Tarimo Edith A M, Moyo Gustav, Masenga Happy, Magesa Paul, Mzava Dafroza
School of Nursing, Muhimbili University of Health and Allied Sciences (MUHAS), P O Box 65004, Dar es Salaam, Tanzania.
Ministry of Health Community Development, Gender, Eldertly and Children (MoHCDGEC), P O Box 9083, Dar es Salaam, Tanzania.
BMC Health Serv Res. 2018 Apr 11;18(1):277. doi: 10.1186/s12913-018-3096-8.
Tanzania is experiencing a severe shortage of human resources for health, which poses a serious threat to the quality of health care services particularly in rural areas. Task shifting has been considered a way to address this problem. However, since a large percentage of health care providers in rural setting is comprised of Enrolled Nurse/Midwives (ENMs), most of the health care tasks are shifted to them. This article analyzes the performance and self-perceived competencies of ENMs at the dispensary level; the lowest health facility in Tanzania. Performance refers to routine duties performed by ENMs, and self-perceived competence means self-perceived proficiency in performing nursing/midwifery and medical duties.
This was a mixed methods study conducted in rural Tanzania. A purposeful sample of twelve (12) informants (six ENMs; two Community Leaders [CLs] and four Dispensary In-charges [DIs]) was recruited for semi-structured interviews. The interviews were supplemented with quantitative data from 59 ENMs. Both thematic and descriptive analysis approaches were used.
Three themes emerged: (1) 'Approval of the performances of ENMs in meeting community health needs' underscores important services the community members got from ENMs at dispensaries. (2) 'Experienced difficulties of meeting community health needs' indicate the problems ENMs encountered while providing services to the community. In striving to serve a large number of demanding clients without adequate medical equipment and supplies, sometimes the ENMs ended up with prescription errors (3) 'Appreciating the performances and competencies of ENMs' shows the acknowledgement of community members towards ENMs' performance and competencies within and beyond their scope of practice. The community members as well as ENMs and their supervisors knew that ENMs must sometimes provide care that is outside their scope of training and competency. Overall, the performance among ENMs above 38 years of age (P < 0.05) and participants of professional development courses (P < 0.01) was high.
The results highlight performance and self-perceived competencies of ENMs in struggling to meet community health needs. Additionally, these results highlight the health care system shortfalls in supporting and developing an adequate number of qualified health care professionals so that health care needs of all citizens, including those in rural areas, are met.
坦桑尼亚正面临严重的卫生人力资源短缺问题，这对医疗服务质量构成了严重威胁，尤其是在农村地区。任务转移被认为是解决这一问题的一种方式。然而，由于农村地区的大部分医疗服务提供者是注册护士/助产士（ENM），大部分医疗任务都转移到了他们身上。本文分析了在坦桑尼亚最低级别的医疗机构——诊疗所层面，注册护士/助产士的工作表现和自我认知能力。工作表现指注册护士/助产士履行的日常职责，自我认知能力是指在履行护理/助产及医疗职责方面的自我认知熟练程度。
这是一项在坦桑尼亚农村地区开展的混合方法研究。有目的地抽取了12名受访者（6名注册护士/助产士、2名社区领袖和4名诊疗所负责人）进行半结构化访谈。访谈还补充了来自59名注册护士/助产士的定量数据。采用了主题分析和描述性分析方法。
出现了三个主题：（1）“认可注册护士/助产士在满足社区卫生需求方面的表现”强调了社区成员在诊疗所从注册护士/助产士那里获得的重要服务。（2）“在满足社区卫生需求方面遇到的困难”指出了注册护士/助产士在为社区提供服务时遇到的问题。在努力为大量有需求的客户提供服务且没有足够医疗设备和物资的情况下，注册护士/助产士有时会出现处方错误。（3）“赞赏注册护士/助产士的表现和能力”表明社区成员对注册护士/助产士在其执业范围内外的表现和能力的认可。社区成员以及注册护士/助产士及其上级都知道，注册护士/助产士有时必须提供超出其培训和能力范围的护理。总体而言，38岁以上的注册护士/助产士（P<0.05）以及参加专业发展课程的人员（P<0.01）工作表现较高。
研究结果突出了注册护士/助产士在努力满足社区卫生需求方面的表现和自我认知能力。此外，这些结果凸显了医疗系统在支持和培养足够数量的合格医疗专业人员方面的不足，以便满足包括农村地区居民在内的所有公民的医疗需求。
