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

Lessons learned from countries that have reduced MMR
Experience has shown that improvements in maternal, newborn, and child health outcomes in
Iran, Malaysia, Sri Lanka, Thailand and China, and from projects in countries such as
Tanzania and India have been the result of the incremental delivery of integrated evidence –
based packages of cost-effective health-care implemented in accordance with the capacity of
health systems (Ekman, Pathmanathan et al. 2008). However, there has been little
examination of the HRH implications and responses at community level that have contributed
to the improvement of MNRH outcomes in these contexts. This knowledge may provide
important strategies for decision makers that can be transferred or modified for use in other
settings.
Sweden
In the 19 th and 20 th centuries many countries that are now considered to be developed saw a
marked drop in maternal mortality rates. In Sweden innovative HRH practices contributed to
rapid declines in comparison to other countries such as the UK (Högberg 2004). Midwife
training was improved and their status elevated so that midwives and doctors provided
complementary roles in maternity care. In addition midwives were involved alongside
doctors in setting public health policy which led to the registration and licensing of midwifery
practice. An increase in the coverage of well trained, regulated and empowered midwives at
community level meant that midwives were able to provide emergency obstetric and neonatal
care when doctors were not available. Midwifery coverage was based on providing adequate
care to an appropriate number of women balanced alongside geographical, cultural and
financial concerns. The professionalization of community midwifery was enhanced by a
system of supervision and continuing education. Midwives were required to regularly report
to the county GP where an audit of practice was undertaken. Midwives were specially
selected for their connections with the community and ability to bring about ―modernisation‖
(Van Lerberghe 2001).There was also some monitoring of TBA practice in the nineteenth
century several TBAs were prosecuted for providing unauthorised help during child birth
(Romlid 1998) in (Högberg 2004).
Japan
Japan also made rapid progress in curbing maternal mortality in the mid twentieth century.
Aiiku-Han activities at the community level helped to improve the planning and
administration of MCH services. Aiihu-Han activities were initiated by the Imperial Gift
Foundation in Japan in 1936. These highly organised activities involve a range of human
resources in the collection and dissemination of information and provision of education on
family planning and MCH. Key features are hierarchical training, reporting and supervision.
Housewife volunteers report to a community worker, who is in charge of 10 volunteers. They
in turn report to the community unit leader, who supervises 5-6 community workers. The unit
leader is accountable to the community leader, who is in charge of 10-20 unit leaders and the
community leader conveys information to public health officials or health professionals such
as midwives. (Hirayama M 1993).
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