Kubota Shogo, Ando Moe, Murray John, Khambounheuang Sengmany, Theppanya Khampasong, Nanthavong Phouvanh, Tengbriacheu Chankham, Sisavanh Malouny, Khattiyod Thongchan, Asai Daisuke, Sobel Howard, Jimba Masamine
WHO Laos, Vientiane, Lao PDR.
WHO Western Pacific Region, Manilla, Philippines.
Lancet Reg Health West Pac. 2023 Dec 5;43:100960. doi: 10.1016/j.lanwpc.2023.100960. eCollection 2024 Feb.
In Lao Peoples Democratic Republic, midwives are the main providers of primary reproductive, maternal, newborn, child and adolescent (RMNCAH) services. We analyzed to what extent practice regulations allow midwives to provide nationally defined essential RMNCAH services.
Stakeholder consultations and document reviews were conducted to identify the essential RMNCAH interventions and care tasks midwives are expected to provide without physicians. These were defined in: 1) the Essential Health Service Package (EHSP) and 2) 18 national standards and guidelines. We then mapped whether midwifery regulations, which provide the legal framework for clinical service provision, supported delivery of these standards to identify regulatory gaps. Data were used to update regulations.
Midwives were expected to provide 39 RMNCAH interventions without physicians, representing 1100 care tasks. Midwifery practice regulations allowed eight of 39 interventions (20.5%) and 705 of 1100 care tasks (64.1%) at baseline. Of the 31 interventions not allowed for provision by midwives, 83.9% (26) required prescribing and giving medicines, 51.6% (16) ordering and conducting diagnostics, 38.7% (12) making a clinical diagnosis, and 22.6% (7) use of non-pharmacological interventions. The Ministry of Health convened a multi-stakeholder group to revise the midwifery practice regulations, which increased the legally supported interventions and care tasks to 37 (94.9%) and 1081 (98.3%), respectively.
This novel methodology enabled systematic identification and quantification of regulatory gaps in midwifery practice and data-driven revisions. Consequently, regulatory support for delivery of primary RMNCAH interventions vastly improved. The approach can be applied to other clinical cadres, service areas and countries.
Korea Foundation for International Health Care (KOFIH) supported research operation.
在老挝人民民主共和国，助产士是初级生殖、孕产妇、新生儿、儿童和青少年保健（RMNCAH）服务的主要提供者。我们分析了实践法规在多大程度上允许助产士提供国家规定的基本RMNCAH服务。
进行了利益相关者协商和文件审查，以确定助产士在无需医生在场的情况下应提供的基本RMNCAH干预措施和护理任务。这些在以下文件中有所定义：1）基本卫生服务包（EHSP）和2）18项国家标准与指南。然后，我们梳理了为临床服务提供法律框架的助产士法规是否支持这些标准的实施，以找出监管差距。利用这些数据来更新法规。
预计助产士在无需医生在场的情况下提供39项RMNCAH干预措施，涉及1100项护理任务。在基线时，助产士实践法规允许39项干预措施中的8项（20.5%）以及1100项护理任务中的705项（64.1%）。在助产士不被允许提供的31项干预措施中，83.9%（26项）需要开药和给药，51.6%（16项）需要安排和进行诊断，38.7%（12项）需要做出临床诊断，22.6%（7项）需要使用非药物干预措施。卫生部召集了一个多利益相关者小组来修订助产士实践法规，这使得法律支持的干预措施和护理任务分别增加到37项（94.9%）和1081项（98.3%）。
这种新颖的方法能够系统地识别和量化助产士实践中的监管差距，并进行数据驱动的修订。因此，对提供初级RMNCAH干预措施的监管支持得到了极大改善。该方法可应用于其他临床干部、服务领域和国家。
韩国国际医疗保健基金会（KOFIH）支持研究运作。
