Human Resources for Health in Maternal, Neonatal and - HRH ...

Improving working partnerships with the community
The PHC approach acknowledges the resourcefulness of communities and the importance of
community participation in their own health care. Many commentators have called for the
provision of care through a community-based participatory approach, not through narrow
technocratic vertical programs (Bang and Bang 1989). Community-based participatory
interventions have been found to reduce neonatal mortality rates (Manandhar, Osrin et al.
2004) and contribute to maternal and reproductive health (Amin, St. Pierre et al. 2001;
Kidney, Winter et al. 2009) and improved child mortality (Bhuiya and Chowdhury 2002).
However their implementation is partially dependent on HRH who: have strong relationships
with community members, participate in community activities and have insight and
understanding of the socio-cultural context. For example HR community involvement which
included attending community health committee meetings improved productivity (Fako
2002). As a result community development is an important part of HRH work which may
also involve motivating and facilitating the development of community structures i.e. the
VHC. This is part of the enabling environment of HR and part of their work (Twumasi 1985).
Mduduzi found that the frontline work context had a greater influence on worker
performance in knowledge transfer than did workers' individual characteristics (Mduduzi
2008) which highlights the importance of this context.
HRH work is therefore greatly affected by the commitment that organisations demonstrate
towards engaging the community in health work. Various organisations have different levels
of commitment to participatory practice and areas of emphasis. A study of family planning
providers in Kenya reported that the providers and supervisors interviewed said that MOH
and faith-based facilities were more likely to involve the community in management of
facility operations than private/parastatal facilities. Of the RH providers and supervisors
employed at private/parastatal facilities, 58% claimed that their facility was not associated
with a community management committee (Rawlins 2003). A review of 18 World Bank
project information documents on health sector reform initiatives in Asia reveals that in six
the emphasis on community participation is weak, and in six community participation is
stressed mainly for strengthening mobilization of resources (finance, labour and time).
Nevertheless, a few health sector reforms espouse a commitment to community participation
in health programme management (determining local health needs and health services, within
a given policy context) and in policy formulation (Murthy 2004).
Professional organisations such as the International Confederation of midwives (ICW 2008)
make their position very clear as to the participatory basis of their work which is informed by
a partnership between women and midwifes. According to the ICM the advancing the
midwifery profession will be premised on:
the health care needs of women and their newborn
the involvement of women in the process of identification of those needs
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