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

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Policy, legislation & regulation Leadership & management Supportive working environment Community participation Appropriate Education & Competence Example of initiatives HRH National policy Accreditation Performance management system Incentives for referral Involvement in local recruitment & selection Regular curriculum review Input indicator example Job descriptions are present provider payment mechanisms, budget & policy Presence of a formal relationship with community organisations Process indicator example % of supervision visits to the field planned that were actually conducted No of payment disbursements to TBAs No of selection panels with community representation Output indicator example Client satisfaction Number of pregnant women referred by TBAs No. of locally recruited SBAs However at a higher level if we are to consider HRH performance improvement in relation to health systems strengthening (horizontal integration) and MDG 5 (vertical integration), the perspective needs to be multidimensional. HRH and service delivery are also linked to information systems, the supply of medical products, vaccines and technologies, financing, leadership and governance. Table 29 provides some examples of indicators at input, process and output levels in reproductive health across the six building blocks of the WHO health systems framework. Plotting indicators in a matrix format provides an opportunity to see how indicators in each of the areas might relate so that appropriate measures can be selected for assessing performance across all areas. Indicators can be developed and selected according to the six criteria (relevance, accessibility, efficiency, acceptability, effectiveness and impact) mentioned above which ensures a coordinated approach to planning, implementation and evaluation. At the process level the HRH indicators are concerned with efficiency and when they are linked in with the other building blocks of the health system contribute to strengthening efforts in a horizontal manner. Output level indicators focus on the effectiveness of HRH. This involves a more vertical approach to achieving the objectives of the organisations which include improving reproductive health outcomes as shown in table 29. These approaches are central to strategic human resource management and the ―fit‖ of HRH activities (Wright 1992) with the goals of health systems strengthening and achievement of MDG5. P a g e | 179
Table 29 Examples of HRH performance indicators alongside others in the health system related to reproductive health HRH Input level Percentage of female trainees provided with knowledge & skills on reproductive health in a given year Process level Proportion of CHWs trained in family planning & reproductive health Output Percentage of CHWs trained in relation to the number of clients who received counselling Service Delivery Number of service delivery points offering family planning services Percentage of clients given counselling on family planning during a year Percentage of clients expressing satisfaction with the counselling services received Finance Percentage of public sector expenditures on contraceptive commodities Proportion of budget spent on contraceptives at community level Cost of contraceptive in relation to average family income Selected Indicators adapted from (ESCAP 2003) Leadership and governance Existence of national population and reproductive health policy & plans Use of national policy targets in monitoring and evaluation plans at community level Number of targets met/ protocols followed as per policy Information systems Percentage of women 15–49 years currently using modern methods of contraception included in routine data collection Collection of data according to national protocols at community level Number of routine data collections as per protocol in household surveys Supply of medical products, vaccines and technologies Percentage of service delivery points stocked with family planning commodities according to needs Percentage of contraceptive supplies that are wasted Available number of contraceptives in relation to need Key recommendations for planning, implementing and evaluating HRH practice The literature reviewed in this study has identified a number of implications for HRH practice in MNRH at the community level. The review has found that enhancing HRH performance is a complex process that requires the use of a number of strategies across HRH as well as in other health system areas. It highlights the need for a more informed, rigorous and well coordinated approach to HRH planning, implementation and evaluation by linking activities across the health system. The following points summarise practical guidelines for enhancing HRH performance in MNRH at community level gleaned from country experiences. P a g e | 180
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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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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
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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
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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 and 178: outlines how the HRH information ba
Page 179: communities. A collaborative approa
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.
Page 227 and 228: Jhpeigo (1998). Participatory techn
Page 229 and 230: 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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