Human Resources for Health in Maternal, Neonatal and - HRH ...
Human Resources for Health in Maternal, Neonatal and - HRH ... Human Resources for Health in Maternal, Neonatal and - HRH ...
Figure 2 Effective HRH and quality MNRH practice Components of effective HRH practice at community level Leadership & management Supportive working environment Appropriate Education & Competence Adequate coverage & composition Policy, legislation & regulation Community participation Effective HRH practice Quality MNRH care practice Impact on MDG 5 Continuity Comprehensiveness Equity & access Technical currency Community relevance Components of quality MNRH care and services at community level Although other aspects of the health system, including efficient information systems, appropriate financing models, infrastructure, technology development, and commodity supply (including essential medicines), also contribute to the delivery of quality MNRH care and services, the operationalisation of these health system components depend on the capacity of human resources for health. The review acknowledges the importance of this whole of health system approach but the discussion of health system components beyond HRH is outside the remit of this work. The community level – what do we mean? The term ‗community‘ refers to a group or category of people who have something in common with each other. For the purposes of this review, a community is defined as a vulnerable population who experiences a high burden of ill-health and resides in settings such as geographically isolated villages, urban slums or on borders. Communities may also be marginalised due to religion, ethnicity or culture. In this review, community based care is defined as the care provided by primary health workers and structures to community groups in these settings. This can also be expressed as ―community orientated primary health care‖ (see Glossary) which integrates the concept of primary health care aimed at individuals with population based services by including clinical services, epidemiology and health promotion as elements of community based ‗care‘(van Weel, De Maeseneer et al. 2008). In line with its primary health care focus, community health offers a comprehensive approach to health directed at the whole person and their whole community. For this reason, the way community health services are structured, organised and practised depends on the needs of each particular community or locale. Just as there is no one definition of a community, there P a g e | 19
is no single prescribed set of ways that community health should be practised. However, in most settings, community health workers provide first line health care to keep people healthy and treat them promptly. Health workers at this level also play a key role in empowering community people to participate in the planning and implementation of their own health care. When operating in its pure form, community health care is then linked to other levels of care such as health centres at sub district level and hospital care through mechanisms for referral and supervision. Figure 3 outlines this relationship; the arrows indicate the directions of referral and supervision. Figure 3 A schematic model of the ideal health care pyramid, linking the three levels - family and community, health centre, and district hospital (WHO 1997) Levels of community health practice It is important to recognise that community-based care itself operates at a number of levels. Home-based refers to care and services that are delivered in the patient or consumer‘s home. This may include births that take place in a woman‘s home or visits made to the family home to distribute family planning commodities. Outreach includes visits that are made by health workers who reside in one village or community to another community, or the visits that midwifes or auxiliary nurses make to communities. These outreach services are delivered at a central point in the community such as a community meeting place, a youth centre, or a market. Care and services at the aid post or clinic level are delivered in a purpose-built facility that provides dedicated work space for health professionals. The different levels at which community health practice may operate, the care and services provided at these levels, and the staff who may be involved are summarised in Table 2 below. P a g e | 20
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- Page 11 and 12: Figure 34 Potential gain in percent
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- Page 15 and 16: Introduction What human resource pr
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Figure 2 Effective <strong>HRH</strong> <strong>and</strong> quality MNRH practice<br />
Components of effective <strong>HRH</strong> practice at community level<br />
Leadership<br />
&<br />
management<br />
Supportive<br />
work<strong>in</strong>g<br />
environment<br />
Appropriate<br />
Education &<br />
Competence<br />
Adequate<br />
coverage &<br />
composition<br />
Policy,<br />
legislation &<br />
regulation<br />
Community<br />
participation<br />
Effective <strong>HRH</strong><br />
practice<br />
Quality MNRH<br />
care practice<br />
Impact on<br />
MDG 5<br />
Cont<strong>in</strong>uity<br />
Comprehensiveness<br />
Equity &<br />
access<br />
Technical<br />
currency<br />
Community<br />
relevance<br />
Components of quality MNRH care <strong>and</strong> services at community level<br />
Although other aspects of the health system, <strong>in</strong>clud<strong>in</strong>g efficient <strong>in</strong><strong>for</strong>mation systems,<br />
appropriate f<strong>in</strong>anc<strong>in</strong>g models, <strong>in</strong>frastructure, technology development, <strong>and</strong> commodity<br />
supply (<strong>in</strong>clud<strong>in</strong>g essential medic<strong>in</strong>es), also contribute to the delivery of quality MNRH care<br />
<strong>and</strong> services, the operationalisation of these health system components depend on the<br />
capacity of human resources <strong>for</strong> health. The review acknowledges the importance of this<br />
whole of health system approach but the discussion of health system components beyond<br />
<strong>HRH</strong> is outside the remit of this work.<br />
The community level – what do we mean?<br />
The term ‗community‘ refers to a group or category of people who have someth<strong>in</strong>g <strong>in</strong><br />
common with each other. For the purposes of this review, a community is def<strong>in</strong>ed as a<br />
vulnerable population who experiences a high burden of ill-health <strong>and</strong> resides <strong>in</strong> sett<strong>in</strong>gs such<br />
as geographically isolated villages, urban slums or on borders. Communities may also be<br />
marg<strong>in</strong>alised due to religion, ethnicity or culture. In this review, community based care is<br />
def<strong>in</strong>ed as the care provided by primary health workers <strong>and</strong> structures to community groups<br />
<strong>in</strong> these sett<strong>in</strong>gs. This can also be expressed as ―community orientated primary health care‖<br />
(see Glossary) which <strong>in</strong>tegrates the concept of primary health care aimed at <strong>in</strong>dividuals with<br />
population based services by <strong>in</strong>clud<strong>in</strong>g cl<strong>in</strong>ical services, epidemiology <strong>and</strong> health promotion<br />
as elements of community based ‗care‘(van Weel, De Maeseneer et al. 2008).<br />
In l<strong>in</strong>e with its primary health care focus, community health offers a comprehensive approach<br />
to health directed at the whole person <strong>and</strong> their whole community. For this reason, the way<br />
community health services are structured, organised <strong>and</strong> practised depends on the needs of<br />
each particular community or locale. Just as there is no one def<strong>in</strong>ition of a community, there<br />
P a g e | 19
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