Foster Allison Annette, Goma Fastone M, Shamian Judith, Moore Carolyn, Kabinga-Makukula Marjorie, Chizuni Nellisiwe Luyando, Kapenda Charity, Mugore Stembile, Viadro Claire, Hollod Laura, Murphy Gail Tomblin
IntraHealth International Washington, DC.
University of Zambia, School of Medicine, Lusaka, Zambia.
World Health Popul. 2017;17(3):55-68. doi: 10.12927/whp.2017.25305.
Despite its achievements in decreasing HIV prevalence and under-five mortality, Zambia still faces high maternal and neonatal mortality, particularly in the rural and remote areas where almost 60% of the population resides. After significant investments in developing its community health system, the Zambian Ministry of Health was interested to understand how to leverage the role of nurses to sustain achievements made and further improve the quality of care in rural communities. The Ministry joined research partners in an assessment into the role and leadership capacity of nurses heading rural health facilities.
A seven-member research team conducted 30 in-depth interviews and 10 focus group discussions in four provinces with four categories of respondents: national decision-makers, provincial and district managers, rural facility staff and community respondents (neighborhood health committee members and volunteers). An initial scoping visit and literature review informed the development of specific interview guides for each category of respondent. After audio-recording and transcription, research team members identified and reached consensus on key themes, and presented and validated the findings at a national stakeholder workshop.
Zambia's front-line health teams are a complex mixture of professional facility staff, community providers, community-based volunteers and neighborhood health committees. Nurses and nurse-midwives head over half the rural facilities in Zambia, where they are expected to lead the delivery of safe, high-quality care with staff and volunteers who often operate beyond their level of training. Nurses and midwives who are assigned to head rural facilities are not adequately prepared or recognized for the leadership responsibilities they are expected to fulfill.
This paper highlights opportunities to support rural facility heads in effectively leading front-line health teams to deliver primary healthcare to rural communities. Front-line teams require a leader to coordinate and motivate seamless and sustainable quality services that are accessible to all. Zambia has the potential to support integrated, responsive quality care and advance toward universal health coverage if nurses are adequately prepared and recognized with job descriptions that reflect their responsibilities and opportunities for career advancement.
尽管赞比亚在降低艾滋病毒感染率和五岁以下儿童死亡率方面取得了成就，但该国仍面临着较高的孕产妇和新生儿死亡率，特别是在近60%人口居住的农村和偏远地区。在对其社区卫生系统进行大量投资后，赞比亚卫生部希望了解如何利用护士的作用来维持已取得的成就，并进一步提高农村社区的医疗服务质量。卫生部与研究伙伴共同对负责农村卫生设施的护士的作用和领导能力进行了评估。
一个由七名成员组成的研究团队在四个省份对四类受访者进行了30次深入访谈和10次焦点小组讨论，这四类受访者分别是：国家决策者、省和地区管理人员、农村医疗机构工作人员以及社区受访者（社区卫生委员会成员和志愿者）。最初的范围界定访问和文献综述为为每类受访者制定具体的访谈指南提供了参考。在进行录音和转录后，研究团队成员确定了关键主题并达成共识，并在全国利益相关者研讨会上展示并验证了研究结果。
赞比亚的一线卫生团队是专业医疗机构工作人员、社区提供者、社区志愿者和社区卫生委员会的复杂组合。护士和助产士管理着赞比亚一半以上的农村医疗机构，在这些机构中，他们需要带领工作人员和志愿者提供安全、高质量的护理服务，而这些工作人员和志愿者的业务水平往往超出了他们的培训范围。被分配管理农村医疗机构的护士和助产士没有得到充分的准备，也没有因其预期履行的领导职责而得到认可。
本文强调了支持农村医疗机构负责人有效领导一线卫生团队为农村社区提供初级医疗服务的机会。一线团队需要一位领导者来协调和激励提供无缝且可持续的优质服务，让所有人都能享受到。如果护士得到充分的准备，并通过反映其职责和职业发展机会的工作描述得到认可，赞比亚有潜力支持提供综合、响应性强的优质护理，并朝着全民健康覆盖迈进。
