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首页> 外文期刊>Health policy and planning >The crisis in human resources for health care and the potential of a 'retired' workforce: case study of the independent midwifery sector in Tanzania.
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The crisis in human resources for health care and the potential of a 'retired' workforce: case study of the independent midwifery sector in Tanzania.

机译：卫生保健人力资源危机和“退休”劳动力的潜力：坦桑尼亚独立助产士部门的案例研究。

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The human resource crisis in health care is an important obstacle to attainment of the health-related targets for the Millennium Development Goals. One suggested strategy to alleviate the strain upon government services is to encourage new forms of non-government provision. Detail on implementation and consequences is often lacking, however. This article examines one new element of non-government provision in Tanzania: small-scale independent midwifery practices. A multiple case study analysis over nine districts explored their characteristics, and the drivers and inhibitors acting upon their development since permitted by legislative change. Private midwifery practices were found concentrated in a 'new' workforce of 'later life entrepreneurs': retired, or approaching retirement, government-employed nursing officers. Provision was entirely facility-based due to regulatory requirements, with approximately 60 'maternity homes' located mainly in rural or peri-urban areas. Motivational drivers included fear of poverty, desire to maintain professional status, and an ethos of community service. However, inhibitors to success were multiple. Start-up loans were scarce, business training lacking and registration processes bureaucratic. Cost of set-up and maintenance were prohibitively high, registration required levels of construction and equipping similar to government sector dispensaries. Communities were reluctant to pay for services that they expected from government. Thus, despite offering a quality of basic maternity care comparable to that in government facilities, often in poorly-served areas, most private maternity homes were under-utilized and struggling for sustainability. Because of their location and emphasis on personalized care, small-scale independent practices run by retired midwives could potentially increase rates of skilled attendance at delivery at peripheral level. The model also extends the working life of members of a professional group at a time of shortage. However, the potential remains unrealized. Successful multiplication of this model in resource-poor communities requires more than just deregulation of private ownership. Prohibitive start-up expenses need to be reduced by less emphasis on facility-based provision. On-going financing arrangements such as micro-credit, contracting, vouchers and franchising models require consideration.
机译：卫生保健方面的人力资源危机是实现千年发展目标与卫生有关的目标的重要障碍。建议的缓解政府服务压力的策略是鼓励新形式的非政府提供。但是，通常缺少有关实施和后果的细节。本文探讨了坦桑尼亚提供的非政府提供的一项新内容：小型独立助产实践。一项针对多个地区的案例研究分析了九个地区的特征，以及立法变革允许以来的驱动因素和阻碍因素。人们发现，私人助产士实践主要集中在“终身企业家”的“新”劳动力中：退休或接近退休的政府雇用的护理人员。由于法规要求，拨款完全基于设施，大约60座“产妇之家”主要位于农村或郊区。动机驱动因素包括对贫穷的恐惧，保持职业地位的愿望以及社区服务的精神。但是，成功的阻碍因素是多方面的。创业贷款稀缺，缺乏业务培训，官僚主义的注册程序。设置和维护成本高得令人望而却步，注册要求的建造和配备水平与政府部门的药房相似。社区不愿为政府期望的服务付费。因此，尽管提供的产妇基本保健质量可与政府机构（通常在服务水平差的地区）相提并论，但大多数私人产妇住房利用不足，并为可持续性而苦苦挣扎。由于他们的位置和对个性化护理的重视，由退休助产士进行的小规模独立实践可能会增加外围级别分娩时熟练的出勤率。该模型还可以在短缺时延长专业小组成员的工作寿命。但是，潜力仍然没有实现。要在资源匮乏的社区中成功推广这种模式，不仅需要放松对私人所有权的管制。需要通过减少对基于设施的提供的重视来减少启动费用。需要考虑持续的融资安排，例如小额信贷，合同，代金券和特许经营模式。

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