Utility of paperless partogram in labor management

Background: Partograph use in labor has revolutionized the obstetric care. WHO recommends universal use of WHO modified partograph, which in clinical setup is less often used. Debdas (2006) proposed the paperless partogram which is designed for use by clinician/nurses/midwives as it is very simple and low skill method. The present study is proposed to evaluate the effectiveness of paperless partogram as a bedside tool and its comparison with WHO modified partograph.Methods: It was a prospective analytical study done in department of obstetrics and gynecology, JNMCH, AMU, Aligarh from September 2017 to July 2019 and included 400 pregnant women at term, divided into 2 groups of 100 each Group A (paperless partogram) and Group B (WHO modified partograph) and their labor events were followed.Results: Out of 200 women that were included in each group, maximum women were multigravida, 58.5% in group A and 61.5% women in Group B. Mean age in Group A was 24.68±3.8years and Group B was 24.93±3.75 years. The mean duration of labor in Group A was 3.57±2.20 hours and Group B was 3.40±2.03 hours. There were 87.5% of women who delivered before alert ETD, likewise in Group B; women who delivered before alert line are 88.5%. These differences were statically not significant. Perinatal outcome was also similar in both groups.Conclusions: In our study, the paperless study was found to be as efficient as WHO modified partograph for management of labor. The mean delivery time was 3.57 hours similar to WHO partograph of difference between alert and action line. Thus, for resource poor setting like India with overburdened population paperless partogram can be used as an alternative to WHO modified partograph which is complex and time consuming.

Gestão do trabalho na saúde: com a palavra, atores da Estratégia Saúde da Família / Management of labor in healthcare: health workers' perceptions of the Family Health Strategy Program

Introdução: A implantação da Estratégia Saúde da Família representou uma expressiva ampliação do mercado de trabalho em saúde, trazendo à cena problemas relacionados à gestão do trabalho. As dificuldades vão desde o despreparo de trabalhadores de saúde e de gestores, entendendo ambos como atores da gestão, para agirem dentro da lógica desse novo modelo, passando pelos vínculos precários de trabalho, pela alta rotatividade de trabalhadores, até pela fragmentação do processo de trabalho. Objetivo: discutir a gestão do trabalho na Estratégia Saúde da Família (ESF), a partir dos sentidos atribuídos pelos gestores e trabalhadores às políticas nesse campo, bem como de suas implicações para as equipes de saúde da família. Métodos: a pesquisa é exploratória, descritiva, de abordagem qualitativa. Foram realizadas entrevistas semiestruturadas com gestores e grupos focais com trabalhadores de equipes de saúde da família. Os dados foram analisados com base na técnica de análise de conteúdo. Resultados: Observou-se pouca valorização de iniciativas voltadas para a melhoria de relações, condições e processos de trabalho das equipes, necessárias para o aprimoramento do processo de produção de saúde na ESF, em Linhares. Conclusão: Considerando o caráter estratégico do campo da gestão do trabalho e da educação para o favorecimento de um maior protagonismo desses trabalhadores na consolidação da ESF, verificamos que essa valorização ainda se encontra mais no plano do discurso e não se reflete na agenda política municipal, enquanto ações capazes de provocar mudanças paradigmáticas no processo de produção de saúde, de modo a romper com o modelo assistencial tradicional.(AU)

Introduction: The implementation of the Family Health Strategy represents a significant expansion of the health labor market, bringing into play issues related to labor management. Obstacles range from the unprepared health workers and managers to act within the logic of this new health model through the precarious work relations, high employee turnover, to the fragmentation of the work process. Objective: To discuss labor management in the Family Health Strategy Program (ESF), from the meanings assigned by managers and workers to the policies in this field, as well as the implications for family health teams. Methods: This is an exploratory, descriptive, qualitative study. Semi-structured interviews were conducted with managers and focus groups were carried out with workers of the family health teams. Data analysis was performed using the content analysis technique. Results: The initiatives aimed at improving working relations, conditions and processes of teams were undervalued, and these are critical to improve health delivery at ESF in Linhares. Conclusion: The strategic role of the labor management on strengthening the role of these workers in the consolidation of the ESF was generally acknowledged in the discourse of health professionals; however, this has yet to be reflected on municipal policy, in order to encourage paradigmatic changes in health delivery, and as such, overcome a traditional and ineffective health care model(AU)

Desafios para gestão do trabalho a partir de experiências exitosas de expansão da Estratégia de Saúde da Família / Challenges for human resources management from successful experiences of Family Health Strategy expansion

Este artigo discute a gestão do trabalho na Estratégia de Saúde da Família em quatro grandes centros urbanos. A pesquisa contempla as perspectivas de diferentes atores que compõem e integram a rede de relações de trabalho no Sistema Único de Saúde por meio de questionários com trabalhadores das categorias profissionais da equipe de saúde da família e entrevistas com gestores e representantes das entidades profissionais. Tratase de estudo de avaliação qualiquantitativo. A política de inserção e remuneração evidencia a substituição dos quadros terceirizados e a contratação por concurso público, que possibilita vínculos trabalhistas mais estáveis. Outras estratégias são o estabelecimento de abono para atuação em áreas de maior vulnerabilidade social e a equiparação do salário dos médicos especialistas em medicina de família e comunidade com demais especialistas atuantes nos serviços secundários. A vontade política do gestor municipal para qualificar a força de trabalho da saúde da família, mantendo a oferta de recursos humanos adequados às necessidades do sistema de saúde, é fator fundamental para a consolidação da Estratégia de Saúde da Família, em face do baixo grau de especialização dos profissionais para atuar em atenção primária em saúde.

This article discusses the management of the work in Family Health Strategy in four major urban centers. The research includes perspectives from different actors who compose and integrate the network of working relationships in Public Health System through questionnaires with employees of professional categories family health team and interviews with managers and representatives of professional bodies. It is a qualitative-quantitative evaluation study. The dimensions analysed were: insertion and remuneration policies, strategies and qualification of employees. The insertion and remuneration policy highlights the replacement of outsourced frames and hiring by public tender that allows links labor more stable. Other strategies are the establishment of allowance for expertise in areas of greater social vulnerability and the assimilation of specialists in Family and Community Medicine with other experts engaged in secondary services. The political will of municipal Manager to qualify the workforce of family health, maintaining the provision of adequate human resources needs of the health system is a fundamental factor for the consolidation of family health strategy in the face of the low degree of specialization of professionals to work in primary health care.