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

Figure 8 Examples of factors that influence the impact and sustainability of community
health programmes
(Haines, Sanders et al. 2007)
In many communities, there is a underinvestment in basic obstetric care (AMDD Working
Group on Indicators 2002; 2002; 2003; 2003; 2004) and a move towards hospital births
(Stanton, Blanc et al. 2006). Although facility-based births will reduce maternal mortality for
those who can access it, the need to access facilities that are outside the community can place
additional stress and financial burden on women. In many locations access to facilities is not
possible for socio-cultural, geographical and financial reasons. Many studies have already
shown that use inequity results when care is not accessible to all women (Houweling,
Ronsmans et al. 2007; Anwar, Sami et al. 2008), leading to the suggestion that in resource
poor countries it may be more cost effective and equitable to prioritise basic obstetric care at
community level and improve referral systems. This is also consistent with primary health
care principles and the Commission on Macroeconomics and Health (2001) which advocated
for increasing health funding to provide a package of basic ‗close to client‘ services alongside
referral systems for emergency obstetric care. It estimated that, among other benefits, this
basic package would reduce child mortality by two-thirds, maternal mortality by threequarters.
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