一项针对坦桑尼亚农村地区非医师临床医生/助理临床医生（NPCs/ACs）进行的孕产妇和新生儿急救及临床领导力培训的定性过程评估：ETATMBA项目，以及该培训对临床服务改善的影响

A qualitative process evaluation of training for non-physician clinicians/associate clinicians (NPCs/ACs) in emergency maternal, neonatal care and clinical leadership, impact on clinical services improvements in rural Tanzania: the ETATMBA project.

作者信息

Ellard David R, Shemdoe Aloisia, Mazuguni Festo, Mbaruku Godfrey, Davies David, Kihaile Paul, Pemba Senga, Bergström Staffan, Nyamtema Angelo, Mohamed Hamed-Mahfoudh, O'Hare Joseph Paul

机构信息

Warwick Clinical Trials Unit, Division of Health Sciences, Warwick Medical School, The University of Warwick, Coventry, UK.

Ifakara Health Institute, Dar es Salaam, Tanzania.

出版信息

BMJ Open. 2016 Feb 12;6(2):e009000. doi: 10.1136/bmjopen-2015-009000.

DOI:10.1136/bmjopen-2015-009000

PMID:26873045

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4762120/

Abstract

OBJECTIVES

The Enhancing Human Resources and Use of Appropriate Training for Maternal and Perinatal Survival in sub-Saharan Africa (ETATMBA) project is training non-physician clinicians as advanced clinical leaders in emergency maternal and newborn care in Tanzania and Malawi. The main aims of this process evaluation were to explore the implementation of the programme of training in Tanzania, how it was received, how or if the training has been implemented into practice and the challenges faced along the way.

DESIGN

Qualitative interviews with trainees, trainers, district officers and others exploring the application of the training into practice.

PARTICIPANTS

During late 2010 and 2011, 36 trainees including 19 assistant medical officers one senior clinical officer and 16 nurse midwives/nurses (anaesthesia) were recruited from districts across rural Tanzania and invited to join the ETATMBA training programme.

RESULTS

Trainees (n=36) completed the training returning to 17 facilities, two left and one died shortly after training. Of the remaining trainees, 27 were interviewed at their health facility. Training was well received and knowledge and skills were increased. There were a number of challenges faced by trainees, not least that their new skills could not be practised because the facilities they returned to were not upgraded. Nonetheless, there is evidence that the training is having an effect locally on health outcomes, like maternal and neonatal mortality, and the trainees are sharing their new knowledge and skills with others.

CONCLUSIONS

The outcome of this evaluation is encouraging but highlights that there are many ongoing challenges relating to infrastructure (including appropriate facilities, electricity and water) and the availability of basic supplies and drugs. This cadre of workers is a dedicated and valuable resource that can make a difference, which with better support could make a greater contribution to healthcare in the country.

摘要

目标

“撒哈拉以南非洲地区加强人力资源与使用适当的孕产妇和围产期生存培训”（ETATMBA）项目正在坦桑尼亚和马拉维培训非医师临床医生，使其成为紧急孕产妇和新生儿护理方面的高级临床领导者。本次过程评估的主要目的是探讨坦桑尼亚培训项目的实施情况、培训的接受程度、培训如何或是否已应用于实践以及在此过程中面临的挑战。

设计

对学员、培训师、地区官员及其他人员进行定性访谈，探讨培训在实践中的应用情况。

参与者

2010年末至2011年期间，从坦桑尼亚农村各地区招募了36名学员，其中包括19名助理医务人员、1名高级临床官员以及16名助产士/护士（麻醉方向），并邀请他们参加ETATMBA培训项目。

结果

36名学员完成培训后返回17家医疗机构，2人离开，1人在培训后不久去世。在其余学员中，27人在其医疗机构接受了访谈。培训受到好评，学员的知识和技能有所提高。学员们面临诸多挑战，尤其是他们回到的医疗机构未升级，新技能无法得到实践。尽管如此，有证据表明培训正在对当地的健康结果产生影响，如孕产妇和新生儿死亡率，并且学员们正在与他人分享他们的新知识和技能。