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 coincided with contextual factors which significantly impacted upon the scale up. These included the economic crisis of 1997 which precipitated the introduction of social safety-net program for the poor and in 2003, decentralisation led to an increase in district level decision making (Utomo 2008). The programme modifications included lengthening the pre service midwife training and providing short in-service training and skills-based retraining (McDermott, Beck et al. 2001). Management practices were improved including performance management which incorporated supervision and career development (Hennessy, Hicks et al. 2006; FK-UGM/WHO 2009). Financial incentives were found to be sufficient to retain midwifes in remote areas although non financial reasons affected their relocation to these settings once established with their family (Ensor, Quayyum et al. 2009). Financial incentives were introduced for TBAs to encourage referral to midwives (Analen 2007). A Workload Indicators of Staffing Need (WISN) approach was introduced to improve work force planning and management in the newly decentralised context (Kolehmainen-Aitken 2009). This bottom up approach began with health centre midwives. Midwife training and selection was also improved led to better coverage and competence. (UPCD 2003; Hennessy, Hicks et al. 2006). These changes were made along with the development of EmOC, audits, and introduction of a comprehensive health policy in 2001that included a making pregnancy safer strategy (Utomo 2008). Figure 32 Examples of structural and economic changes in Indonesia which impacted upon improved HRH performance Village midwifery programme: Indonesia Structural changes Advocacy & leadership: safe motherhood seminars in the mid-1990s involving President Suharto, HRH coverage: SBA% increased from 34 to 62% by 1998 Improved education and skills: pre & in-service competency based Monitoring & evaluation: clinical audits used to assess performance Policy : MPS strategy 2001 Management Practice: National MoH midwife training & placement plan, Clinical Performance Development and Management System for Nurses and Midwives, WISN tool for workforce planning Community participation: Village Integrated service post (posyandu) Economic changes Increased financial resources & coordination of finances : Extended salary support & formalised administrative oversight eased the transition to private practice Procurements of drugs, equipment etc: District control through decentralization Areas that require strengthening: clinical & communication training, mentoring & supervision, job description, ensuring adequate case loads, HIS on private providers & legality of solo private nurse providers (Shankar, Sebayang et al. 2008; Utomo 2008; Heywood and Harahap 2009) There are some key lessons that can be learned from the Indonesian village midwife scale up effort. Shankar (2008) groups these into ―essential elements and monitoring points for scaling P a g e | 153
up skilled birth attendance‖. These and other elements are included in the figure 32 below. There are similarities with the UNFPA ICM model (2006) for scaling up community midwives with an emphasis on the pertinent HR aspects of certification, supervision, clear responsibilities and realistic workload. Community participation and engagement contribute to the enabling environment which is further supported by political and economic reform brought about by resource mobilisation and effective management and leadership. On-going monitoring and evaluation facilitates the modification of programmes to suit the changing environment contributing to the sustainability of interventions. Indonesia‘s experience shows that HRH efforts must be coordinated with an efficient health information system, financial commitment, the appropriate supply of medical products, vaccines and technologies, quality service delivery and leadership and governance. Shankar emphasises a systems top down and bottom up approach. This highlights the need for support from the existing health system in order to accommodate expansion that ensures quality as well as equity. Figure 33 Essential elements and monitoring points for scaling up skilled birth attendance Clear scope of practice Political & economic commitment Community participation Certification Quality Training Health systems approach to Scaling up HRH at community level in MNRH Realistic workload Supervision Monitoring & evaluation system Stewardship, resource mobilisation & management Adapted from (Shankar, Sebayang et al. 2008) and (UNFPA ICM WHO 2006) Midwife deployment at community or facility level? Koblinsky et al have undertaken modelling to investigate the most efficient approach to the deployment of SBAs (2006). Six scale up options were investigated and are outlined at figure 15. The results suggest that teams of midwives and midwife assistants working in facilities would be a more efficient means of rapidly increasing coverage rather than solo providers working in homes with assistants. They propose that this team approach will increase coverage by up to 40% by 2015. The paper argues that this can be a cost effective approach when case loads are high at the health centre level making it a less expensive option than home based births and normal delivery at hospital. This scale up would require investment in health centres and probably involve the move of midwifery staff from community to facility level. However a study in Matlab, Bangladesh, has provided evidence favouring a P a g e | 154
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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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files suggests that more careful at
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Management autonomy at community le
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Initiative focus Details Context Re
Page 103 and 104: informal, mutual-help action groups
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Page 109 and 110: Summary This section has identified
Page 111 and 112: encouraging midwives to proactively
Page 113 and 114: Facilitation & attendance at MOH/ N
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Page 117 and 118: Table 19 Examples of initiatives in
Page 119 and 120: information and advice from peers (
Page 121 and 122: esources to provide clinical and ma
Page 123 and 124: Strengthening Education and compete
Page 125 and 126: Table 20 Examples of Partnership ap
Page 127 and 128: Table 21 Learner needs analysis and
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
Page 145 and 146: Malaysia The sharp decline in mater
Page 147 and 148: although supplemented with epidemio
Page 149 and 150: A technical meeting in Bangkok in 2
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Page 153: flexibility in order to overcome ge
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Page 161 and 162: Figure 37 Critical success factors
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Page 167 and 168: (Dieleman 2006) Selected key indica
Page 169 and 170: In order to determine the answers t
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
Page 177 and 178: outlines how the HRH information ba
Page 179 and 180: communities. A collaborative approa
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
Page 199 and 200: Appendix 4: Barriers and Constraint
Page 201 and 202: Area Barriers & constraints in MNRH
Page 203 and 204: 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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