Mumtaz Zubia, Levay Adrienne V, Bhatti Afshan
School of Public Health, University of Alberta, Edmonton, Alberta, Canada.
Real Medicine Foundation Pakistan, Islamabad, Pakistan.
PLoS One. 2015 Sep 2;10(9):e0135302. doi: 10.1371/journal.pone.0135302. eCollection 2015.
In response to the low levels of skilled birth attendance in rural Pakistan, the government introduced a new cadre of community midwives (CMWs) in 2006. Assessments to-date have found that these CMWs have yet to emerge as significant providers for a number of sociocultural, geographic and financial reasons. However, a small number of CMWs have managed to establish functional practices in the private sector in conservative, infrastructure-challenged rural contexts. With an objective to highlight "what are the successful CMWs doing right given their context?" this paper adopts an asset-based approach to explore the experiences of the Pakistani CMWs who have managed to overcome the barriers and practice. We drew upon ethnographic data that was collected as part of a larger mixed methods study conducted in 2011-2012 in districts Jhelum and Layyah, Pakistan. Thirty eight CMWs, 45 other health care providers, 20 policymakers, 78 women, 35 husbands and 23 older women were interviewed. CMW clinics and practices were observed. Our data showed that only eight 8 out of 38 CMWs sampled were active providers. Poverty as a push factor to work and intrinsic individual-level characteristics that enabled the CMWs to respond successfully to the demands of the midwifery profession in the private sector emerged as the two key themes. Household poverty pushed the CMWs to work in this perceived low-status occupation. Their families supported them since they became the breadwinners. The successful CMWs also had an intrinsic sense of what was required to establish a private practice; they exhibited professionalism, had strong business sense and provided respectful maternity care. The study provides insight into how the program might improve its functioning by adapting its recruitment criteria to ensure selection of right candidates.
针对巴基斯坦农村地区熟练助产服务水平较低的情况，政府于2006年引入了一批新的社区助产士。迄今为止的评估发现，由于一些社会文化、地理和经济原因，这些社区助产士尚未成为重要的服务提供者。然而，少数社区助产士在保守、基础设施薄弱的农村地区的私营部门成功建立了有效的业务。为了突出“在这种情况下，成功的社区助产士做对了什么？”，本文采用基于资产的方法，探讨成功克服障碍并开展业务的巴基斯坦社区助产士的经验。我们借鉴了2011 - 2012年在巴基斯坦杰赫勒姆和莱雅地区进行的一项更大规模混合方法研究中收集的人种学数据。采访了38名社区助产士、45名其他医疗服务提供者、20名政策制定者、78名妇女、35名丈夫和23名老年妇女。观察了社区助产士诊所和业务。我们的数据显示，在抽样的38名社区助产士中，只有8名是活跃的服务提供者。贫困作为促使她们工作的因素以及使社区助产士能够成功应对私营部门助产职业需求的内在个人层面特征，成为两个关键主题。家庭贫困促使社区助产士从事这种被认为地位较低的职业。由于她们成为了家庭的经济支柱，家人支持她们。成功的社区助产士对于建立私人业务所需的条件也有一种内在的认识；她们表现出专业精神，有很强的商业意识，并提供尊重产妇的护理。该研究为该项目如何通过调整招聘标准以确保选拔合适的候选人来改善其运作提供了见解。
