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

appendix 5 lists the numbers and references by country. This indicates a gap in knowledge
regarding training in Pacific Island countries. There is considerable literature on TBA
training with a lack of information available on professional midwifery training with the
exception of Indonesia. The majority of training courses focus on improving skilled
attendance at childbirth. There is a lack of information concerning competencies in
reproductive health.
Family Care International‘s (FCI) Skilled Care Initiative provides a useful example of the
implementation and evaluation of training within a comprehensive programme. This initiative
aimed to test and evaluate strategies to increase skilled attendance at childbirth in four rural,
underserved districts in Burkina Faso, Kenya, and Tanzania. The initiative included training
over 300 maternity care providers in routine maternal health services (e.g. antenatal care,
normal delivery care, and postpartum care), as well as essential obstetric skills, such as active
management of the third stage of labour, use of the partograph, infection prevention, and
management of obstetric complications (e.g. retained placenta, haemorrhage, abnormal
labour, incomplete abortion, etc.). Training was also provided in interpersonal
communication and counselling, with an emphasis on compassionate treatment of clients and
birth preparedness counselling. To reinforce the training and to address the lack of standards
and protocols, FCI worked with the Ministry of Health in each country to develop job aids
and clinical reference tools on obstetric care (FCI 2007; FCI 2007). The programme
evaluation employed a pre-test/post-test, quasi experimental design with purposively selected
comparison zones. In addition to survey instruments used to gather information from
managers facilities and clients, tools were developed to assess community level provider
training, qualifications, supervision, knowledge, and stated practises (FCI 2005).
Although the evaluation found improvements in the training and deployment of skilled
attendant cadres the shortages of skilled attendants had negative consequences for the
availability and quality of maternity care. The findings highlight the need for quality preservice
training programmes to ensure that essential competencies of a skilled attendant as
well as the need to address manpower shortages within the health system. The findings of the
FCI Skilled Care Initiative concur with other studies that conclude that competency alone
will not necessarily improve maternal health. Skilled attendants must be ―widely available,
they must be allowed to do what they are trained to do, and they must have logistical and
policy support ―(Carlough and McCall 2005).
Training appears to be a useful component of human resource strengthening however it is
difficult to draw conclusions from the multitude of studies into HRH training due to issues
with their quality particularly that of TBA training (Bergström 2001). Studies that linked
improvements in mortality and morbidity are suspect as they require large numbers to show
effect and there are many confounders. In addition training on its own is unlikely to bring
about sustained change in MNRH outcomes. This highlights the importance of training
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