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

Executive Summary
Addressing the barriers and constraints faced by health workers and managers is a key
component in health system strengthening and improving the quality of health care in low
and low middle income countries in the Asia and Pacific regions. A number of reports (de
Savigny 2009; WHO 2009 ) have highlighted the lack of knowledge available to policy
makers and practitioners concerning tools and approaches that have proved useful in
addressing HRH challenges in similar contexts. Such knowledge serves to support informed
decision making and help countries prioritize the limited resources available for systems
strengthening. There is therefore a need to understand what tools work in specific settings
and to identify lessons from successful (and unsuccessful) reform efforts that can be applied
by countries with comparable objectives. However, assessing what constitutes a successful
HRH intervention and the extent to which it translates into enhanced management, team and
individual health worker performance that impacts upon health outcomes at community level
depends on coordinated approaches and efficient monitoring and evaluation systems.
Knowledge of successful HRH practice in maternal, neonatal and reproductive health
(MNRH) at community level is critical. Millennium development goal 5 (MDG 5) is the goal
towards which least progress has been made. Maternal mortality remains unacceptably high
in many developing countries, with 61% of women delivering alone or with an unskilled
attendant and access to reproductive health services including family planning remains
limited.(UNDESA 2009). The community is often the first point of contact women and their
families have with the health system and it is at the household level that the activities of the
health sector are ultimately directed (Wagstaff 2004). People centred health care is a key
principle of primary health care (PHC) and health workers and human resources for health
(HRH) management processes have an important role in ―enabling people to increase control
over, and to improve, their health‖ (WHO 1986). The community level has received renewed
attention due to the revitalisation of PHC. Primary health care reform has highlighted the
need to better link community level care with district level services (WHO 2008) improving
the support of HRH and strengthening referral mechanisms.
This literature review provides examples of lessons learned in the planning, implementation
and evaluation of HRH interventions in MNRH at the community level in the Asia and
Pacific regions. The review outlines interventions in the areas of HRH policy, management
and education and training. It synthesises what are considered effective ways of working with
the community and ways towards building supportive environments for health workers.
Important HRH experiences from countries that have made progress towards MDG 5 are
discussed as well as country experiences of scaling up HRH interventions in MNRH and
proposed models practice. Finally approaches to the assessment of individual health worker,
team and HRH management performance are presented in the context of health system
strengthening and the achievements of Millennium Development Goal 5 (MDG 5).
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