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

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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 P a g e | 175
outlines how the HRH information base may be strengthened, and how success might be assessed in terms of HRH performance and beyond. This highlights key recommendations for planning, implementing and evaluating HRH practice in MNRH at community level. Improving the quality of community level HRH information HRIS systems and community level information HRH information concerning those working in MNRH at community level is not comprehensively available from one source and the quality of the information is variable. This suggests that community level HRH information is not routinely collected in a consistent manner which highlights the need for standard indicators and improved reporting procedures. Such indicators could augment a national human resources for health information system (HRIS) and provide a more accurate picture of the current situation at community level so that additional resources can be properly justified. Indicators could be drawn from the main HRH components or areas of HRH interventions at community level. These areas are: Policy, regulation and legislation Management and leadership Education and competencies Supportive working environments Working with the community HRH indicators that have been suggested by a number of authors are collated below in figure 41. These include quantitative and qualitative indicators and are categorised under the first three main headings with indicators concerning supportive working environments and working with the community woven through the list. Figure 41 Indicator fields for HRH in MNRH at community levels P a g e | 176
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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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information and advice from peers (
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esources to provide clinical and ma
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Strengthening Education and compete
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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 and 164: Health system standards are explici
Page 165 and 166: prevalence rate, however in order t
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: Discussion and Recommendations What
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
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
Page 221 and 222: Flanagan, D., Williams, C., Mahler,
Page 223 and 224: Greenwood, A. M., Bradley, A.K., By
Page 225 and 226: 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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