Substitution Reduced Health Work Force Syndrome: A Way Forward for Developing Countries

Abstract

World Health Organization (WHO) state Worlds 57 countries suffered from shortage of doctors in term of health worker imbalance, maldistribution. The objective of this study is to assess does substitution can be carried out in the mainstream of health systems to reduce health workforce syndrome for developing countries. Six facilities (two union health family welfare center, two Upazilla health complex and two clinics from Non-Government Organizations) were taken purposively. A structured questioner addressing one hundred and eleven (111) variables for Essential service package was used for in-depth interviews and observation. A hypothetical framework was used to focus on substitution, crisis and policy implication. Study report reveals that in seven components of Essential Service Package most of the services provided by doctors in public health facilities were same services served by non-doctor health care providers in health care facilities operated by non-government organizations. Non-doctor health care providers are not allow to serve even for non-communicable disease screening. Research result reveal that non-doctor health care service providers skill and expertise regards maternal health care, child health care, adolescent care, nutritional care and care for other diseases are gold standard. Regard maternal health care services non-doctor health care service providers not able to serve and referred the cases of identify obstetric emergencies (ANC7), labour induction (ND4), episiotomy (ND7) and identify and manage obstetric emergencies (isolation or B/CEmonC), obstructed labour, pre/eclampsia, haemorrhage, pre-term labour, including administration of antenatal Corticosteroids (ND8) and complicated cases (ND9), identification and management of obstetric complications:, Hemorrhage, Puerperal infection/sepsis (PNC4). In respect to neonatal care non-doctor providers not cannot manage preterm or low birth weight (LBW) neonate (INC4), identification and management of sepsis (NCD5), identification and management of omphalitis (NCD6), identification and management of LBW babies (refer <1, 800 (NCD7), identification and management of neonatal jaundice (NCD8) and obs and neonatal emergencies. Among family planning services non-doctor provider at NGO clinic do not serve the services are advocacy and awareness development on PPFP and post-MR/PAC–FP (FP2), menstrual regulation(FP11), post abortion FP(FP12), post-partum FP (FP13), post MR–FP (FP14), management of contraceptive complications (FP15). IMCI and EPI were well covered by non-doctor health care service providers following book chart let. Non-doctor health care service providers well capable to serve the services of essential service package (ESP). If top-up training given to them and allow to served more services that presently not covered would able to covered and doctors were get to engage themselves to manage more complicated cases. A special cadre will create in the mainstream of health service systems that increase service range in public health sector and able to ensure universal health coverage.