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

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and agreeing on objectives and the structure, process and outcome criteria for each. In the second participants agreed on a final list of standards and criteria and the third workshop involved the selection of criteria to audit. This approach ensures ―buy in‖ from stakeholders and staff and ensures consensus and ownership which is probably conducive to the success of a performance management process. The development of indicators and those selected depends upon the objectives of the evaluation itself and the perspective taken. Approaches can range from a focus on the economic viability of the workforce, a management perspective health systems approach to the use of a human rights framework to assess practice such as that suggested by Thompson (2004). There appears to be a lack of focus on linking HRH performance to other aspects of health systems strengthening and the MDG indicators. P a g e | 169
Summary of findings This narrative synthesis has examined a range of peer reviewed and grey the literature in order to address the following questions: 1. What barriers and constraints inhibit HR practice in MNRH at community level? 2. How can MNRH health workers at community level be better supported to improve performance and deliver accessible evidence based interventions? 3. What HR approaches in MNRH at community level are practiced in countries that have made significant progress towards MDG 5a and 5b? 4. How can, or have these HR practices be scaled up? 5. What indicators might be used to determine the effectiveness of the community health workforce in MNRH in various settings? The key findings of this literature review are summarised below. HRH barriers and constraints A review of barriers found a lack of coordination, poor workforce planning and investment has resulted in chronic shortages of staff, poor workforce coverage and skill mix. In addition there are weak HRH policies, legislation and regulation, difficult working environments, a lack of HRH leadership and management systems, low clinical competencies, poor relationships with community members and weak community organisational structures. Supportive HRH approaches in MNRH at community level A number of examples have been drawn from the literature that highlight country experiences in the areas described below. Improving policy, legislation and regulation Strategies identified in the literature in this area include the provision of support for the development of HRH policy, models of HRH policy at community level, accreditation of education and training programmes, licensing of facilities, legal mechanisms to support task shifting to community health workers and TBAs, ethical standards of practice. Strengthening Management and leadership Examples of successful HRH management practice include the establishment of performance management systems, models of supportive supervision, the development of appropriate job descriptions. In addition examples of practice in the following areas are identified: career pathways, workforce planning, selection and recruitment, task shifting, substitution and delegation, development of new cadres, remuneration, incentives, HRH information systems, leadership support and training. P a g e | 170
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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
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Facilitation & attendance at MOH/ N
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of community leaders improved the c
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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 149 and 150: A technical meeting in Bangkok in 2
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Page 153 and 154: flexibility in order to overcome ge
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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
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Page 165 and 166: prevalence rate, however in order t
Page 167 and 168: (Dieleman 2006) Selected key indica
Page 169: In order to determine the answers t
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
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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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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
Page 215 and 216: University South Africa with the Re
Page 217 and 218: Cruse, D. (1997). Community Health
Page 219 and 220: 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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