Human Resources for Health in Maternal, Neonatal and - HRH ...
Human Resources for Health in Maternal, Neonatal and - HRH ... Human Resources for Health in Maternal, Neonatal and - HRH ...
Tamil Nadu equivalent of Auxiliary Nurse Midwives). They are also told who to contact if they fear a villager is contemplating killing a female child. Each girl is then expected to take care of 5 to 6 pregnant women and 5 postnatal women in their village, providing advice on diet, regular consumption of Iron and Folic Acid (IFA) tablets and the benefits of breastfeeding, as well as persuading them to use institutional services. The programme has yet to be evaluated but will be monitored with a monthly review on the number of visits made by the adolescent girls to pregnant women; the number of women taking IFA; number of cases referred to VHNs/other hospitals; number of women having AN/PN care; number of newborns referred and number of infants fully immunised (Government of India 2004). Partnerships with CHVs or Lay health workers There are many examples of HRH community partnerships that highlight the importance of the need for appropriate training, supervision and support of lay and volunteer workers. In India the Mitanin programme has resulted in increased post natal care visits and immunisation due to the strong linkages developed between women, community structures, (womens groups), volunteer health workers (Mitanins), Auxiliary Nurse Midwifes (ANM) and Anganwadi Workers (Mishra 2004; Society for Community Health Awareness 2005). The development of clear roles for health worker, family and support person during birth may help to demark areas of responsibility to ensure quality care and collaboration. An example of the various roles that women, TBAs volunteers health workers and families can play and the interventions that they can deliver is outlined at appendix 2 (Family and Community Health 2002). Another approach is the HBLSS programme in Ethiopia. This targets a homebirth team consisting of all of those who can be expected to be present at a birth, namely, the pregnant woman, her family caregivers, and the birth attendant. Health education was delivered to the team by the TBA who also in most cases was the birth attendant. There was improved performance in management of postpartum hemorrhage but weakness in the management of newborn infection. Exposure to HBLSS training in the community was estimated at 38%, and there was strong community support (Sibley, Buffington et al. 2004). The transference of mobilisation and engagement strategies to other communities is highly depended on the socio-cultural context. However support for lay health workers who often form the link between the community and the health sector is necessary. A number of factors need to be considered if intervention effects are to be transferable to other settings. This includes: financial support for lay health worker programmes; the availability of routine data on who might benefit from the intervention (e.g.children whose immunization is not up-to-date); P a g e | 119
esources to provide clinical and managerial support for lay health workers; the availability of drugs outreach for family planning (Flottorp 2008) Partnerships with Village Health Committees VHCs in Guinea were essential players in bridging the physical and attitudinal gap between families and health services in order to increase family planning and contraceptive uptake. Met need for family planning rose from 24 to 61 percent after just 4 years and uptake continued high through mid-2008, 2 years later. Other successful initiatives involving village health committees, women‘s committees and nurse midwife engagement (Mubyazi 2007). (IntraHealth 2001). A project in South Africa that included health workers in MNRH initiated a process to strengthen the relationship between the community Liaison Officers and health advisors working within Nelson Mandela Bay Municipality and the community health committees of Sub-district B (Uitenhage and Despatch). (Boulle 2008 ). Health workers conducted a three-day Participatory Reflection and Action (PRA) workshop with thirty representatives from community health committees and key stakeholders, intended to strengthen community participation and deepen an understanding of the roles and responsibilities of community health committees. Working with community based organisations Health worker support of Women's health groups was an important component of the establishment and maintenance of these groups which were developed to improve perinatal care in rural Nepal. (Morrison, Tamang et al. 2005). Close linkages with community leaders and community health workers improved strategy implementation. Regular meetings were organized in co-ordination with the local Female Community Health Volunteer, an unpaid community based health worker. Village health workers were trained to visit newborn infants in their homes and identify and treat neonatal sepsis. This intervention appeared highly successful as a drop in neonatal mortality of 62% occurred. Village health workers were intensively managed and supported by the research team, and therefore large-scale implementation may be difficult. Partnerships for commodity distribution Collaborative partnerships between HRH and community have proved to be successful in the distribution of MNRH commodities. A study in West Java Indonesia found that midwives and community health workers successfully worked together with women, TBAs and community volunteers to distribute and encourage the use of Misoprostol to prevent post partum haemorrhage (Sanghvi 2004). A non-randomised community trial assessed a new delivery system of IPTp through traditional birth attendants, drug shop vendors, community reproductive health workers and adolescent peer mobilisers (the intervention) compared with IPTp at health units (control) in Uganda (Mbonye, Bygbjerg et al. 2007). This trial found that the community-based system was effective in delivering IPTp, whilst women still accessed P a g e | 120
- Page 69 and 70: The Health and Family Planning Mana
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- Page 93 and 94: Figure 24 Motivational determinants
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- Page 161 and 162: Figure 37 Critical success factors
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esources to provide cl<strong>in</strong>ical <strong>and</strong> managerial support <strong>for</strong> lay health workers;<br />
the availability of drugs outreach <strong>for</strong> family plann<strong>in</strong>g (Flottorp 2008)<br />
Partnerships with Village <strong>Health</strong> Committees<br />
VHCs <strong>in</strong> Gu<strong>in</strong>ea were essential players <strong>in</strong> bridg<strong>in</strong>g the physical <strong>and</strong> attitud<strong>in</strong>al gap between<br />
families <strong>and</strong> health services <strong>in</strong> order to <strong>in</strong>crease family plann<strong>in</strong>g <strong>and</strong> contraceptive uptake.<br />
Met need <strong>for</strong> family plann<strong>in</strong>g rose from 24 to 61 percent after just 4 years <strong>and</strong> uptake<br />
cont<strong>in</strong>ued high through mid-2008, 2 years later. Other successful <strong>in</strong>itiatives <strong>in</strong>volv<strong>in</strong>g village<br />
health committees, women‘s committees <strong>and</strong> nurse midwife engagement (Mubyazi 2007).<br />
(Intra<strong>Health</strong> 2001). A project <strong>in</strong> South Africa that <strong>in</strong>cluded health workers <strong>in</strong> MNRH <strong>in</strong>itiated<br />
a process to strengthen the relationship between the community Liaison Officers <strong>and</strong> health<br />
advisors work<strong>in</strong>g with<strong>in</strong> Nelson M<strong>and</strong>ela Bay Municipality <strong>and</strong> the community health<br />
committees of Sub-district B (Uitenhage <strong>and</strong> Despatch). (Boulle 2008 ). <strong>Health</strong> workers<br />
conducted a three-day Participatory Reflection <strong>and</strong> Action (PRA) workshop with thirty<br />
representatives from community health committees <strong>and</strong> key stakeholders, <strong>in</strong>tended to<br />
strengthen community participation <strong>and</strong> deepen an underst<strong>and</strong><strong>in</strong>g of the roles <strong>and</strong><br />
responsibilities of community health committees.<br />
Work<strong>in</strong>g with community based organisations<br />
<strong>Health</strong> worker support of Women's health groups was an important component of the<br />
establishment <strong>and</strong> ma<strong>in</strong>tenance of these groups which were developed to improve per<strong>in</strong>atal<br />
care <strong>in</strong> rural Nepal. (Morrison, Tamang et al. 2005). Close l<strong>in</strong>kages with community leaders<br />
<strong>and</strong> community health workers improved strategy implementation. Regular meet<strong>in</strong>gs were<br />
organized <strong>in</strong> co-ord<strong>in</strong>ation with the local Female Community <strong>Health</strong> Volunteer, an unpaid<br />
community based health worker. Village health workers were tra<strong>in</strong>ed to visit newborn <strong>in</strong>fants<br />
<strong>in</strong> their homes <strong>and</strong> identify <strong>and</strong> treat neonatal sepsis. This <strong>in</strong>tervention appeared highly<br />
successful as a drop <strong>in</strong> neonatal mortality of 62% occurred. Village health workers were<br />
<strong>in</strong>tensively managed <strong>and</strong> supported by the research team, <strong>and</strong> there<strong>for</strong>e large-scale<br />
implementation may be difficult.<br />
Partnerships <strong>for</strong> commodity distribution<br />
Collaborative partnerships between <strong>HRH</strong> <strong>and</strong> community have proved to be successful <strong>in</strong> the<br />
distribution of MNRH commodities. A study <strong>in</strong> West Java Indonesia found that midwives<br />
<strong>and</strong> community health workers successfully worked together with women, TBAs <strong>and</strong><br />
community volunteers to distribute <strong>and</strong> encourage the use of Misoprostol to prevent post<br />
partum haemorrhage (Sanghvi 2004). A non-r<strong>and</strong>omised community trial assessed a new<br />
delivery system of IPTp through traditional birth attendants, drug shop vendors, community<br />
reproductive health workers <strong>and</strong> adolescent peer mobilisers (the <strong>in</strong>tervention) compared with<br />
IPTp at health units (control) <strong>in</strong> Ug<strong>and</strong>a (Mbonye, Bygbjerg et al. 2007). This trial found that<br />
the community-based system was effective <strong>in</strong> deliver<strong>in</strong>g IPTp, whilst women still accessed<br />
P a g e | 120
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