农村医疗服务提供者应对临床医疗服务挑战的经验：来自加纳三个卫生中心的经验教训。
Rural healthcare providers coping with clinical care delivery challenges: lessons from three health centres in Ghana.
机构信息
Faculty of Health and Allied Sciences, Catholic University College of Ghana, Fiapre, Ghana.
Research for Sustainable Development Consult (r4sd consult), Sunyani, Ghana.
出版信息
BMC Fam Pract. 2021 Feb 5;22(1):32. doi: 10.1186/s12875-021-01379-y.
BACKGROUND
Rural settings in low- and middle-income countries are bedeviled with poverty and high disease burden, and lack adequate resources to deliver quality healthcare to the population. Drug shortage and inadequate number and skill-mix of healthcare providers is very common in rural health facilities. Hence, rural healthcare providers have no choice but to be innovative and introduce some strategies to cope with health delivery challenges at the health centre levels. This study explored how and why rural healthcare providers cope with clinical care delivery challenges at the health centre levels in Ghana.
METHODS
This study was a multiple case studies involving three districts: Bongo, Kintampo North, and Juaboso districts. In each case study district, a cross-sectional design was used to explore the research question. Purposive sampling technique was used to select study sites and the study participants. The authors conducted 11 interviews, 9 focus group discussions (involving 61 participants), and 9-week participant observation (in 3 health centres). Transcription of the voice-recordings was done verbatim, cleaned and imported into the Nvivo version 11 platform for analysis. Data was analysed using the inductive content analysis approach. Ethical clearance was granted by the Ethics Review Committee of the Ghana Health Service.
RESULTS
The study found three main coping strategies (borrowing, knowledge sharing and multi-tasking). First, borrowing arrangements among primary health care institutions help to address the periodic shortage of medical supplies at the health centres. Secondly, knowledge sharing among healthcare providers mitigates skills gap during service delivery; and finally, rural healthcare providers use multi-tasking to avert staff inadequacy challenges during service delivery at the health centre levels.
CONCLUSION
Borrowing, knowledge sharing, and multi-tasking are coping strategies that are sustaining and potentially improving health outcomes at the district levels in Ghana. We recommend that health facilities across all levels of care in Ghana and other settings with similar challenges could adopt and modify these strategies in order to ensure quality healthcare delivery amidst delivery challenges.
背景
在中低收入国家的农村地区，贫困和高疾病负担问题严重，且缺乏足够的资源为当地居民提供高质量的医疗服务。农村卫生机构经常面临药品短缺以及医疗服务提供者人数和技能组合不足的问题。因此，农村医疗服务提供者别无选择，只能创新并引入一些策略，以应对基层卫生中心的医疗服务提供方面的挑战。本研究探讨了加纳农村医疗服务提供者如何以及为何应对基层卫生中心临床护理提供方面的挑战。
方法
本研究采用了多个案例研究方法，涉及三个地区：邦戈、金坦波北和朱阿索地区。在每个案例研究地区，均采用横断面设计来探讨研究问题。采用目的抽样技术选择研究地点和研究参与者。作者进行了 11 次访谈、9 次焦点小组讨论（涉及 61 名参与者）和 9 周的参与式观察（在 3 个卫生中心进行）。将录音的文字记录逐字转录，清理后导入 Nvivo 版本 11 平台进行分析。使用归纳内容分析方法进行数据分析。加纳卫生局伦理审查委员会批准了伦理审查。
结果
研究发现了三种主要的应对策略（借用、知识共享和多任务处理）。首先，基层医疗机构之间的借用安排有助于解决卫生中心定期出现的医疗用品短缺问题。其次，医疗服务提供者之间的知识共享缓解了服务提供过程中的技能差距；最后，农村医疗服务提供者采用多任务处理来避免基层卫生中心服务提供过程中的人员不足挑战。
结论
借用、知识共享和多任务处理是加纳各地区维持和潜在改善卫生结果的应对策略。我们建议加纳各级医疗保健机构以及其他面临类似挑战的环境可以采用并修改这些策略，以确保在面临服务提供挑战的情况下提供高质量的医疗服务。
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