增加加纳宫内节育器的获取机会：利益相关者对与社区卫生护士分担任务提供服务的看法。
Increasing access to intrauterine contraceptive device uptake in Ghana: stakeholders views on task sharing service delivery with community health nurses.
作者信息
Gbagbo Fred Y, Morhe Emmanuel Sk
机构信息
Department of Health Administration, University of Education Winneba, P. O. Box 25. Winneba, Ghana.
Depart of Obstetrics and Gynaecology, University of Health and Allied Sciences, PMB 31, Ho, Ghana.
出版信息
Ghana Med J. 2020 Jun;54(2):114-120. doi: 10.4314/gmj.v54i2.10.
INTRODUCTION
Evidence supporting successful task sharing to increase Intrauterine Contraceptive Device (IUD) uptake exist in some developing countries that have challenges with availability of trained health professionals. Although Community Health Nurses (CHNs) in Ghana are trained to provide primary health care including emergency deliveries in rural communities, they are not professionally mandated to provide IUD services.
OBJECTIVES
To explore stakeholders' views on task sharing IUD services with CHNs in Ghana.
METHODS
This qualitative case study was conducted in Accra, Ghana between June and September 2018. Focus group discussions and in-depth interviews were used to collect data from purposively selected participants. Included in the study were policy makers, policy implementing institutions, service regulators, Non-Governmental Organisations, field providers and service end users. Interviews were recorded and transcribed verbatim. We manually performed thematic analysis of data and findings were appropriately described by paraphrasing and/or quoting relevant responses verbatim.
RESULTS
There is a general mixed feeling towards task sharing IUD services with community health nurses in Ghana. Policy makers, programmers, gynaecologists and IUD users interviewed believed that CHNs are capable of providing safe IUD services when well trained, adequately resourced and supervised. Based on some field experiences of complications associated with IUD insertions, participants who were midwives clearly indicated the need for effective training and careful implementation strategies.
CONCLUSIONS
Despite concerns about user safety, respondents endorsed task-sharing IUD services with trained CHNs in Ghana. Implementation study focusing on competency-based IUD training for selected CHNs is recommended to provide empirical evidence to back policy decisions.
FUNDING
Marie Stopes Ghana funded the field work.
引言
在一些难以获得训练有素的卫生专业人员的发展中国家，存在支持通过成功的任务分担来提高宫内节育器（IUD）使用率的证据。尽管加纳的社区卫生护士（CHNs）接受过提供初级卫生保健（包括农村社区的紧急分娩）的培训，但她们并没有提供宫内节育器服务的专业授权。
目的
探讨利益相关者对在加纳与社区卫生护士进行宫内节育器服务任务分担的看法。
方法
这项定性案例研究于2018年6月至9月在加纳阿克拉进行。焦点小组讨论和深入访谈被用于从有目的地选择的参与者那里收集数据。研究包括政策制定者、政策实施机构、服务监管机构、非政府组织、现场提供者和服务最终用户。访谈进行了录音并逐字转录。我们手动对数据进行了主题分析，并通过释义和/或逐字引用相关回复来恰当地描述研究结果。
结果
加纳对于与社区卫生护士进行宫内节育器服务任务分担普遍存在复杂的看法。接受访谈的政策制定者、规划者、妇科医生和宫内节育器使用者认为，社区卫生护士在接受良好培训、有充足资源和监督的情况下，有能力提供安全的宫内节育器服务。基于一些与宫内节育器插入相关并发症的现场经验，身为助产士的参与者明确表示需要有效的培训和谨慎的实施策略。
结论
尽管对用户安全存在担忧，但受访者支持在加纳让经过培训的社区卫生护士分担宫内节育器服务任务。建议开展针对选定社区卫生护士的基于能力的宫内节育器培训的实施研究，以提供实证依据来支持政策决策。
资金来源
玛丽斯特普斯加纳为实地工作提供了资金。
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