Chauhan Vishal, Dumka Neha, Hannah Erin, Ahmed Tarannum, Kotwal Atul
National Health Mission, Ministry of Health and Family Welfare, India.
National Health Systems Resource Centre, Ministry of Health and Family Welfare, India.
Dialogues Health. 2023 Jul 4;3:100146. doi: 10.1016/j.dialog.2023.100146. eCollection 2023 Dec.
For primary healthcare systems to bring care closer to the communities, the availability of appropriate human resources is crucial. The primary care workforce in the world is expanding to include non-physician health workers (NPHWs) to increase its capacity. Also, NPHWs as mid-level health providers (MLHPs) are currently being employed in high- and low-income countries to assist doctors and specialists to make up for the scarcity of health professionals. Given the wide prevalence in the deployment of NPHWs as mid-level health providers, this article collates recent evidence on the role of MLHPs in improving access to primary healthcare services, and their enablers and barriers in integrating them in primary care teams. The article also presents gaps in evidence and recommendations for the way forward.
A systematic search of contemporary literature published from January 2012 to September 2022 was undertaken using two bibliographic databases (PubMed and Cochrane) and hand searching the reference list of retrieved papers. Duplicates, papers older than ten years, and whose focus was not on primary healthcare were excluded. The papers finalised for appraisal were scrutinised for key themes and their summaries were collated for analysis. The papers comprised of twenty-four quantitative, twenty-three qualitative, and nine mixed approach study designs ( = 56) due to which a narrative approach was conducted as per guidelines.
The review identified and presents the following themes - task shifting and its effectiveness in service delivery, quality of care, enablers and barriers of NPHWs in primary health care in both HIC and LMIC settings.
Task-shifting interventions need effective engagement and constant coordination with relevant stakeholders. For this, policymakers, public health researchers, healthcare professionals of all cadres and community members need to be involved across all stages of introduction and absorption of the cadre into the primary healthcare delivery system.
对于基层医疗保健系统而言，使医疗服务更贴近社区，拥有合适的人力资源至关重要。全球基层医疗保健劳动力队伍正在扩大，纳入了非医师卫生工作者（NPHWs）以增强其能力。此外，作为中级卫生服务提供者（MLHPs）的非医师卫生工作者目前在高收入和低收入国家均有受雇，以协助医生和专科医生，弥补卫生专业人员的短缺。鉴于非医师卫生工作者作为中级卫生服务提供者的广泛应用，本文整理了近期有关中级卫生服务提供者在改善基层医疗保健服务可及性方面的作用，以及将他们纳入基层医疗团队的促进因素和障碍的证据。本文还指出了证据方面的差距以及对未来方向的建议。
使用两个文献数据库（PubMed和Cochrane）对2012年1月至2022年9月发表的当代文献进行系统检索，并人工搜索检索论文的参考文献列表。排除重复项、超过十年的论文以及重点不在基层医疗保健的论文。对最终选定进行评估的论文进行关键主题审查，并整理其摘要进行分析。这些论文包括24项定量研究、23项定性研究和9项混合方法研究设计（共56项），因此根据指南采用叙述性方法。
该综述确定并呈现了以下主题——任务转移及其在服务提供中的有效性、护理质量、高收入国家和低收入国家基层医疗保健中非医师卫生工作者的促进因素和障碍。
任务转移干预措施需要与相关利益攸关方进行有效互动和持续协调。为此，政策制定者、公共卫生研究人员、所有类别的医疗保健专业人员和社区成员需要参与将该干部群体引入和融入基层医疗保健服务体系的各个阶段。
