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

Malaysia
The sharp decline in maternal mortality in Malaysia from the 1930s from an MMR of nearly
1,500 per 100,000 live births to less than 58 in 2005 (UNDP 2007)(see figure 14) was the
result of a number of factors including the establishment and regulation of a new midwifery
cadre. Midwives were deployed as front-line community health workers to provide maternal
care and the numbers of midwives that were registered doubled in 1971 and slowly increased
over the next 10 years. In the late 1970s the eighteen month community midwife training was
upgraded and expanded to include child health and basic outpatient care. The cadre became
known as community health nurses (CHNs) raising their status and improving the range of
MNRH care and services at community level (Pathmanathan 2003).
Figure 30 Phases of Health Systems Development for Maternal Health as Related to
Reduction in Maternal Mortality Ratio,
(Pathmanathan 2003)
CHNs are supervised by certified nurse midwives (3 year basic training + 12 month
midwifery course) or public health nurses (additional 1 year training) (Pathmanathan 2003)
They used a competency-based approach, founded on protocols and manuals involving a
written supervisory checklist that covered facility maintenance, record keeping, and
interpersonal skills. Supervisors provide CHNs with regular on-the-spot feedback on clinical
and programmatic issues (Rizzuto 2002). Supervisory midwives provided support for CHNs
in emergency situations through either hands on clinical assistance or by facilitating referral
to hospital.
Midwifery practice at community level was guided by a manual of procedures and clinical
protocols produced in 1988. A colour coded risk approach for the referral of pregnant women
was implemented in 1983 and in-service management training using problem solving
approaches was used to overcome communication and attitudinal barriers between midwives
and nurses in rural services and hospital staff. Midwives also received in-service training in
clinical skills as well as in community mobilization. Despite a lack of evaluation studies
showing an impact upon referral it is likely that the HR interventions contributed to the
increase in the increase in hospital admissions for complicated cases (Pathmanathan 2003).
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