南非卫生工作者感知的结核病控制中的卫生系统障碍。
Perceived Health System Barriers to Tuberculosis Control Among Health Workers in South Africa.
机构信息
School of Population and Public Health, University of British Columbia, Vancouver, CA.
British Columbia Centre for Disease Control, Vancouver, CA.
出版信息
Ann Glob Health. 2020 Feb 12;86(1):15. doi: 10.5334/aogh.2692.
BACKGROUND
The healthcare workforce in high tuberculosis burden countries such as South Africa is at elevated risk of tuberculosis infection and disease with adverse consequences for their well-being and productivity. Despite the availability of international guidelines on protection of health workers from tuberculosis, research globally has focused on proximal deficiencies in practice rather than on health system barriers.
OBJECTIVE
This study sought to elicit perceptions of informed persons within the health system regarding health system barriers to protecting health workers from tuberculosis.
METHODS
Semi-structured interviews were conducted with 18 informants active in spheres related to workplace tuberculosis prevention and management in South Africa. Interviews were audio recorded and transcribed verbatim, validated and analysed to derive emergent themes. Responses were analysed using the World Health Organization building blocks as core elements of a health system bearing on protection of its health workforce.
FINDINGS
The following health system barriers were identified by informants: leadership and governance were "top-down" and fragmented; lack of funding was a major barrier; there were insufficient numbers of staff trained in infection prevention and control and occupational health; occupational health services were not comprehensively available and the ability to sustain protective technologies was questioned. A cross-cutting barrier was lack of priority afforded to workforce occupational health associated with lack of accurate information on cases of TB among health workers.
CONCLUSIONS
We conclude that deficiencies in implementation of recommended infection control and tuberculosis management practices are unlikely to be corrected until health system barriers are addressed. More committed leadership from senior health system management and greater funding are needed. The process could be assisted by the development of indicators to characterise such barriers and monitor progress.
背景
南非等结核病负担高的国家的医疗保健工作者感染和罹患结核病的风险较高，这对他们的健康和生产力都有不利影响。尽管有关于保护卫生工作者免受结核病侵害的国际指南，但全球的研究都集中在实践中的近端缺陷上，而不是在卫生系统障碍上。
目的
本研究旨在了解卫生系统内知情人士对保护卫生工作者免受结核病侵害的卫生系统障碍的看法。
方法
对 18 名在南非与工作场所结核病预防和管理相关领域活跃的知情人士进行了半结构式访谈。访谈进行了录音，并逐字记录下来，经过验证和分析，得出了出现的主题。使用世界卫生组织的构建模块（作为影响其卫生劳动力保护的卫生系统的核心要素）分析了回应。
结果
受访者确定了以下卫生系统障碍：领导力和治理是“自上而下”和分散的；缺乏资金是一个主要障碍；受过感染预防和控制以及职业健康培训的员工人数不足；职业健康服务不是全面提供的，维持保护技术的能力受到质疑。一个贯穿各领域的障碍是缺乏对与卫生工作者结核病病例相关的劳动力职业健康的重视，这与缺乏准确的信息有关。
结论
我们得出的结论是，除非解决卫生系统障碍，否则不太可能纠正推荐的感染控制和结核病管理实践中的缺陷。需要来自高级卫生系统管理层的更坚定的领导和更多的资金。可以通过制定指标来描述这些障碍并监测进展，从而促进这一进程。
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