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The Critical Role of Supervision in Retaining Staff in Obstetric Services: A Three Country Study.

机译:监督在保留产科服务人员中的关键作用:三国研究。

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摘要

Millennium Development Goal (MDG) 5 commits us to reducing maternal mortality rates by three quarters and MDG 4 commits us to reducing child mortality by two-thirds between 1990 and 2015. In order to reach these goals, greater access to basic emergency obstetric care (EmOC) as well as comprehensive EmOC which includes safe Caesarean section, is needed.. The limited capacity of health systems to meet demand for obstetric services has led several countries to utilize mid-level cadres as a substitute to more extensively trained and more internationally mobile healthcare workers. Although this does provide greater capacity for service delivery, concern about the performance and motivation of these workers is emerging. We propose that poor leadership characterized by inadequate and unstructured supervision underlies much of the dissatisfaction and turnover that has been shown to exist amongst these mid-level healthcare workers and indeed health workers more generally. To investigate this, we conducted a large-scale survey of 1,561 mid-level cadre healthcare workers (health workers trained for shorter periods to perform specific tasks e.g. clinical officers) delivering obstetric care in Malawi, Tanzania, and Mozambique. Participants indicated the primary supervision method used in their facility and we assessed their job satisfaction and intentions to leave their current workplace. In all three countries we found robust evidence indicating that a formal supervision process predicted high levels of job satisfaction and low intentions to leave. We find no evidence that facility level factors modify the link between supervisory methods and key outcomes. We interpret this evidence as strongly supporting the need to strengthen leadership and implement a framework and mechanism for systematic supportive supervision. This will promote better job satisfaction and improve the retention and performance of obstetric care workers, something which has the potential to improve maternal and neonatal outcomes in the countdown to 2015.
机译:千年发展目标(MDG)5承诺我们将产妇死亡率降低四分之三,而千年发展目标4(MDG 4)则承诺我们将儿童死亡率降低1990年至2015年之间的三分之二。卫生系统的能力有限,无法满足对产科服务的需求,导致一些国家利用中层干部来替代受过更广泛培训且更具国际影响力的人员医护人员。尽管这确实提供了更大的服务提供能力,但人们对这些工人的绩效和动力的担忧正在出现。我们建议,以缺乏充分的监督和无组织的监督为特征的领导能力低下,是这些中层医务人员乃至更普遍的医务人员所表现出的许多不满和离职的基础。为了对此进行调查,我们在马拉维,坦桑尼亚和莫桑比克对提供产科护理的1,561名中层干部卫生保健工作者(接受短期培训以执行特定任务的卫生工作者,例如临床官员)进行了大规模调查。参与者指出了他们工厂使用的主要监督方法,我们评估了他们的工作满意度和离开当前工作场所的意图。在所有这三个国家中,我们发现有力的证据表明正式的监督程序可以预测较高的工作满意度和较低的离职意愿。我们没有证据表明设施水平的因素会改变监管方法与关键成果之间的联系。我们认为这些证据强烈支持加强领导和实施系统性支持性监督的框架和机制的需要。这将提高工作满意度,提高产科护理人员的保留率和绩效,这可能会改善到2015年倒计时的孕产妇和新生儿结局。

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