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

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Policy / regulation / Legislation Presence of national and district HRH policy that addresses community level & MNRH workers in private & non state sector Presence of job classification system that includes community cadres & service functions Compensation & benefits system used in a consistent manner to determine salary upgrades & awards Formal processes for recruitment, hiring, transfer, promotion , disciplinary actions Employee conditions of service documentation (e.g., policy manual) Presence of a formal relationship with unions (if applicable) Registration, certification, or licensing is required for categories of staff in order to practice Management systems Staff supply, retention & loss Ratio of CHWs, nurse & midwives & TBAs at community level to population (2.28) (Speybroeck 2006) The distribution of HRH in urban and rural communities Distribution by age, Distribution of HRH by sector (state/non state), Distribution by sex Distribution of HRH by occupation, specialization or other skill-related characteristic Proportion of staff in dual employment / employed at more than one location Number of vacancies, posts filled, duration in job, proportion of HRH unemployed Hours worked compared with hours rostered Presence of human resources information system The existence of a functioning HR planning system Days of absenteeism among health workers Ratio of entry to and exit from the health workforce Proportion of nationally trained health workers HR dedicated budget and community services identified Personnel administration / employee relations Salary: average earnings, average occupational earnings & income among HRH Health and safety in the workplace, standard operating procedures, protocols & manuals Incentives, monetary and non-monetary, teamwork, practice, functional partnerships Performance management Job descriptions & duty statements are present Supervision (especially clinical supervision) schedule Frequency of supervision visits to the field planned that were actually conducted There is a formal mechanism for individual performance planning and review Peer review mechanisms Level of job satisfaction, Level of staff motivation Education , training & competencies Existence of a formal in-service training component for all cadres Existence of a management and leadership development program Relative number of specific tasks performed correctly by health workers / adherence to protocol etc Community / consumer engagement in HRH Client satisfaction, No of Patient contacts Frequency of community meetings attended & evidence of community participation Presence of a formal relationship with community organisations Mechanisms for involving community & HRH in pre and post service curriculum development & review Community involvement in: policy development, recruitment & selection, pperformance management ie supervision Monitoring HRH in MNRH at the community level Regular monitoring of HRH would help to provide updated information concerning HRH performance at individual, team and management levels so that issues can be quickly identified and changes made. Monitoring using indicators that are drawn from a national HRH information system ensure consistency and comparability across a number of P a g e | 177
communities. A collaborative approach to monitoring across the public and non government health sectors would assist in information sharing and may promote consistent HRH planning and implementation. Quality HRH research Improvements in the rigour of HRH research would provide a better understanding of the context of HRH and areas where findings can be generalisable. The review has identified a lack of focus in literature on workforce issues concerning reproductive health, neonatal care and cadres such as peer health educators. In addition there is a lack of discussion of adolescent reproductive health despite growing youthful populations in developing countries and increasing incidence of sexually infectious diseases. This indicates a need for a more inclusive approach to the study of workforce issues in this area. Strategic dissemination of knowledge Sharing not just HRH information and research findings but knowledge as well is vital for improving policy and practice. However this is more than the provision of access to knowledge. For change to take place which involves the application of knowledge decision makers need to be engaged in dialogue about this knowledge. This enables the relevance, usefulness and cost effectiveness of various HRH approaches to be clearly understood and that the required support for implementation communicated to partners such as donors. A comprehensive approach to assessing HRH performance in MNRH at the community level The relevance, accessibility, efficiency, acceptability, effectiveness and impact of HRH performance can be approaches strategically and assessed at a number of levels. Indicators or measurable variables of performance can be drawn from the main components or areas of HRH practice as describe above. In order to achieve a strategic and comprehensive approach to performance assessment HRH practices and their respective indicators need to be aligned or horizontally integrated with other HRH components as well as vertically integrated with the HRH objectives of the organisation (Baird 1988). This includes the horizontal and vertical integration of input, process and output indicators for measuring HRH performance. Figure 42 provides some examples of how HRH interventions and related indicators can be linked across the HRH system in order to ensure the integration of the right mix of packages of interventions which are delivered in a co-ordinated manner. Linkages across other dimensions in the HRH system can also be considered. This includes the relationship between performance at the community district and national levels and HRH performance at the individual health worker, team and management levels. Effective implementation of these approaches requires that HR systems are acceptable to managers and health workers which is critical in ensuring enhanced performance outcomes (Guest 1997). Figure 42 Horizontal and vertical integration of indicators across an HRH system P a g e | 178
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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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Table 20 Examples of Partnership ap
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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 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
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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 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: outlines how the HRH information ba
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
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.
Page 227 and 228: 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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