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

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Concepts and their use in this review MNRH and its meaning in this study This review will identify and evaluate the effectiveness of current human resource practices for a range of community-based maternal, newborn and reproductive health services that are integral to the equitable achievement of MDG 5, including the promotion and provision of: Effective family planning Safe medical abortion and referral for safe surgical abortion Gender empowerment programs Quality antenatal care (including nutritional advice and supplements, intermittent preventive treatment (IPT) and bednets for malaria prevention, tetanus vaccination and prevention of parent to child transmission (PPTCT) for HIV) Skilled attendance at birth Postnatal care for the mother and her baby (including advice and support for breastfeeding, routine immunisations, and access to effective family planning for birth spacing) It is important to note that although this review focuses on health worker practice in relation to MDG 5 there is a relationship between health care in maternal and reproductive health with other areas that are linked to other MDGs. For example maternal mortality strongly affects newborn mortality and progress on MDG 5 will also influence the efforts to reduce child mortality (MDG 4). Gender inequality is one of the social determinants at the centre of inequity in health. Progress in achieving MDG 3, promoting gender equality and women‘s empowerment, will help in achieving MDG 5. Increasing primary education (MDG 2) for girls and eradicating extreme poverty and hunger (MDG 1) are means to empower women and will positively influence the achievement of MDG 5. Progress on MDG 5 is also related to MDG 6, which focuses on combating HIV/AIDS and malaria that are two important indirect causes of maternal death. As health workers roles are not always narrowly defined and PHC focuses on the continuum of care and comprehensive approaches, this review recognises the linkages between HRH and their roles across neonatal health, gender empowerment and HIV/AIDS. The role of community health workers in promoting the role of male partners in reproductive, maternal and newborn health will also be considered, as will the distribution of commodities for the above services at community level. To the extent that services for the prevention, diagnosis and treatment of sexually transmitted infections (STIs) and HIV are integrated with maternal and reproductive health services at the community level, these will also be considered. However, specialised targeting of STI and HIV prevention, diagnosis and treatment services to marginalised populations, the procurement of reproductive and maternal health commodities at the provincial and national levels, and emergency obstetric care that does not occur at the community level are beyond the scope of this review. P a g e | 17
Effective HRH practice and quality health care The contribution of effective HRH practice to quality health care Human resources are engaged at community level in delivering various interventions to improve MNRH. MNRH care and services can be regarded as a continuous cycle comprised of four components. These are outlined in Figure 1 along with the possible interventions undertaken by HRH. Figure 1 The continuum of care and possible interventions undertaken by HRH at community level *Promotion and provision of contraception – family planning *Promotion of safe sex *Promotion of safe abortion *gender empowerment *youth development *treatment of STIs *primary prevention of HIV *Pregnancy planning: Folic acid & iron Reproductive care Community Level Antenatal care *Promotion of good nutrition & birth preparedness *Promotion & provision of Malaria IPT & ITNs *Promotion PMTCT of HIV *tetanus vaccination *nutritional supplements *creating role for expectant fathers *Postnatal review *Promotion of hygiene *Exclusive breastfeeding *Complementary feeding *good nutrition *Care of LBW/ pre term baby *ITN use *Provision of Vaccination Hep B, DTap etc *Early detection & referral of complications includ. pneumonia *Promotion of PMTCT of HIV *family planning *Contraception advice Postnatal care Intrapartum care *Promotion & provision of SBA *Emergency referral *Clean delivery practice *Promotion of PMTCT of HIV *recognition of complications The continuum of care is a core principle of MNRH programmes and enables the efficient delivery of eight packages of care (Kerber 2007) throughout the life cycle and across health facilities through the health system (Mathai 2008). It is also the conceptual framework of the Partnership for Maternal, Newborn and Child Health, a global alliance of approximately 300 organisations advocating for the achievement of better health outcomes for women, infants and children (PMNCH 2009). The goal of this approach is to provide integrated, accessible and on-going care that is informed by the latest research evidence. However this is only possible if delivered by a competent, motivated and well managed workforce operating within a functional health system. Figure 2 outlines the core components of effective HRH practice that facilitate quality MNRH practice which, in turn, improves reproductive and maternal health outcomes. P a g e | 18
Page 1 and 2: Human Resources for Health in Mater
Page 3 and 4: What human resource practices in ma
Page 5 and 6: Collaboration with traditional and
Page 7 and 8: Acronyms AAAH Asia and Pacific Acti
Page 9 and 10: TBA T & L UNFPA UNICEF UOG UPNG USA
Page 11 and 12: Figure 34 Potential gain in percent
Page 13 and 14: Executive Summary Addressing the ba
Page 15 and 16: Introduction What human resource pr
Page 17: Review Questions 1. What HR approac
Page 21 and 22: is no single prescribed set of ways
Page 23 and 24: Table 3 Classification of health ce
Page 25 and 26: Figure 5 Millennium Development Goa
Page 27 and 28: (UNICEF 2007) However, the road to
Page 29 and 30: A number of steps are purported to
Page 31 and 32: Figure 10 Overview of HRH at commun
Page 33 and 34: functions, the latter involving mob
Page 35 and 36: settings‖(ICN 2009). They may be
Page 37 and 38: Table 7 What Skilled attendants can
Page 39 and 40: Traditional healers may also be inv
Page 41 and 42: Methodology What human resource pra
Page 43 and 44: Table 9 Search terms used for the s
Page 45 and 46: findings. Differences and similarit
Page 47 and 48: Barriers and constraints to HRH pra
Page 49 and 50: PHEs. In the Pacific the density of
Page 51 and 52: partum services as being from 1:60
Page 53 and 54: husbands who oppose family planning
Page 55 and 56: Remuneration for CHWs, nurse and mi
Page 57 and 58: Supportive HRH strategies and appro
Page 59 and 60: Strengthening HRH policy legislatio
Page 61 and 62: Strategies to improve Human resourc
Page 63 and 64: there are interrelationships betwee
Page 65 and 66: Table 11 Tools for managing HR in M
Page 67 and 68: 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
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Table 22 Some approaches to the des
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Participants/ Method / document typ
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strengthening and establishing accr
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Participants / context LMICs method
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alongside health service improvemen
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Country / cadre Niger: Birth attend
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Country / cadre Indonesia Surabaya
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Lessons learned from countries that
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Malaysia The sharp decline in mater
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although supplemented with epidemio
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A technical meeting in Bangkok in 2
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Development approach is an example
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flexibility in order to overcome ge
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up skilled birth attendance‖. The
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Scaling up of the Navrongo service
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conditions (Walt, Perera et al. 198
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Figure 37 Critical success factors
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Health system standards are explici
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prevalence rate, however in order t
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(Dieleman 2006) Selected key indica
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In order to determine the answers t
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Summary of findings This narrative
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Health worker performance is theref
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Discussion and Recommendations What
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outlines how the HRH information ba
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communities. A collaborative approa
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Table 29 Examples of HRH performanc
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Appendices Appendix 1. MDG5 Country
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World Health Statistics http://www.
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Appendix 3. Sources of all material
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Data source Keywords used in search
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Appendix 4: Barriers and Constraint
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Area Barriers & constraints in MNRH
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Area Barriers & constraints in MNRH
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Appendix 5 Literature that document
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P a g e | 206
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IMNCI PMTCT Perinatal Period Postna
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Ambegaokar, M., Lush, L. (2004). "F
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Barrett, B., J. Ladinsky, et al. (2
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University South Africa with the Re
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Cruse, D. (1997). Community Health
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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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