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

encouraging midwives to proactively have women, as the consumers of midwifery
care, participate in the activities directed at the provision of quality care
encouraging midwives‘ associations to involve women and consumers in their
activities (ICW 2008)
HRH play an important role in facilitating community engagement in the design and delivery
of health care. There is evidence that community mobilisation is an effective method for
promoting participation and empowering communities in MNRH (Rosato 2008). However
the current extent to which the community is organised and motivated affects HRH output
and performance (Mangelsdorf 1988). The need for leadership within the community itself is
regarded as critical to any social and behavioural change endeavour to improve health over
and above health workers.
The issue is not to deploy twice as many village-level health workers to speed community
improvements through family planning, neither is it to supply a multipurpose worker to each
village to be a spokesman of "integrated development". First and foremost, it is the
promotion and acceptance of an indigenous political economic leadership in the 65,000
villages of Bangladesh -- a leadership that understands the need for the potential of self-help
and self-reliance in creating a better life for the members of the community. (Demeny 1975)
in (Amin, Ahmed et al. 1994)
In addition community acceptance and support of the health worker is important. This was
found to be critical in the Ghana Community-based Health Planning and Services Initiative
(Nyonator, Awoonor-Williams et al. 2005) and in a safe motherhood project in Tanzania
(Ahluwalia, Schmid et al. 2003). In Colombia community support in the form of feedback
and rewards for rural health promoter was found to have considerable impact upon effective
performance (Robinson and Larsen 1990).
The successful implementation of community based health interventions and the provision of
MNRH care and services therefore depends upon HRH and community members their
relationships their context and the participatory processes they engage in. The factors that
affect the interaction between HRH and community members are outlined in the diagrams
below. A rights-based process should underpin this interaction which is necessary for scale
up of MNRH care (Knippenberg, Lawn et al. 2005).
From the health worker perspective there are a number of factors that can help to facilitate
partnership building. Most importantly is management support for engagement which might
include community participation as a key aspect of performance management and the
provision of in-service training in areas such as community development. Community
structures also need to be functional and receptive so that there are points through which
health workers can engage. Health workers need to be motivated and culturally competent
and participate in community meetings where health issues are discussed. Health worker
commitment is often expressed through voluntary contributions to communities particularly if
health workers reside in or close to the community. This may be in the form of committee
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