背景:印度东北部的公共卫生景观以公平医疗保健提供的基本原则为标志,考虑到该地区错综复杂的地理和与国际边界的接近,这是一项关键的努力。医护人员努力应对挑战,比如危险的路线,有限的基础设施,和不同的文化细微差别,在提供基本医疗服务时。尽管自2005年国家农村卫生任务以来有所改善,但挑战依然存在,促使一项研究确定曼尼普尔邦和那加兰邦的医护人员面临的挑战和替代策略。
目的:本研究旨在记录在印度东北部地理上具有挑战性的地形中,医护人员在提供服务期间所经历的挑战。
方法:这项研究是i-DRONE(印度医学研究理事会的无人机响应和东北外展)项目的一部分,旨在评估无人机介导的疫苗和医疗服务的可行性。本研究涉及i-DRONE项目的次要目标。在5个地区(那加兰邦的Mokokchung和Tuensang,使用半结构化问卷对29名医护人员进行了深入访谈,和ImphalWest,Bishnupur,和Manipur的Churachandpur)。十九个卫生设施,包括初级卫生保健中心,社区卫生中心,和地区医院,被选中。该研究考虑了过去6个月积极就业而没有重大假期的各级医疗保健专业人员以及从事地面执行的人员,政策,和维护活动。记录数据,转录,翻译,随后,代码,主题,子主题是使用NVivo14(QSRInternational)进行主题分析开发的。
结果:从数据中产生了五个主题:(1)一般挑战(由于成为国际边界地区而引起的挑战,人力资源约束,医疗供应的后勤挑战,基础设施问题,和运输挑战);(2)COVID-19大流行期间的挑战(工作量增加,缺乏诊断中心,心理健康挑战和家庭问题,常规卫生保健设施受到影响,耻辱和对感染的恐惧,以及疫苗犹豫和错误信息);(3)对COVID-19疫苗接种的看法和认识;(4)医护人员为应对挑战而采取的替代行动或策略;(5)医护人员提供的建议。卫生保健工作者通过克服这些挑战表现出适应性,并为将来应对这些挑战提供了建议。
结论:面对大流行加剧的众多挑战,曼尼普尔邦和那加兰邦的医护人员表现出了非凡的韧性。尽管基础设施有限,沟通障碍,偏远地区医疗供应分配不足,他们通过有效的数据管理等创新解决方案展示了适应性,疫苗接种宣传运动,并利用技术改善护理服务。这些发现不仅与卫生保健从业人员和决策者有关,而且与更广泛的科学和公共卫生社区有关。然而,这些发现可能在曼尼普尔邦和那加兰邦之外具有有限的普遍性。
BACKGROUND: The public health landscape in North-East India is marked by the foundational principle of equitable health care provision, a critical endeavor considering the region\'s intricate geography and proximity to international borders. Health care workers grapple with challenges, such as treacherous routes, limited infrastructure, and diverse cultural nuances, when delivering essential medical services. Despite improvements since the National Rural Health Mission in 2005, challenges persist, prompting a
study to identify health care workers\' challenges and alternative strategies in Manipur and Nagaland.
OBJECTIVE: This
study aims to document the challenges experienced by health care workers during service delivery in the geographically challenging terrains of North-East India.
METHODS: This
study is part of the i-DRONE (Indian Council of Medical Research\'s Drone Response and Outreach for North East) project, which aims to assess the feasibility of drone-mediated vaccine and medical delivery. This
study addresses the secondary objective of the i-DRONE project. In-depth interviews of 29 health care workers were conducted using semistructured questionnaires in 5 districts (Mokokchung and Tuensang in Nagaland, and Imphal West, Bishnupur, and Churachandpur in Manipur). Nineteen health facilities, including primary health care centers, community health centers, and district hospitals, were selected. The
study considered all levels of health care professionals who were in active employment for the past 6 months without a significant vacation and those who were engaged in ground-level implementation, policy, and maintenance activities. Data were recorded, transcribed, and translated, and subsequently, codes, themes, and subthemes were developed using NVivo 14 (QSR International) for thematic analysis.
RESULTS: Five themes were generated from the data: (1) general challenges (challenges due to being an international borderline district, human resource constraints, logistical challenges for medical supply, infrastructural issues, and transportation challenges); (2) challenges during the COVID-19 pandemic (increased workload, lack of diagnostic centers, mental health challenges and family issues, routine health care facilities affected, stigma and fear of infection, and vaccine hesitancy and misinformation); (3) perception and awareness regarding COVID-19 vaccination; (4) alternative actions or strategies adopted by health care workers to address the challenges; and (5) suggestions provided by health care workers. Health care workers demonstrated adaptability by overcoming these challenges and provided suggestions for addressing these challenges in the future.
CONCLUSIONS: Health care workers in Manipur and Nagaland have shown remarkable resilience in the face of numerous challenges exacerbated by the pandemic. Despite infrastructural limitations, communication barriers, and inadequate medical supply distribution in remote areas, they have demonstrated adaptability through innovative solutions like efficient data management, vaccination awareness campaigns, and leveraging technology for improved care delivery. The findings are pertinent for not only health care practitioners and policymakers but also the broader scientific and public health communities. However, the findings may have limited generalizability beyond Manipur and Nagaland.