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

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Area Barriers & constraints in MNRH Reference Teamwork •Lower levels of HR trust in CHWs , lack of intersectoral collaboration will lead to bypassing CHWs for referrals •Politicization of conflict between different providers •Poor interpersonal relations with the govt. health staff, community & professionals •Disrespectful attitudes of HR towards TBAs •Paternal relationships result in poor communication •VHW face competition from other providers •Vertical relationships impedes teamwork •Supervisors face hostility •Gender discrimination •perceived low status of auxiliary nurse midwives & CHW •Competition between midwives & TBA (Sauerborn 1989; Cruse 1997) (Twumasi 1985; Doherty 2005) (Singh 1994; Campos 2004; Haider, Adhish et al. 2008) (Izugbara, Ezeh et al. 2009) (Iyun 1989; Replogle 2007) (Walt, Perera et al. 1989) (Kahssay 1998) (Rowe 2005) (WHO 2005) (Walt 1990; FIGO 2009) (Utomo 2008) Partnership Lack of referral and partnership between traditional (Peltzer 2009) Working with the community Health worker Education & competence Attitudes (towards patients) Knowledge system and biomedical system Low community participation, villagers not involved in identification of problems Donor support of VHW led to dependency on this finance Hostility towards CHWs, socio-cultural & political barriers to practice Poor links with VNC members CHWs used as aides in facilities rather than communities Women dissatisfied with care as skills are perceived as poor & poor patient provider relationships this affects care seeking behaviour fear of HIV infection fear and negative perceptions towards SP poor attitudes in STI staff insensitive to social-cultural context of patients Authoritarian attitudes Attitudes manifest in violence towards women lack of knowledge on HIV & PMTC poor knowledge of neonatal problems (Sauerborn 1989; Campos 2004) (Maclure 1995) (Stark 1985; WHO 1989; Simmons 1992) (Haider, Adhish et al. 2008) (WHO 1989) (Dogba and Fournier 2009) (Dovlo 2005; Nguyen, Oosterhoff et al. 2009) (Nsimba 2006) (Passey 1996 ) (Duke, Oa et al. 2005; Replogle 2007) (Bossyns and Van Lerberghe 2004; PNG NDoH 2009) (d'Oliveira 2002) Nguyen, Oosterhoff et al. 2009)(Piwoz, Ferguson et al. 2006; Bassey, Elemuwa et al. 2007; Peltzer 2009) (de Haas 1994; Ogunfowora and Daniel 2006) P a g e | 201
Area Barriers & constraints in MNRH Reference Skills Poor communication skills Low literacy skills means growth monitoring problematic Poor neonatal clinical skills Poor SBA skills Poor TBA, VHW, CHW record keeping skills Poor TBA delivery skills Losing skills through lack of use or case load Lady HW (Pakistan)& Aux nurse midwife (India) have not always the clinical skills to recognise & manage complications Poor negotiation and advocacy skills Lack of local language skills (Tlebere, Jackson et al. 2007) (QAP 2000; Bossyns and Van Lerberghe 2004; FCI 2005) (Oxford Policy Management 2002; Campos 2004) (Awasthi, Verma et al. 2006; Darmstadt 2008; Eriksson 2009) (Harvey 2004; Srinivasan K 2006; Harvey, Blandon et al. 2007; Darmstadt 2008; Hatt, Stanton et al. 2009) (Chaulagai 1993; Umar 2003) (Darmstadt 2008; Thatte, Mullany et al. 2009) (Ashwell and Freeman 1995; Utomo 2008) (FIGO 2009) (FIGO 2009) (Replogle 2007) Area Barriers/ issues / constraints in MNRH Reference Education & training Non- standardization / certification of CHW education Poor quality of education and training Lack of exclusive midwife training & professionalization lack of standardised training for TBAs Poor selection of trainee CHWs / midwives & nurses Little / poor evaluation of training programmes Linkages & interdependency between education and service sectors are absent or weak Continuing education is ad hoc Indigenous skills not recognised Internship year for Drs in rural areas requirements from Medical Boards tend to specify a duration of attachment within a specialty rather than the attainment of competencies. Often trained by midwives or other COs on clinical mgt due to poor clinical training on posting Low status of Aux midwives has meant that they are not necessarily given access to patients in labor for learning, let alone the opportunity to practice the management of complications under supportive supervision (Doherty 2005) (UNFPA 1996; Hull 1998; Khanum 2008; Wakabi 2008; FIGO 2009; Manafa, McAuliffe et al. 2009) (Mavalankar 2008) (Narayanan 2004; Hussein 2005) (Stekelenburg 2003) / (WHO/SEARO 2003) (Campos 2004; Sibley 2004) (WHO/SEARO 2003) (WHO 1989; WHO/SEARO 2003) (Van Wagner, Epoo et al. 2007) (FIGO 2009) (FIGO 2009) P a g e | 202
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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
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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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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
Page 163 and 164: Health system standards are explici
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 and 180: communities. A collaborative approa
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: 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
Page 231 and 232: Manandhar, D. S., D. Osrin, et al.
Page 233 and 234: Morisky, D. E. (1985-86). "Evaluati
Page 235 and 236: O‘Brien-Pallas, L., Irvine, D., P
Page 237 and 238: Pfeiffer, J. and J. Pfeiffer (2003)
Page 239 and 240: Replogle, J. (2007). "Training Trad
Page 241 and 242: Shankar, A., S. Sebayang, et al. (2
Page 243 and 244: Teela, K. C., L. C. Mullany, et al.
Page 245 and 246: van Damm, W., et. al (2008). "Scali
Page 247 and 248: WHO (2008). Global Standards for In
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