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

Rationale and definitions
Purpose of this literature review
Millennium Development Goal (MDG) 5 commits the international community to reducing
maternal mortality by three-quarters and ensuring universal access to reproductive health by
2015. Despite the evidence-based interventions required to improve maternal and
reproductive health being well established, MDG 5 is the goal towards which least progress
has been made. Maternal mortality remains unacceptably high in many developing countries,
with 61% of women delivering alone or with an unskilled attendant, and access to
reproductive health services including family planning remains limited (UNDESA 2009).
Human and financial resource interventions have the potential to address a large part of the
maternal health burden (Prata, Sreenivas et al. 2009) and therefore evidence concerning what
works is urgently required by countries. The purpose of this review is to identify evidence of
effective community based human resources (HR) practices in maternal, newborn and
reproductive health (MNRH) that enable HRH to deliver quality MNRH services and care
and thereby contribute to the achievement of MDG 5.
The need for this review
The return to PHC has signalled a renewed interest in service delivery in community settings
and highlights the challenges to delivering quality MNRH care and services. One major
health system bottleneck is human resources. Although research in HR for the provision of
basic MNRH care at this level is limited, it depicts a context where staff are often unequally
distributed across communities, imbalances occur in the available skills mix, and there are
high levels of staff turn-over, poor remuneration and a lack of leadership. Specialist services
for quality emergency obstetric care are rarely available in communities and cannot be
provided by existing human resources for health (HRH) due to poor technical knowledge,
lack of equipment and commodities, legislative restrictions, and the inaccessibility of health
facilities for efficient referral.
Details of the strategies and approaches that have been adopted to address these HRH issues
at community level, and the effect they have had on the quality of MNRH care and services,
are not readily available to decision makers. There is a need to identify, synthesize and
disseminate what is currently known about the roles, competencies, management, coverage
and working environment of HRH in resource poor settings. This information will provide
policy makers with evidence about best practice and what strategies may be the most
appropriate to adopt in their own context so that communities can access basic MNRH care
and services. Such knowledge will also inform a research agenda in this area.
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