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

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Indicators of HRH performance have been defined as ―a measurable variable (or characteristic) that can be used to determine the degree of adherence to a standard or the level of quality achieved‖ (QAP 2009). In addition to providing important information for benchmarking and ensuring patient safety indicators and technical or clinical practice they can be used health service managers to help establish appropriate staffing levels and training needs to make certain that available resources are used in the most suitable way. HRH indicators also provide comparisons between different components of a health system (Hornby 2002). Indicators can be understood in terms of the three levels (structure, process and outcome) upon which health care quality can be assessed (Donabedian 1988). Hornby and Forte provide a more detailed model that is specific to HRH (2002) which is outlined in the diagram below. HRH indicators on the structural level are concerned with the attributes of the setting, what resources are available and the needs. These include the skill mix of the staff, the available numbers of staff in relation to the case load and population, the associated staff costs in relation to the total health expenditure. These indicators are key inputs in the HRH system. Process level HRH indicators are concerned with efficiency. This includes the organisational environment in which people work had how it affects how people deliver care and services as well as how efficiently HRH are utilised in the service. At the individual health worker level this denotes the efficiency of care and services such as case management and patient satisfaction. This process area, although not discussed includes task performance measurement which focus on technical aspects and contextual performance of tasks outside core job practice such as involvement in village health committees (VHCs) (Michie 2003). Team and individual performance measures can also be included in this dimension. Figure 38 Aspects of HRH Indicators (Hornby 2002) Hornby and Forte include indicators to denote the outputs or results of interventions and changes in the system. These indicators give an indirect picture of the effect of how health is affected by HRH. They give the example of trained nurses/ midwives per 1000 live births (Hornby 2002) another could be the percentage of births attended by skilled health personnel. These indicators have strong links with health outcomes such as MMR or the contraception P a g e | 163
prevalence rate, however in order to make them more impact focused a comparison needs to be made involving health outcomes and the workforce. For example using Hornby and Forte‘s logic, an HRH outcome indicator might be the contraception prevalence rate in relation to family welfare workers staff employed in India or adolescent fertility rate in relation to number of PHEs. This combines population based data with service based data. HRH indicators have been categorised according to 12 key areas listed below and a possible array of indicators were developed from this at a WHO meeting in 1997 (Hornby 2002). Figure 39 Main HRH indicator categories (Hornby 2002) Indicators can also be developed from areas used for bases line assessment of HRH. MSH tools such as the Human Resources Management Rapid Assessment Tool for Public and Private Sector Health Organisations (2003) assess HRH according in six areas outlined in the diagram below. P a g e | 164
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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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Building relationships with cultura
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groups; encouraging recruitment thr
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Summary This section has identified
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encouraging midwives to proactively
Page 113 and 114: Facilitation & attendance at MOH/ N
Page 115 and 116: of community leaders improved the c
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
Page 137 and 138: alongside health service improvemen
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 149 and 150: A technical meeting in Bangkok in 2
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Page 153 and 154: flexibility in order to overcome ge
Page 155 and 156: up skilled birth attendance‖. The
Page 157 and 158: Scaling up of the Navrongo service
Page 159 and 160: conditions (Walt, Perera et al. 198
Page 161 and 162: Figure 37 Critical success factors
Page 163: Health system standards are explici
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
Page 205 and 206: Appendix 5 Literature that document
Page 207 and 208: P a g e | 206
Page 209 and 210: IMNCI PMTCT Perinatal Period Postna
Page 211 and 212: Ambegaokar, M., Lush, L. (2004). "F
Page 213 and 214: 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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