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

Experiences from some countries in the Asia and Pacific regions provide some lessons for
practice. Indonesia has gained some success in increasing midwife numbers through mass
training efforts. The country increased its village midwife coverage from 15 000 in 1991, to
54 000 by 1997. This represents a ratio of one village midwife per 2389 population, or
roughly one per 54 births per year which exceeds international recommendations of one
midwife per 175 births (Hatt, Stanton et al. 2007). A competency based training programme
was developed and then subsequently improved through the provision of short in-service
training and skills-based retraining and lengthening the course for new midwives
(McDermott, Beck et al. 2001).
Scaling up basic training of health workers needs to include essential competences, skills, and
attitudes that can be adapted to fit changing needs and burdens of disease. This also requires
greater investment in training schools and educators and tutors alongside innovative and
pedagogically rigorous curriculum and processes (WHO 2007). In service or continuing
professional development needs to be linked to regular certification and accreditation of
providers to ensure maintenance of competencies and accountability (Koblinsky, Matthews et
al. 2006)
Crisp et al outline some broad factors on scaling up education and training of health workers
across all areas not just MNRH based the experience of ten countries that have or are
implementing, a large-scale increase in their overall health workforce, or of a specific cadre
(Crisp and Sharp 2008). These are listed in at figure 37 below. Political support, leadership,
stakeholder commitment and financial investment are necessary to ensure the implementation
of a plan of scaling up education and training. An information system is necessary in order to
assess progress and make modifications which all need to be managed effectively. In addition
the labour market must be considered so that staff is able to be absorbed and retained.
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