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

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there are a number of approaches that may potentially be of use in HR in MNRH at community level and deserve attention and piloting in this context. The various approaches are outlined in the table below. These can be grouped according to three methods of collaboration, expansion and replication (Cooley 2006) as well as vertical, horizontal or combined approaches to scaling for sustainability (WHO 2008). Table 25 Scaling up approaches that have applicability for HR in MNRH at community level Scaling up approach Methodology / HR focus Applicability at community level in MNRH Reference Improvement Collaborative (IC) Collaborative QA of norms of training, job aids, material and equipment, supervision Network of community members & providers form a collaborative mgt. structure to deliver MNRH & monitor performance (Bornstein 2007) Management Systems International Framework Structured and planned approach with M&E & advocacy Community based approach in RH education piloted participants must have key skills (Cooley 2006) Expandnet/ WHO approach 9 step plan involving choices of types of scaling up, dissemination & advocacy plan, consideration of organizational process, costs, resources mobilization, M&E Analysis of team at community level may lead to training, linking to reforms, working with leaders to gain acceptance, plans to address HR shortages (WHO 2008) MSH Change Approach Based on diffusion of innovations Change agents necessary at community level (MSH 2007 ) CARE India‘s IDEAS model Emphasizes explicit, institutionally grounded strategy for replicating a tested, validated innovation Need to involve leaders and champions at community level, social learning key (Bailey 2005 ) Van Damme ART models Model A: No change to delivery model or HRH base ART scale-up gets increased funding and priority Continued use of nurses & midwives in PMTCT activities (van Damm 2008) Model B: Change in service model B1. focus on task shifting to lower cadres B2: lay providers or expert patients would take on much of the work CHW and community personnel take on the bulk of work in PMTCT ECR Capacity Development Emphasizes Human capital, Public sector institutional context, Networks and linkages, Social capital and community participation, Human resources policy reform. Policy reform must consider community level in PMTC (FHI 2009) P a g e | 147
A technical meeting in Bangkok in 2007 concerning scaling up high impact family planning/MNCH best practices in the Asia/ Near East Region presented various methodologies for assisting countries in their scaling up efforts. These included the Improvement Collaborative approach (IC), Management System International (MSI) and the Expandnet/WHO‘s model. These are discussed below. The Improvement Collaborative approach is an organized network of a large number of sites (e.g. districts, facilities or communities) that work together in teams for a limited period of time, usually 9 to 24 months, to rapidly achieve improvements in a focused topic area through shared learning and intentional spread methods (Nicholas 2007). This can involve joint ventures, alliances or communities of practice approach. The system, processes, quality and efficiency of care are the focus of improvement which involves training, monitoring and supervision. Bornstein (2007) gives an examples of CI in practice in EONC Niger. This involves the linking of the community level with the facility level and national policies and plans. Activities in the community to increase demand and access to EONC were connected with HRH procedures that enabled Referral and counter-referral, EONC continuous quality improvement teams and the Adaptation of services to the cultural needs of patients and families. Management System International (MSI) is an expansion method that involves a three step strategic management framework for scaling up. This has been applied to scaling up successful innovations by NGOs in reproductive health in India, Nigeria and Mexico. Toolkits have been developed on Assessing Scalability, Advocacy for Scaling Up, Monitoring and Evaluation for Scaling Up (forthcoming), Building Scaling Up into Pilot Project Design (forthcoming). The Expandnet/WHO approach is based on four key elements regarded as necessary for scaling up. They are: the innovation (novel approach), the resources team (the staff), the scaling up strategy (could include HRH strategies) and the user organisation. According to this framework a number of skills are needed by the team to scale up interventions. These are: health programme and policy analysis; research, monitoring and evaluation; management and organization development; human resource development, training and curriculum development; participatory approaches; clinical skills; P a g e | 148
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Human Resources for Health in Mater
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What human resource practices in ma
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Collaboration with traditional and
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Acronyms AAAH Asia and Pacific Acti
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TBA T & L UNFPA UNICEF UOG UPNG USA
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Figure 34 Potential gain in percent
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Executive Summary Addressing the ba
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Introduction What human resource pr
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Review Questions 1. What HR approac
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Effective HRH practice and quality
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is no single prescribed set of ways
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Table 3 Classification of health ce
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Figure 5 Millennium Development Goa
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(UNICEF 2007) However, the road to
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A number of steps are purported to
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Figure 10 Overview of HRH at commun
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functions, the latter involving mob
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settings‖(ICN 2009). They may be
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Table 7 What Skilled attendants can
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Traditional healers may also be inv
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Methodology What human resource pra
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Table 9 Search terms used for the s
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findings. Differences and similarit
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Barriers and constraints to HRH pra
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PHEs. In the Pacific the density of
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partum services as being from 1:60
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husbands who oppose family planning
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Remuneration for CHWs, nurse and mi
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Supportive HRH strategies and appro
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Strengthening HRH policy legislatio
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Strategies to improve Human resourc
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there are interrelationships betwee
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Table 11 Tools for managing HR in M
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Performance management Effective ma
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The Health and Family Planning Mana
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as a guide to mentoring, delegation
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eceived from outside the routine pu
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The isolated nature of much communi
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progress over time. This tool and t
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At national level, countries may ha
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evaluating and adjusting the size a
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There are a number of difficulties
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Figure 23 The Task Shifting Process
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Substitution Substitution is differ
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which was developed in 2002. This w
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al. 2008). Dual practice is another
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Figure 24 Motivational determinants
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Many of the incentives to health wo
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Page 109 and 110: Summary This section has identified
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Page 121 and 122: esources to provide clinical and ma
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Page 129 and 130: Table 22 Some approaches to the des
Page 131 and 132: Participants/ Method / document typ
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Page 135 and 136: Participants / context LMICs method
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Page 139 and 140: Country / cadre Niger: Birth attend
Page 141 and 142: Country / cadre Indonesia Surabaya
Page 143 and 144: Lessons learned from countries that
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Page 157 and 158: Scaling up of the Navrongo service
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Page 161 and 162: Figure 37 Critical success factors
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Page 171 and 172: Summary of findings This narrative
Page 173 and 174: Health worker performance is theref
Page 175 and 176: Discussion and Recommendations What
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Page 181 and 182: Table 29 Examples of HRH performanc
Page 183 and 184: Appendices Appendix 1. MDG5 Country
Page 185 and 186: World Health Statistics http://www.
Page 187 and 188: Appendix 3. Sources of all material
Page 189 and 190: Data source Keywords used in search
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Appendix 4: Barriers and Constraint
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Area Barriers & constraints in MNRH
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Area Barriers & constraints in MNRH
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Appendix 5 Literature that document
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P a g e | 206
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IMNCI PMTCT Perinatal Period Postna
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Ambegaokar, M., Lush, L. (2004). "F
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Barrett, B., J. Ladinsky, et al. (2
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University South Africa with the Re
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Cruse, D. (1997). Community Health
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Elson, D., Evers, B. (1998). Sector
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Flanagan, D., Williams, C., Mahler,
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Greenwood, A. M., Bradley, A.K., By
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Howard, G., Bogh, C., Goldstein, G.
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Jhpeigo (1998). Participatory techn
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Kroll, D., Dwyer, D. (1994). "Postn
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Manandhar, D. S., D. Osrin, et al.
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Morisky, D. E. (1985-86). "Evaluati
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O‘Brien-Pallas, L., Irvine, D., P
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Pfeiffer, J. and J. Pfeiffer (2003)
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Replogle, J. (2007). "Training Trad
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Shankar, A., S. Sebayang, et al. (2
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Teela, K. C., L. C. Mullany, et al.
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van Damm, W., et. al (2008). "Scali
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WHO (2008). Global Standards for In
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