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

There are two key areas under which the findings of this literature review can be discussed
and from which recommendations emerge. The first area is concerned with the findings that
have emerged from the experiences of countries that have made progress towards MDG5 and
those that have successfully scaled up health workers at community level in MNRH. These
experiences highlight the need for investment in HRH at community level. The literature
review has also drawn attention to successful HRH practices which shed light upon the
complex nature of planning, implementing and evaluating HRH. This raises a number of
implications for HRH practice and the need for a more inclusive and comprehensive
approach that is informed by evidence.
Investment at community level
Evidence based long term workforce planning, management and financial investment is
necessary in the provision of MNRH care and services at community level. The finding of
this review show that nations who have made significant progress towards MMR have
invested in HRH at community level however in some countries such as Thailand and
Malaysia this has led over time to a trend towards facility based services. This relocation of
services from communities is often accompanied by the move of public sector community
based workers to facilities or the private sector. This requires considerable financial
investment which may not be viable in many resource poor countries. In PNG disinvestment
at community level has resulted in the closure of community health aid posts requiring
women to travel to facilities which may have contributed to the increase in maternal deaths.
However there are plans to re focus attention at community level. Countries such as
Indonesia have concentrated on the community level however the village midwife
programme‘s emphasis on outreach services at the woman‘s home, has meant that the
providing access to emergency obstetric care in hospitals has remained relatively neglected
(Hatt, Stanton et al. 2007). Clearly appropriate attention needs to be given to both community
and facility level. Expanding access to basic obstetric care by upgrading existing lower level
facilities, increasing availability of such facilities, and improving emergency referral systems
may be more cost-effective in achieving widespread coverage than focusing on increasing
hospital-based births.(Stanton, Blanc et al. 2006).
Towards a comprehensive approach to enhancing HRH practice in MNRH
The achievement of improved reproductive, newborn and maternal health outcomes is reliant
on effective HRH performance and quality MNRH service delivery. Yet, despite the
importance of the relationship between HRH and MNRH care and services, there is little
discussion concerning the complex interaction of the components of effective HRH and
quality MNRH practice at the various levels. This includes an examination of contributing
factors such as socio-cultural norms, health system structures, and ideologies that impact
upon the accessibility, acceptability and quality of health services. An improved
understanding of the interaction of these factors may enhance efforts to undertake a
comprehensive approach to planning, implementing and evaluating health care. However a
solid understanding of the context of HRH is necessary for effective decision making in this
area which is dependent on the availability of quality information or evidence. This section
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