示了提供者的知识差距、不太积极的态度和实践问题。研究结果对所开具和/或分发的产品、供应频率以及提供给消费者的信息和建议的了解有限。研究指出了岗前培训和在职培训的需求。
随着紧急避孕药的供应从基于诊所的卫生部门转向私营部门的供应增加，本综述中所揭示的对提供者表现的有限理解和实践差距凸显了进一步检查提供者表现以为制定适当的劳动力干预措施提供信息的必要性。采用商定的结果指标来评估表现的标准化方法可能有助于确保以系统的方式推进，这种方式要涵盖提供紧急避孕药的多样化劳动力。文中概述了提高提供者表现以改善紧急避孕药获取情况的建议。还提供了一个框架，以帮助用指标指导这一过程。
