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

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This broad inter-sectoral approach to community health practice is based on primary health care principles which are receiving renewed attention. This has been prompted by the WHO World Health Report ―Primary Health Care (Now More Than Ever)‖ (WHO 2008) and replaces a recent focus on vertical programs, disease centred approaches and the domination of health sector reform agenda that aims at the economic rationalisation of health care. Although some have argued that primary health care has simply been added as another appendage to the assortment of vertical programs directed at the population without attention to cultural values and existing traditional health care systems (Mosley 1983), an understanding of context is essential for the provision of MNRH care and services at community level. Despite the critical importance of primary health care at community level in order to progress towards MDG5 this has not been achieved in all countries highlighting among many factors weak health systems which includes HRH issues. An introduction to HR and MNRH at the community level Progress towards improving MNRH Indicators of progress Over the last decade, the Millennium Development Goals have shaped the international development agenda. From the perspective of countries, donors, and advocates, the six targets under MGD 5 are therefore central to measuring success in MNRH. Assessment of HRH performance in MNRH, in turn, is also tied to these targets. Parts a and b of MDG5 are outlined in Figure 5 below. P a g e | 23
Figure 5 Millennium Development Goal 5: Improve maternal health Millennium Development Goal 5: Improve maternal health Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio 5.1 Maternal mortality ratio 5.2 Proportion of births attended by skilled health personnel Target 5.B.: Achieve, by 2015, universal access to reproductive health 5.3 Contraceptive prevalence rate 5.4 Adolescent birth rate 5.5 Antenatal care coverage (at least one visit and at least four visits) 5.6 Unmet need for family planning 12th Inter-Agency and Expert Group meeting on MDG indicators, Paris, November 2007 Global targets for skilled attendance at birth are not specified within the Millennium Declaration but were established by the United Nations International Conference on Population and Development + 5 (ICPD+5) in 1999. This agreement set a goal of 40% of all births to be assisted by a skilled attendant by 2005, with 50% coverage by 2010 and 60% by 2015 among countries with very high maternal mortality. Globally, the goal is to have 80% of all births assisted by skilled attendants by 2005, 85% by 2010 and 90% by 2015 (United Nations Commission on Population and Development 1999). Current country progress Country progress towards MDG5 is monitored by the Countdown to 2015 Initiative. Ten of the twenty six low or low middle income countries in the SEARO and WPRO are off track for reducing maternal mortality by three quarters. The on and off track status of countries in the Asia Pacific region are listed below while a more detailed overview of country status for each of the MDG5 target areas can be found at appendix 1. Despite the achievement of some countries the pace of scaling up is slow and coverage gaps for key interventions remain wide (Countdown 2008 Equity Analysis Group 2008). P a g e | 24
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 and 18: Review Questions 1. What HR approac
Page 19 and 20: Effective HRH practice and quality
Page 21 and 22: is no single prescribed set of ways
Page 23: Table 3 Classification of health ce
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
Page 69 and 70: The Health and Family Planning Mana
Page 71 and 72: as a guide to mentoring, delegation
Page 73 and 74: 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.
Page 245 and 246:
van Damm, W., et. al (2008). "Scali
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WHO (2008). Global Standards for In
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