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首页> 外文期刊>BMC International Health and Human Rights >Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence
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Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence

机译：将艾滋病毒治疗纳入孕产妇保健服务：在艾滋病毒高发国家提高产科护理质量所需的重大变化

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Background The failure to reduce preventable maternal deaths represents a violation of women’s right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks. Discussion Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman’s death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women’s lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients’ rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques. Summary In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes of hemorrhage, hypertension and sepsis. Advocacy for all pregnant HIV-positive women to be on anti-retroviral therapy must extend to improvements in the quality of service offered, better organised obstetric services and integration of clinical HIV care into maternity services. Improved communication and specialist support to peripheral facilities can be facilitated through advances in technology such as mobile phones.
机译：背景无法减少可预防的孕产妇死亡是对妇女生命，健康，非歧视和平等权的侵犯。孕产妇死亡是由于卫生系统的弱点造成的：服务筹资不足，信息系统差，后勤管理效率低下，最重要的是，对最有价值的资源，卫生工作者的人力资源缺乏投资。在解释医疗质量低下时，屡屡引用了高层领导不力，沟通不畅和员工士气低落的观点。纵向计划通过竞争稀缺的熟练员工，单独的报告系统以及重复培训和任务，破坏了其他服务领域。讨论机密查询和其他质量改进活动已经确定了孕产妇死亡的根本原因，但要依靠卫生系统采取补救措施。与其将艾滋病毒，结核病和生殖健康分开管理的垂直方案，不如将护理与怀孕和艾滋病毒的联合管理相结合将更加有效。解决导致每个妇女死亡的卫生系统故障，将对改善整个卫生服务提供的护理质量产生更广泛的影响。如果更有效地利用现有资源，可以实现更多目标。非洲国家面临的挑战是如何将研究已知的干预措施付诸实践，以有效改善护理质量。倡导和致力于挽救妇女的生命是影响政府和决策者根据调查结果采取行动的运动的关键要素。应当更新卫生专业培训课程，以使用成人学习方法和解决问题的方法，包括对患者权利，沟通技巧和综合方法的看法。总结在人类免疫缺陷病毒（HIV）发生率很高的国家中，由HIV相关感染引起的孕产妇死亡的间接原因现已超过出血，高血压和败血症的直接原因。对所有孕妇艾滋病毒抗体阳性的妇女进行抗逆转录病毒治疗的倡导必须扩展到改善所提供的服务质量，更好地组织产科服务以及将临床艾滋病毒治疗纳入产妇服务。通过移动电话等技术的进步，可以促进对外围设备的更好的通信和专家支持。

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