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 ...
However there is a need to go beyond regional strategies and for countries to develop HRH policies adapted to their own contexts (Dussault and Dubois 2003). Many countries in the Asia and Pacific regions are moving towards this. Overview of community level HR in MNRH The Alma-Ata declaration (WHO 1978) outlines the importance of competent HRH working together at community level to achieve health outcomes. Primary health care… Relies, at local and referral levels, on health workers, including physicians, nurses, midwives, auxiliaries and community workers as applicable, as well as traditional practitioners as needed, suitably trained socially and technically to work as a health team and to respond to the expressed health needs of the community In an effort to quantify HRH numbers the WHO has suggested that a density of greater than 2.5 doctors, nurses and midwives per 1000 population is needed to implement essential health interventions to reach the MDGs (WHO 2006). However, human resources are most stretched at community level where medical practitioners are rarely found and midwives may also not be common. There are, however, a range of other health workers across a number of sectors in the formal and informal workforce who do operate at community level. This profile will vary depending on the resources, geography and socio-cultural context of the community. Figure 10 below provides an overview of the diverse nature of those involved in providing MNRH care and services at community level. Health workers may be employed by the Ministry of Health, NGOs, the church, or be private practitioners. They may reside in the community and visit homes, or provide outreach services at a designated place. In a well resourced setting there may be a basic purpose-built clinic. A number of terms are used to describe those who work at community level including low-level cadres (Dovlo 2004), auxiliaries (Elliot 1975), lay health workers (Lewin 2005), paramedical personnel (World Health Organization 2001), professional and non professional workers (Bechtel 1980) or health professional and other community workers (WHO 2006). P a g e | 29
Figure 10 Overview of HRH at community level Remuneration Salaried / fee for service/ voluntary Cadre Nursing/ midwifery/ community health worker/ traditional/ cultural/ peripheral worker Community MNRH workers Service function Specialist / generalist/ curative/ promotive / preventive Place of work Resident / outreach worker/ facility based Public / private practitioner / NGO / faith based/ self employed Employer In this review, human resources at community level are broadly categorised into three main groups: community health workers, nursing and midwifery cadre, and traditional or cultural practitioners. The term ‗skilled birth attendant‘ is generally applied to workers in the nursing and midwifery cadre although in some circumstances community health workers may have received specialised training in midwifery qualifying them as SBAs. One example could be the plans that Papua New Guinea has for up-skilling CHWs (Government of Papua New Guinea 2009). In addition, workers in other sectors may be involved in the provision of MNRH care and services including school teachers and community development workers. This section will briefly describe the roles of these groups. Community health workers Designations and roles The community health worker group is perhaps the largest and most difficult to define as it covers a range of workers with a number of designations, roles and training. Practitioners in this group are often referred to as basic or lay health workers (LHWs) however their role is far from simple and is sometimes unclear across countries and regions. This can be problematic (Doherty 2005), particularly if decisions are to be made concerning the large scale implementation of interventions by this cadre. Other terms such as community based health personnel (CBHP) is an ―umbrella term‖ used to describe practitioners who are often ―selected, trained and work within the communities from which they come‖ (Lehmann 2004). It is impossible to define CHWs or create a standard set of functions for them as CHW tasks are assigned according to the local conditions (WHO 1989). Table 5 provides some examples Page | 30
- 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 and 26: Figure 5 Millennium Development Goa
- Page 27 and 28: (UNICEF 2007) However, the road to
- Page 29: A number of steps are purported to
- 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
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Figure 10 Overview of <strong>HRH</strong> at community level<br />
Remuneration<br />
Salaried / fee <strong>for</strong><br />
service/<br />
voluntary<br />
Cadre<br />
Nurs<strong>in</strong>g/<br />
midwifery/<br />
community health<br />
worker/<br />
traditional/<br />
cultural/ peripheral<br />
worker<br />
Community MNRH workers<br />
Service function<br />
Specialist /<br />
generalist/<br />
curative/<br />
promotive /<br />
preventive<br />
Place of work<br />
Resident /<br />
outreach<br />
worker/ facility<br />
based<br />
Public / private<br />
practitioner /<br />
NGO / faith<br />
based/ self<br />
employed<br />
Employer<br />
In this review, human resources at community level are broadly categorised <strong>in</strong>to three ma<strong>in</strong><br />
groups: community health workers, nurs<strong>in</strong>g <strong>and</strong> midwifery cadre, <strong>and</strong> traditional or cultural<br />
practitioners. The term ‗skilled birth attendant‘ is generally applied to workers <strong>in</strong> the nurs<strong>in</strong>g<br />
<strong>and</strong> midwifery cadre although <strong>in</strong> some circumstances community health workers may have<br />
received specialised tra<strong>in</strong><strong>in</strong>g <strong>in</strong> midwifery qualify<strong>in</strong>g them as SBAs. One example could be<br />
the plans that Papua New Gu<strong>in</strong>ea has <strong>for</strong> up-skill<strong>in</strong>g CHWs (Government of Papua New<br />
Gu<strong>in</strong>ea 2009). In addition, workers <strong>in</strong> other sectors may be <strong>in</strong>volved <strong>in</strong> the provision of<br />
MNRH care <strong>and</strong> services <strong>in</strong>clud<strong>in</strong>g school teachers <strong>and</strong> community development workers.<br />
This section will briefly describe the roles of these groups.<br />
Community health workers<br />
Designations <strong>and</strong> roles<br />
The community health worker group is perhaps the largest <strong>and</strong> most difficult to def<strong>in</strong>e as it<br />
covers a range of workers with a number of designations, roles <strong>and</strong> tra<strong>in</strong><strong>in</strong>g. Practitioners <strong>in</strong><br />
this group are often referred to as basic or lay health workers (LHWs) however their role is<br />
far from simple <strong>and</strong> is sometimes unclear across countries <strong>and</strong> regions. This can be<br />
problematic (Doherty 2005), particularly if decisions are to be made concern<strong>in</strong>g the large<br />
scale implementation of <strong>in</strong>terventions by this cadre. Other terms such as community based<br />
health personnel (CBHP) is an ―umbrella term‖ used to describe practitioners who are often<br />
―selected, tra<strong>in</strong>ed <strong>and</strong> work with<strong>in</strong> the communities from which they come‖ (Lehmann 2004).<br />
It is impossible to def<strong>in</strong>e CHWs or create a st<strong>and</strong>ard set of functions <strong>for</strong> them as CHW tasks<br />
are assigned accord<strong>in</strong>g to the local conditions (WHO 1989). Table 5 provides some examples<br />
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