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

alongside health service improvement (Carlough and McCall 2005; Sibley 2007). Training
does not take place in a vacuum and there are considerable socio-cultural aspects related to
the provision of MNRH care and services. This indicates the need to involve all health
workers including cultural workers such as TBAs who may serve as a valuable adjunct to
healthcare delivery (Townsend 1986). Effective health programmes are multi faceted and
include other interventions that along with contextual factors work together to affect health
outcomes. The challenge is to identify what HRH interventions work together in particular
contexts to improve health worker performance.
Interventions and evidence
The complexity of the context into which HRH interventions are delivered into makes it
difficult to undertake research studies to ascertain the evidence based for certain
interventions. According to Grobler there are no studies in which bias and confounding are
minimised to support any of the interventions that have been implemented to address the
inequitable distribution of health care professionals. He calls for well-designed studies to
confirm or refute findings of various observational studies regarding educational, financial,
regulatory and supportive interventions that may influence health care professionals' choice
to practice in underserved areas (Grobler 2005). However quantitative studies such as
randomised control trails may not always be the most appropriate to determine the outcomes
of HRH interventions. Mixed methods are probably more useful as they provide insight into
the ways in which the context (political, socio-cultural) interacts with HRH interventions,
tools and approaches. HRH needs to be understood within the health system setting and the
level of functionality of this system and work environment. This whole of context perspective
includes the context of health system reform where changes in financial management and
market forces may be taking place alongside decentralisation.
Raffety et als report (2005) summarises what is known about the relationship between human
resources and organisational performance. They quote several broad findings from research
studies in the business sector that identify practices that contribute to performance these
include seven HR policies
Employment security.
Careful recruitment.
Teamwork and decentralisation.
High pay with an incentive element.
Extensive provision of training.
Narrow status differentials and barriers.
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