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

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Table 4 MDG 5 Country status in the Asia Pacific Region (UNICEF 2008) On track China Fiji Kiribati Korea DPR Maldives Marshall Islands Micronesia, FS Mongolia Philippines Samoa Solomon Islands Sri Lanka Thailand Tonga Vanuatu Vietnam Off track Bangladesh Bhutan Cambodia India Indonesia Lao PDR Myanmar Nepal PNG Timor-Leste What are the key determinants of MNRH? The most common proximal causes of maternal mortality are haemorrhage and hypertensive disorders, both of which are major contributors to MMR in developing countries. Haemorrhage was the leading cause of maternal death in Asia in 2006 (30·8%, 5·9–48·5; 11, 16 089) (Khan, Wojdyla et al. 2006). Figure 6 Causes of maternal mortality (UNICEF 2007) Neonatal deaths are largely attributed to infections, complications arising from pre-term delivery and asphyxia (see Figure 7). It is important to note that 50% of neonatal deaths are attributable to delivery and therefore amenable to maternal health interventions. Figure 7 Causes of neonatal mortality P a g e | 25
(UNICEF 2007) However, the road to death is a long one, and socio-cultural factors play an important role. Examples of socio-cultural factors include early childbearing due to early marriage, lack of access to contraceptives leading to too early or late childbearing, too many and too closelyspaced births, and unwanted pregnancy; poor nutrition of girls and women, especially during pregnancy and after childbirth; and low utilisation of health services due to limited decisionmaking power, traditional beliefs about the causes of ill-health, and lack of knowledge about service availability. Other factors include the generally lower educational attainment and low social status of women as well as limited physical and financial access to health-care services. Certain vulnerable groups such as religious, ethnic and linguistic minorities, people affected by armed conflict and the very poor experience high maternal mortality and high unmet need for reproductive health services. Factors influencing MNRH and HRH at the community level The ability of health workers to facilitate progress towards MNRH at community level is affected by a complex interaction of factors, many of which are largely beyond their control and include lack of political commitment and governance, government and donor funding priorities, weak health systems, a lack of infrastructure at the community level, and sociocultural factors that impact upon health seeking behaviour. These factors, outlined below in Figure 8, are interrelated and affect the impact and sustainability of community health programmes. P a g e | 26
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 and 24: Table 3 Classification of health ce
Page 25: Figure 5 Millennium Development Goa
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
Page 75 and 76: 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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