Teffo Mantshi E, Rispel Laetitia C
a School of Public Health, Faculty of Health Sciences , University of the Witwatersrand , Johannesburg , South Africa.
Glob Health Action. 2017;10(1):1347369. doi: 10.1080/16549716.2017.1347369.
Globally, universal access to sexual and reproductive health care services has been re-emphasised. One-third of maternal deaths could be averted by improving access to safe abortion services. Anecdotal evidence suggests that the implementation of the Choice of Termination of Pregnancy Act has been suboptimal in South Africa.
In two South African provinces, determine: the proportion of designated termination of pregnancy (TOP) facilities that provide these services; explore the factors that influence the provision of TOP services; and explore the work experiences of health care providers at designated TOP facilities.
During 2014 and 2015, we conducted a cross-sectional study at designated TOP facilities in Gauteng and North West provinces. A combination of methods was used, consisting of: site visits to, and observation of, each of the designated facilities using a checklist, and in-depth interviews with a sub-set of 30 TOP service providers, using a semi-structured interview schedule. The interview questions focused on the factors influencing TOP service provision, and the work experiences of TOP service providers. We used interpretative phenomenological analysis to analyse the data from the interviews.
Overall, 77% (47/61) of designated facilities were providing TOP services, with 87.5% (28/32) in Gauteng Province, compared with 65.5% (19/29) in North West Province. Service provision was influenced by health system deficiencies, human resource challenges, lack of prioritisation and lack of management support. Study participants reported a heavy burden of care provision and expressed an overwhelming feeling of loneliness, courtesy stigma and lack of support from other nurses and doctors, which further influence TOP service provision.
South Africa has an enabling legal environment for the provision of TOP services. Supportive management, prioritisation of TOP services and employee wellness programmes to address the psychosocial issues experienced by providers are critical elements of an enabling health policy environment.
在全球范围内,性与生殖健康保健服务的普遍可及性再次得到强调。改善安全堕胎服务的可及性可避免三分之一的孕产妇死亡。轶事证据表明,《终止妊娠选择法案》在南非的实施情况并不理想。
在南非的两个省份,确定:提供这些服务的指定终止妊娠(TOP)设施的比例;探讨影响TOP服务提供的因素;并探究指定TOP设施中医护人员的工作经历。
在2014年和2015年期间,我们在豪登省和西北省的指定TOP设施开展了一项横断面研究。采用了多种方法,包括:使用检查表对每个指定设施进行实地考察和观察,并使用半结构化访谈提纲对30名TOP服务提供者进行深入访谈。访谈问题聚焦于影响TOP服务提供的因素以及TOP服务提供者的工作经历。我们使用解释现象学分析来分析访谈数据。
总体而言,77%(47/61)的指定设施提供TOP服务,豪登省为87.5%(28/32),而西北省为65.5%(19/29)。服务提供受到卫生系统缺陷、人力资源挑战、缺乏优先级和缺乏管理支持的影响。研究参与者报告了护理工作负担沉重,并表达了强烈的孤独感、耻辱感以及缺乏其他护士和医生的支持,这些进一步影响了TOP服务的提供。
南非拥有有利于提供TOP服务的法律环境。支持性管理、TOP服务的优先级设定以及解决提供者所经历的心理社会问题的员工健康计划是有利的卫生政策环境的关键要素。