Multipurpose worker or new worker
Skill mix in the signifier of new worker came into being to increase the wellness range in rural and distant countries, where people do non near appropriate wellness services thereby widening the unmet demand spread. Support workers from the several community are used with appropriate preparation to pull off the common complaints, to advance healthy patterns in the community and to take societal tabus with respect to wellness patterns. ( 16 ) This thought was besides extrapolated to include such workers who can take attention of providing drugs to registered and turn out instances thereby advancing the general wellness and productiveness in the concerned community. Using such workers in primary wellness attention scene may be economically good and productive. For illustration, these workers may be fundamentally skilled for cookery and cleansing, wherein appropriate cross preparation can use them as multipurpose workers who can be used for shop maintaining, records care and patient conveyance. With preparation such people can be employed for health care bringing in assorted community degree wellness programmes. In a higher cell of work, nursing helpers moving as accoucheuses and technicians fliping in as support staff are besides illustrations of new workers.
This procedure of presenting multipurpose worker has besides been done in India before but in a different manner. As portion of the National Health Mission, every small town is provided with a trained female community wellness militant ASHA or Accredited Social Health Activist. The ASHA, selected from the same small town, is trained to work as an interface between the community and the public wellness system. There are norms sing the educational makings, choice procedure, preparation and wage of ASHAs. Preliminary appraisal of competence of ASHA in the field of HIV/AIDS in Andhra Pradesh, India showed first-class consequences and should move as an inducement to take this forward ( 17 ) . The assorted functions and duties of ASHA as envisioned in National Health Mission is summarised in Box 4. ( 18 ) Over and above these duties, farther countries in which they can be trained include monitoring of drug associated inauspicious events in relation to intervention of diseases like Tuberculosis and HIV/AIDS. Involving them in contact tracing for early sensing of Tuberculosis and HIV and appropriate referral of patients developing long term sequelae and timeserving infections.
Prerequisites
Execution of skill mix requires inputs from many beginnings. Achieving equal support from all involved countries is of import for skill mix to win. Some of these are outlined in Box 4.
Advantages
Advanced solutions bank on the advantages they can supply in comparing with the present techniques. Skill Mix came into drama because of the figure of advantages that it can supply. The basic purpose of skill mix is to increase the entree to wellness attention without later increasing the cost of wellness attention, in short, increasing the productiveness. In add-on this besides serves in cut downing the work load of higher class staff and later increasing their efficiency in covering with complicated therapeutics. Surveies on skill mix highlight the utility and efficaciousness of skill mix. Surveies have besides documented that skill blend attack had no inauspicious effects in patient satisfaction. ( 19 ) It has besides been found that there is no important difference in drug prescription or cost benefit ratio but the nurses scored better in patient satisfaction. ( 20 ) ( 21 ) In good trained scenes Nurse practicians can play polar functions in patient attention even in ague attention state of affairss. ( 22 )
Apart from the patient oriented advantages, accomplishment mix besides provides development chances for the staff. The wellness attention workers besides respond positively towards extra duty and the work result is besides noted to be error free.
Last but non the least, the clip taken for a specializer to be trained is besides well reduced when the occupation is divided and decentralised. Hence the immense job of wellness attention supplier deficit can be met with appropriate skill Mix. ( 23 )
These advantages of skill mix are summarised in Box 6.
Disadvantages
Skill mix has its ain set of disadvantages. Though there are many proposed advantages in skill mix, there is non adequate grounds to demo that skill mix is fruitfully efficient. We have many surveies favoring it, which show increased patient satisfaction, contracting the unmet needs spread. But many of the surveies did non mensurate the cost effectivity of skill mix. Patient satisfaction, straight related to nurse practicians listening more patiently than physicians has been taken as an end point in many of the surveies. Effectiveness in footings of equality sing a physicians and nurse practicians prescription, designation of associated diseases, early acknowledgment of complications were non measured. Most of the surveies were based on pull offing simple diseases with defined pattern guidelines. Some surveies have besides showed that better attention for hospitalised patients is straight relative to the figure hours of nursing attention provided by the registered nurses and the attention provided by registered nurses better than that of nursing Plutos. ( 24 )
Besides, function sweetening leads to nurse practicians demanding a higher wage, contradicting the cost effectivity of skill mix. ( 25 ) A important investing is required in the initial stages of developing the new recruits, which makes accomplishment blend a hard topic of debut in developing states where the GDP of wellness outgo in itself is low ( 26 ) .
In twenty-four hours to twenty-four hours pattern the clear limit of functions between different wellness workers may non be possible ( 27 ) . Blurring of single functions may hold its consequence on squad work. Many doctors are non comfy with the thought of nurse practicians. The traditional thought of powers of a physician gets diluted when Nurse practicians or such workers are given the right to order medicines ; this has been a bone of contention among professional administrations of physicians. Patients have concerns sing a lower grade staff run intoing their jobs and may be dissatisfied with the health care bringing. The effectivity of skill mix can besides non be generalised to all wellness sections and different health care scenes. Effort has to be made to continuously supervise the quality of attention provided through accomplishment mix which is one of the concealed costs. ( 3 ) The demand for guaranting answerability and criterion of attention besides needs equal accent as shown by some surveies when newer workers are straight involved in patient direction. ( 28 ) This is peculiarly of import before we introduce skill mix in critical attention or exigency direction squads. ( 29 )
In the instance of qualified accomplishment mix, where primary wellness attention doctors take on the function of specializers, it should be ensured that patients of physicians working entirely or in little groups, specifically in rural countries are non disadvantaged. It should besides be seen that referral is non delayed and made more appropriate to the demands of patients and their wellness jobs. Such a specialization should non come at the disbursal of their accomplishments in general pattern. ( 30 )
Hence Skill blend can be a success merely when it is being used in a controlled scene where the functions of each wellness attention forces is good defined, where the direction and referral of a peculiar wellness status has good defined guidelines, equal systems are in topographic point for the supervising and answerability, with the wellness attention supplier holding adequate motive for enlisting and use of newer staff and outgo of resources. These assorted disadvantages are summarised in box 7.
Future directives and the manner in front in South East Asiatic Region
Skill Mix as discussed above is the advanced mode that arose out of the demand for more wellness workers. Skill Mix though being an advantageous solution, may non be applicable in all state of affairss. Strengthening of the wellness attention services and quality wellness bringing goes a long manner in advancing wellness attention in the community. The possible range of this construct is summarised in Box 8.
Skill Mix has its maximal use in primary wellness attention scenes to increase the wellness service bringing, particularly in developing states. When the basic and minor wellness jobs are met and dealt with suitably in the primary degree, the referred patients will go a minority thereby cut downing the work load in secondary and third scenes. Empowering the bing system, function expansion of bing ASHA workers is a possible country. They can be of aid in covering with follow up patients, like that of HIV/AIDS, Tuberculosis and other chronic conditions wherein they can be trained in appropriate drug bringing and seasonably referral when complications arise. Such steps cut down a major load on the wellness attention systems. This system of community wellness workers or ASHAs can besides be adapted in other South East Asiatic states particularly in bar, intervention, follow up of HIV/ AIDS population as in Thailand or Tuberculosis control in Nepal.
Skill mix may be utilised in the approaching field of pharmacovigilance, wherein appropriate and timely drug inauspicious event monitoring can besides be carried out by trained field workers. This may be of premier importance in inauspicious event monitoring of rampant endemic diseases in the South East Asian part which uses drugs with possible serious and fatal toxic effects like Tuberculosis.
Before advancing skill mix on a big graduated table, we need equal grounds to back up its function in bettering patient attention. In the present scenario, we have surveies to demo that qualified workers in any healthcare scene can better patient result. ( 31 ) It is of import to retroflex the same consequences in an adequately trained ‘skill mix’ environment.
It should non be forgotten that accomplishment mix is merely non a cost reduction step. Sufficient pecuniary and clip investing and a dedicated programme are necessary to do it a success.
