通过助产士和医疗机构指导加强中低收入国家性健康、生殖健康、孕产妇健康和新生儿健康系统的质量：综合评价。

Strengthening quality in sexual, reproductive, maternal, and newborn health systems in low- and middle-income countries through midwives and facility mentoring: an integrative review.

机构信息

The Faculty of Health and Medicine, Lancaster University, Lancaster, UK.

Department of Health Sciences, James Madison University, Harrisonburg, Virginia, USA.

出版信息

BMC Pregnancy Childbirth. 2023 Oct 5;23(1):712. doi: 10.1186/s12884-023-06027-0.

DOI:10.1186/s12884-023-06027-0

PMID:37798690

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10552246/

Abstract

BACKGROUND

There is an urgent global call for health systems to strengthen access to quality sexual, reproductive, maternal, newborn and adolescent health, particularly for the most vulnerable. Professional midwives with enabling environments are identified as an important solution. However, a multitude of barriers prevent midwives from fully realizing their potential. Effective interventions to address known barriers and enable midwives and quality sexual, reproductive, maternal, newborn and adolescent health are less well known. This review intends to evaluate the literature on (1) introducing midwives in low- and middle-income countries, and (2) on mentoring as a facilitator to enable midwives and those in midwifery roles to improve sexual, reproductive, maternal, newborn and adolescent health service quality within health systems.

METHODS

An integrative systematic literature review was conducted, guided by the Population, Intervention, Comparison, Outcome framework. Articles were reviewed for quality and relevance using the Gough weight-of-evidence framework and themes were identified. A master table categorized articles by Gough score, methodology, country of focus, topic areas, themes, classification of midwives, and mentorship model. The World Health Organization health systems building block framework was applied for data extraction and analysis.

RESULTS

Fifty-three articles were included: 13 were rated as high, 36 as medium, and four as low according to the Gough criteria. Studies that focused on midwives primarily highlighted human resources, governance, and service delivery while those focused on mentoring were more likely to highlight quality services, lifesaving commodities, and health information systems. Midwives whose pre-service education met global standards were found to have more efficacy. The most effective mentoring packages were comprehensive, integrated into existing systems, and involved managers.

CONCLUSIONS

Effectively changing sexual, reproductive, maternal, newborn and adolescent health systems is complex. Globally standard midwives and a comprehensive mentoring package show effectiveness in improving service quality and utilization.

TRIAL REGISTRATION

The protocol is registered in PROSPERO (CRD42022367657).

摘要

背景

全球紧急呼吁加强卫生系统获得优质性、生殖、孕产妇、新生儿和青少年健康的机会，特别是为最脆弱的人群提供服务。拥有有利环境的专业助产士被认为是一个重要的解决方案。然而，有许多障碍阻碍了助产士充分发挥其潜力。针对已知障碍并使助产士和具有助产士角色的人员能够在卫生系统内提高性、生殖、孕产妇、新生儿和青少年健康服务质量的有效干预措施则知之甚少。本综述旨在评估以下方面的文献：（1）在中低收入国家引入助产士；（2）以导师制作为促进者，使助产士和从事助产士工作的人员能够提高卫生系统内性、生殖、孕产妇、新生儿和青少年健康服务质量。

方法

采用人口、干预、比较、结局（Population, Intervention, Comparison, Outcome）框架进行综合系统文献综述。使用 Gough 证据权重框架对文章进行质量和相关性评估，并确定主题。一个主表根据 Gough 评分、方法、重点国家、主题领域、主题、助产士分类和导师制模式对文章进行分类。采用世界卫生组织卫生系统构建模块框架进行数据提取和分析。

结果

共纳入 53 篇文章：根据 Gough 标准，其中 13 篇为高评分，36 篇为中评分，4 篇为低评分。重点关注助产士的研究主要强调了人力资源、治理和服务提供，而重点关注导师制的研究则更可能强调优质服务、救生商品和卫生信息系统。发现接受符合全球标准的助产士职前教育的助产士更有成效。最有效的导师制方案是全面的、融入现有系统的、并涉及管理人员的方案。