Human Resources for Health in Maternal, Neonatal and - HRH ...
Human Resources for Health in Maternal, Neonatal and - HRH ...
Human Resources for Health in Maternal, Neonatal and - HRH ...
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A number of modifications were made to the programme (summarised at figure 31) which<br />
co<strong>in</strong>cided with contextual factors which significantly impacted upon the scale up. These<br />
<strong>in</strong>cluded the economic crisis of 1997 which precipitated the <strong>in</strong>troduction of social safety-net<br />
program <strong>for</strong> the poor <strong>and</strong> <strong>in</strong> 2003, decentralisation led to an <strong>in</strong>crease <strong>in</strong> district level decision<br />
mak<strong>in</strong>g (Utomo 2008). The programme modifications <strong>in</strong>cluded lengthen<strong>in</strong>g the pre service<br />
midwife tra<strong>in</strong><strong>in</strong>g <strong>and</strong> provid<strong>in</strong>g short <strong>in</strong>-service tra<strong>in</strong><strong>in</strong>g <strong>and</strong> skills-based retra<strong>in</strong><strong>in</strong>g<br />
(McDermott, Beck et al. 2001). Management practices were improved <strong>in</strong>clud<strong>in</strong>g per<strong>for</strong>mance<br />
management which <strong>in</strong>corporated supervision <strong>and</strong> career development (Hennessy, Hicks et al.<br />
2006; FK-UGM/WHO 2009). F<strong>in</strong>ancial <strong>in</strong>centives were found to be sufficient to reta<strong>in</strong><br />
midwifes <strong>in</strong> remote areas although non f<strong>in</strong>ancial reasons affected their relocation to these<br />
sett<strong>in</strong>gs once established with their family (Ensor, Quayyum et al. 2009). F<strong>in</strong>ancial <strong>in</strong>centives<br />
were <strong>in</strong>troduced <strong>for</strong> TBAs to encourage referral to midwives (Analen 2007). A Workload<br />
Indicators of Staff<strong>in</strong>g Need (WISN) approach was <strong>in</strong>troduced to improve work <strong>for</strong>ce plann<strong>in</strong>g<br />
<strong>and</strong> management <strong>in</strong> the newly decentralised context (Kolehma<strong>in</strong>en-Aitken 2009). This<br />
bottom up approach began with health centre midwives. Midwife tra<strong>in</strong><strong>in</strong>g <strong>and</strong> selection was<br />
also improved led to better coverage <strong>and</strong> competence. (UPCD 2003; Hennessy, Hicks et al.<br />
2006). These changes were made along with the development of EmOC, audits, <strong>and</strong><br />
<strong>in</strong>troduction of a comprehensive health policy <strong>in</strong> 2001that <strong>in</strong>cluded a mak<strong>in</strong>g pregnancy safer<br />
strategy (Utomo 2008).<br />
Figure 32 Examples of structural <strong>and</strong> economic changes <strong>in</strong> Indonesia which impacted upon<br />
improved <strong>HRH</strong> per<strong>for</strong>mance<br />
Village midwifery programme: Indonesia<br />
Structural changes<br />
Advocacy & leadership: safe motherhood sem<strong>in</strong>ars <strong>in</strong> the mid-1990s <strong>in</strong>volv<strong>in</strong>g<br />
President Suharto,<br />
<strong>HRH</strong> coverage: SBA% <strong>in</strong>creased from 34 to 62% by 1998<br />
Improved education <strong>and</strong> skills: pre & <strong>in</strong>-service competency based<br />
Monitor<strong>in</strong>g & evaluation: cl<strong>in</strong>ical audits used to assess per<strong>for</strong>mance<br />
Policy : MPS strategy 2001<br />
Management Practice: National MoH midwife tra<strong>in</strong><strong>in</strong>g & placement plan, Cl<strong>in</strong>ical<br />
Per<strong>for</strong>mance Development <strong>and</strong> Management System <strong>for</strong> Nurses <strong>and</strong> Midwives,<br />
WISN tool <strong>for</strong> work<strong>for</strong>ce plann<strong>in</strong>g<br />
Community participation: Village Integrated service post (posy<strong>and</strong>u)<br />
Economic changes<br />
Increased f<strong>in</strong>ancial resources & coord<strong>in</strong>ation of f<strong>in</strong>ances : Extended salary support &<br />
<strong>for</strong>malised adm<strong>in</strong>istrative oversight eased the transition to private practice<br />
Procurements of drugs, equipment etc: District control through decentralization<br />
Areas that require strengthen<strong>in</strong>g: cl<strong>in</strong>ical & communication tra<strong>in</strong><strong>in</strong>g, mentor<strong>in</strong>g &<br />
supervision, job description, ensur<strong>in</strong>g adequate case loads, HIS on private providers<br />
& legality of solo private nurse providers<br />
(Shankar, Sebayang et al. 2008; Utomo 2008; Heywood <strong>and</strong> Harahap 2009)<br />
There are some key lessons that can be learned from the Indonesian village midwife scale up<br />
ef<strong>for</strong>t. Shankar (2008) groups these <strong>in</strong>to ―essential elements <strong>and</strong> monitor<strong>in</strong>g po<strong>in</strong>ts <strong>for</strong> scal<strong>in</strong>g<br />
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