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

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community-based maternity-care delivery system. In this study maternal mortality decreased in intervention sites where number of skilled attendants increased, together with development of a referral chain and basic essential obstetric care (BEOC) facilities (Ronsmans 1997). The challenge is to retain a balance between ensuring access to care at community level where it is difficult to attract and retain staff and providing links to expensive tertiary facilities that require highly trained and well paid cadres. Figure 34 Potential gain in percentage of skilled care at delivery under six scale up options: MW=midwife. MA=midwife assistant (Koblinsky, Matthews et al. 2006) This modelling and the experience of countries highlight the need for the scale-up of SBA care and services at community level to be driven by evidence gathered through monitoring and evaluation. As each community is unique scale up options should be easily modifiable to suit each context. The costs and benefits of scaling up should be weighed up for each location in comparison to other approaches, such as facility-based birth care. Scaling up other workers at community level The need to be sensitive to context in scaling up endeavours is also central to the success of CHW programmes. However Sundararaman (2007) points out the enormous difficulties in gathering data concerning the scale up and sustainability of programmes such as the Mitanin initiative in India. Evaluation of selection, training of Mitanins and community mobilisation activities was undertaken but community baselines, controls or sufficient sample sizes were not available to measure success against. In addition the diverse training, roles and working environments of CHWs can lead to a range of outcomes. A number of countries have grappled with these issues and successfully scaled up care and services at community level. These experiences can provide guidance for others. P a g e | 155
Scaling up of the Navrongo service model The experience of Ghana demonstrates how strategies tested in the successful Navrongo experiment helped to guide national health reforms that resulted in the community-based Health Planning and Services (CHPS) initiative that has been rolled out across all districts in the country. CHPS involves mobilizing volunteerism, resources and cultural institutions in order to support community-based primary health care. HRH are central to the success of these initiatives which hinge on mobile resident nurses delivering care in villages rather than outreach or facility based services. In response to poor services at community level, which was mostly due to the location of community health nurses (CHNs) in health clinics, the Navrongo experiment involved retraining, renaming and recertifying CHNs as Community Health Officers (CHOs). These resident health care providers worked out of health compounds that were donanted and constructed by the community. This accessible nursing care reduced childhood mortality by 16 percent during the five years of program implementation (Pence 2005). The CHPS adaption of this service model emphasises community mobilisation, ownership and the use of community structures for service delivery. The District Health Management Team (DHMT) and community leaders are responsible for the support and supervision of the CHO who travel from compound to compound via motorcycle providing care to approximately 3000 people with the assistance of community volunteers (Nyonator, Awoonor-Williams et al. 2005). The principles of organisational change guided the process of scale up which was based on six objectives (Nyonator, Awoonor-Williams et al. 2005) which are listed at figure 34. Community and health sector partnership is central to each. The process involved consensus building, community ownership, health sector support at all levels, the engagement of advocates to facilitate change, the communication of success stories which helped to establish the credibility and feasibility of the initiative. Figure 35 Key components of the CHPS initiative DHMT & community planning Community liaison Community compound CHO posting Essential equipment Volunteer deployment P a g e | 156
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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
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informal, mutual-help action groups
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Page 109 and 110: Summary This section has identified
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Page 117 and 118: Table 19 Examples of initiatives in
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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
Page 145 and 146: Malaysia The sharp decline in mater
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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
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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
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
Page 205 and 206: 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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