南非豪登省公立卫生机构中医疗保健提供者对移民的社会排斥及相关看法
Social exclusion and the perspectives of health care providers on migrants in Gauteng public health facilities, South Africa.
机构信息
School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
出版信息
PLoS One. 2020 Dec 28;15(12):e0244080. doi: 10.1371/journal.pone.0244080. eCollection 2020.
BACKGROUND
Universal health coverage (UHC) for all people, regardless of citizenship, is a global priority. Health care providers are central to the achievement of UHC, and their attitudes and behaviour could either advance or impede UHC for migrants. Using a social exclusion conceptual framework, this study examined the perspectives of health care providers on delivering health services to migrants in public health facilities in Gauteng Province, South Africa.
METHODS
We used stratified, random sampling to select 13 public health facilities. All health care providers working in ambulatory care were invited to complete a self-administered questionnaire. In addition to socio-demographic information, the questionnaire asked health care providers if they had witnessed discrimination against migrants at work, and measured their perspectives on social exclusionary views and practices. Multiple regression analysis was used to identify predictors of more exclusionary perspectives for each item.
RESULTS
277 of 308 health care providers participated in the study-a response rate of 90%. The participants were predominantly female (77.6%) and nurses (51.9%), and had worked for an average of 6.8 years in their facilities. 19.2% of health care providers reported that they had witnessed discrimination against migrants, while 20.0% reported differential treatment of migrant patients. Exclusionary perspectives varied across the different items, and for different provider groups. Enrolled nurses and nursing assistants were significantly more exclusionary on a number of items, while the opposite was found for providers born outside South Africa. For some questions, female providers held more exclusionary perspectives and this was also the case for providers from higher levels of care.
CONCLUSION
Health care providers are critical to inclusive UHC. Social exclusionary views or practices must be addressed through enabling health policies; training in culture-sensitivity, ethics and human rights; and advocacy to ensure that health care providers uphold their professional obligations to all patients.
背景
全民健康覆盖（UHC）对于所有人，无论其公民身份如何，都是全球优先事项。医疗保健提供者是实现 UHC 的核心，他们的态度和行为可能会促进或阻碍移民获得 UHC。本研究使用社会排斥概念框架，调查了南非豪登省公立卫生机构医疗保健提供者对向移民提供医疗服务的看法。
方法
我们使用分层随机抽样选择了 13 家公立卫生机构。邀请所有在门诊护理部门工作的医疗保健提供者填写一份自填式问卷。除了社会人口统计学信息外，问卷还询问医疗保健提供者是否在工作中目睹过针对移民的歧视行为，并衡量他们对社会排斥观点和做法的看法。使用多元回归分析确定每个项目中更具排斥性观点的预测因素。
结果
共有 308 名医疗保健提供者中的 277 名（90%的回应率）参与了研究。参与者主要为女性（77.6%）和护士（51.9%），平均在其机构工作 6.8 年。19.2%的医疗保健提供者报告说，他们曾目睹过针对移民的歧视行为，而 20.0%的医疗保健提供者报告说对移民患者存在区别待遇。排斥性观点因不同的项目和不同的提供者群体而异。注册护士和护理助理在许多项目上的排斥性观点更为明显，而来自南非境外的提供者则相反。在一些问题上，女性提供者持有更具排斥性的观点，而在提供更高层次护理的提供者中也是如此。
结论
医疗保健提供者是包容性 UHC 的关键。必须通过制定有利的卫生政策、进行文化敏感性、伦理和人权培训以及倡导来解决社会排斥观点或做法，以确保医疗保健提供者履行其对所有患者的专业义务。
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