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

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;
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