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

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and benefited from essential care at health units. Despite these successes it is important to note that many community members who distribute MNRH commodities are also driven by their own personal agendas and interests in getting ahead in life. This can be at odds with the goals of the MNRH programme. HRH knowledge of distributors motivations can help to provide more realistic expectations from such programmes and improve relationships between the two (Kaler 2001). Partnerships with fathers A key component of the MNH Program which commenced in 1998 in Indonesia was the community partnership developed through the SIAGA campaign. This programme began with as a mass media campaign that focused on increasing the husband‘s role in preparing for delivery. The success of the programme led to an enlarged remit including interventions to reduce post partum haemorrhage. SIAGA (an acronym for ready, take transport, be on guard) became associated with the concept of shared responsibility which is central to the Indonesian value of Gotong Royong or self help (Palmer 2004). The village midwife was promoted as a skilled friendly provider who was willing to help. The BIDAN SIAGA campaign encourages pregnant women and their husbands to consult a bidan for maternal health services and encourages the bidan to proactively approach the community to offer support. An evaluation of the programme found that the campaign played an important role in making Indonesian women, their husbands, and their communities more prepared for complications during pregnancy and delivery. Summary Experiences from LMICs highlight a number of factors that contribute to the strengthening of relationships with communities which facilitates a partnership approach to the delivery of MNRH care and services. This includes the need for a motivated health workers who are cultural competent and willing to engage with existing community structures. Likewise, HRH depend on communities that are well organised with strong leadership that can mobilise local women and traditional power holders. The co-production of health outcomes in LMIC, therefore, is a shared responsibility between health workers and communities and enabled by HRM systems with mechanisms to support this community engagement. Despite much documentation that describes the need for participatory approaches there is little description of actual health worker experience applying these approaches and the strategies applied when faced with various obstacles. P a g e | 121
Strengthening Education and competencies This section outlines initiatives that have led to the strengthening of health worker education and training including pedagogical aspects and graduate competencies. Approaches to large scaling up efforts in education and training have been discussed previously in this review but the details of these and other initiatives are discussed here. There are a number of documents that have attempted to review the education and training of health workers engaged in MNRH at community level. A Global review of CHW training surveyed CHW curriculum presents a study of trainer characteristics, training strategies used, monitoring and evaluation and the cost of the selected programmes (Li, Goethals et al. 2006/2007). Sibley et. als systematic review focuses on the impact of TBA training (Sibley 2007) while a review of training initiatives for essential obstetric care in developing countries examines curriculum approaches, tools used to assess training and evaluation lessons (Penny and Murray 2000). Crisp and Sharp have outlined some of the key aspects involved in the improvement of education and training. This emphasises the need for a comprehensive approach that looks beyond traditional ways of delivering education and training. Figure 28 key aspects involved in the improvement of education and training Reduce attrition among students and teachers Integrate pres-ervice & in-service training improve accessibility Integrate pre-service and in-service training Develop common educational platforms for different health workers Increase community based learning modular education & action learning Increase use of ICT Improve education through QA Expanding teaching capability Fostering twinning and partnerships Maximising impact through regional approaches Harnessing public-private partnerships (Crisp and Sharp 2008) A collaborative approach to education training There are a number of benefits in that stem from a partnership approach to health worker training The Pan American Health Office (PAHO) calls for the development of cooperation mechanisms between training institutions (universities and schools) and health services to ensure that workforce training reflects a universal and equitable model of quality care that meets the health needs of the population (PAHO). Collaboration helps to ensure that curriculum is developed and delivered according to certain standards and with the input of technical experts, practitioners, learners and community members themselves. One example Page | 122
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Human Resources for Health in Mater
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What human resource practices in ma
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Collaboration with traditional and
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Acronyms AAAH Asia and Pacific Acti
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TBA T & L UNFPA UNICEF UOG UPNG USA
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Figure 34 Potential gain in percent
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Executive Summary Addressing the ba
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Introduction What human resource pr
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Review Questions 1. What HR approac
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Effective HRH practice and quality
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is no single prescribed set of ways
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Table 3 Classification of health ce
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Figure 5 Millennium Development Goa
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(UNICEF 2007) However, the road to
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A number of steps are purported to
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Figure 10 Overview of HRH at commun
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functions, the latter involving mob
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settings‖(ICN 2009). They may be
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Table 7 What Skilled attendants can
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Traditional healers may also be inv
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Methodology What human resource pra
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Table 9 Search terms used for the s
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findings. Differences and similarit
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Barriers and constraints to HRH pra
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PHEs. In the Pacific the density of
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partum services as being from 1:60
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husbands who oppose family planning
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Remuneration for CHWs, nurse and mi
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Supportive HRH strategies and appro
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Strengthening HRH policy legislatio
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Strategies to improve Human resourc
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there are interrelationships betwee
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Table 11 Tools for managing HR in M
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Performance management Effective ma
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The Health and Family Planning Mana
Page 71 and 72: as a guide to mentoring, delegation
Page 73 and 74: eceived from outside the routine pu
Page 75 and 76: The isolated nature of much communi
Page 77 and 78: progress over time. This tool and t
Page 79 and 80: At national level, countries may ha
Page 81 and 82: evaluating and adjusting the size a
Page 83 and 84: There are a number of difficulties
Page 85 and 86: Figure 23 The Task Shifting Process
Page 87 and 88: Substitution Substitution is differ
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Page 91 and 92: al. 2008). Dual practice is another
Page 93 and 94: Figure 24 Motivational determinants
Page 95 and 96: Many of the incentives to health wo
Page 97 and 98: files suggests that more careful at
Page 99 and 100: Management autonomy at community le
Page 101 and 102: Initiative focus Details Context Re
Page 103 and 104: informal, mutual-help action groups
Page 105 and 106: Building relationships with cultura
Page 107 and 108: groups; encouraging recruitment thr
Page 109 and 110: Summary This section has identified
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Page 113 and 114: Facilitation & attendance at MOH/ N
Page 115 and 116: of community leaders improved the c
Page 117 and 118: Table 19 Examples of initiatives in
Page 119 and 120: information and advice from peers (
Page 121: esources to provide clinical and ma
Page 125 and 126: Table 20 Examples of Partnership ap
Page 127 and 128: Table 21 Learner needs analysis and
Page 129 and 130: Table 22 Some approaches to the des
Page 131 and 132: Participants/ Method / document typ
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Page 135 and 136: Participants / context LMICs method
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Page 141 and 142: Country / cadre Indonesia Surabaya
Page 143 and 144: Lessons learned from countries that
Page 145 and 146: Malaysia The sharp decline in mater
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Page 149 and 150: A technical meeting in Bangkok in 2
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Page 153 and 154: flexibility in order to overcome ge
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Page 157 and 158: Scaling up of the Navrongo service
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Page 161 and 162: Figure 37 Critical success factors
Page 163 and 164: Health system standards are explici
Page 165 and 166: prevalence rate, however in order t
Page 167 and 168: (Dieleman 2006) Selected key indica
Page 169 and 170: In order to determine the answers t
Page 171 and 172: Summary of findings This narrative
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Health worker performance is theref
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Discussion and Recommendations What
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outlines how the HRH information ba
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communities. A collaborative approa
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Table 29 Examples of HRH performanc
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Appendices Appendix 1. MDG5 Country
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World Health Statistics http://www.
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Appendix 3. Sources of all material
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Data source Keywords used in search
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Appendix 4: Barriers and Constraint
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Area Barriers & constraints in MNRH
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Area Barriers & constraints in MNRH
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Appendix 5 Literature that document
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P a g e | 206
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IMNCI PMTCT Perinatal Period Postna
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Ambegaokar, M., Lush, L. (2004). "F
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Barrett, B., J. Ladinsky, et al. (2
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University South Africa with the Re
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Cruse, D. (1997). Community Health
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Elson, D., Evers, B. (1998). Sector
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Flanagan, D., Williams, C., Mahler,
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Greenwood, A. M., Bradley, A.K., By
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Howard, G., Bogh, C., Goldstein, G.
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Jhpeigo (1998). Participatory techn
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Kroll, D., Dwyer, D. (1994). "Postn
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Manandhar, D. S., D. Osrin, et al.
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Morisky, D. E. (1985-86). "Evaluati
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O‘Brien-Pallas, L., Irvine, D., P
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Pfeiffer, J. and J. Pfeiffer (2003)
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Replogle, J. (2007). "Training Trad
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Shankar, A., S. Sebayang, et al. (2
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Teela, K. C., L. C. Mullany, et al.
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van Damm, W., et. al (2008). "Scali
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WHO (2008). Global Standards for In
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