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

Appendix 4: Barriers and Constraints to HRH Practice
Area Barriers & constraints in MNRH Reference
Coverage
Too few skilled personnel:
Too few Nurses/midwives at community level
Oversupply of VHW
Lack of female providers
inefficiently distributed in rural areas-poor skills mix
High attrition / low retention rates (low pay + poor working
conditions=migration, retirement, HIV, career change, move
from rural areas, move to private sector)
Absenteeism can prevent hiring of other staff as the post is
technically filled
(Gerein, Green et al. 2006; WHO 2006; Henderson 2008; Dogba and Fournier
2009)
(Kwast 1991)
(Matomora 1989)
(Naisho 1982)
(Olsen, Ndeki et al. 2005)
(Ofosu-Amaah 1983; Pfeiffer and Pfeiffer 2003; Dovlo 2005; WHO 2005;
Henderson 2008; Willis-Shattuck, Bidwell et al. 2008)
(Berman 1984; Berman 1987; FIGO 2009)
Policy & legislation
Too much focus on Drs & nurses-other cadres need to be
included
Lack of government policies & support
CHW programs vertical not integrated
Lack of involvement of CHWs nurses & Midwives in
policy & planning
No laws concerning solo practice of nurses
Uneven enforcement of regulations
Outlawing TBAs affected links with the community & led
to extinction of cultural support approaches
Unregulated small clinics undertaking surgery
without appropriate infrastructure
Use of employee facilities for private practice &
personal gain
(Kruk, Prescott et al. 2009)
(Singh 1994; Campos 2004; Haider, Adhish et al. 2008)
(WHO 1989)
(WHO 1989; WHO/SEARO 2003)
(Heywood and Harahap 2009)
(WHO/SEARO 2003)
(Jenkins 2003)
(FIGO 2009)
(Omaswa 2006)
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