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 ...
of community health workers employed to provide MNRH care and services in a number of countries in the Asia and Pacific regions. Table 5 Examples of Community health workers in MNRH the Asia Pacific region Country Designation Role in MNRH Reference Bangladesh Community health worker Make ANC home visits to promote birth and newborn-care preparedness, and postnatal home visits to assess newborns and refer or treat sick (Baqui 2008) neonate Bangladesh Family welfare Supply condoms and contraceptive pills during assistant home visits. May act as SBAs if trained by MoH Bangladesh Shasthya Sebika Female volunteers who disseminate family planning messages, register pregnancy cases Cambodia Expert patient or Peer health education advocate Nepal Female Provide family planning, maternal care, child Community health, vitamin A supplementation/ de-worming health volunteer and immunization coverage India Mitanin Female volunteers in villages trained to dispense drugs ie IPTp from specially designed kit India Sahiyyas Women who facilitate integrated mother and child health care, encourages ANC, institutional delivery, and immunization. Provides family planning advice and first aid. Burma Vanuatu Indonesia Mobile Obstetric Maternal Health Worker Peer health educator Village family planning volunteers Skilled birth attendants, community mobilisers (MoHFW Bangladesh 2009; Mridha 2009) (Ahmed 2008) (Standing and Chowdhury 2008) (Sood 2003) (Shrestha 2003) (Government of India 2004) (Government of India 2004) (Teela, Mullany et al. 2009) Deliver reproductive health information (Walker 1998) Promote family planning, organise meetings, provide information, organise income-generation activities, give savings and credit assistance, collect and report data and deliver other family welfare services (Utomo, Arsyad et al. 2006) Indonesia Peer health Deliver reproductive health information (Senderowitz 1998) educator Indonesia kaders IMC-trained community health workers (Bowen 2006) (Bailey 1996) Health assistants Health promotion (Keni 2006) Marshall Islands The roles outlined in Table 5 indicate the broad range of tasks that CHWs undertake in MNRH which can be classified as curative, preventive and promotive functions. These include health education and promotion, advocacy, community mobilisation, dispensing reproductive health commodities and drugs, and basic clinical interventions and referral. CHWs may be employed to perform a mix of tasks or focus on one particular area. For example, CHWs may focus on supporting pregnant women and / or assisting during labour and in the postnatal period and / or may have a role in reproductive care as well. Some CHWs may assist during births, some without training and legislative mandate, and others with specialised midwifery training. Female CHWs may direct more attention to maternal and child health and family planning, while males take care of other functions (Ofosu-Amaah 1983). In addition, CHWs perform a mix of health service functions and development P a g e | 31
functions, the latter involving mobilising the community to improve their social and economic as well as health status. CHWs have also been described as a ―bridge between the community and the health service‖ (Kuhn 1990), and cultural brokers (Willis 1999) however their role goes beyond this. According to Bender and Pitkin CHWs are the cornerstone of PHC work (1987). CHWs often reside in the community and therefore have an intimate understanding of community needs, issues and the socio-cultural context. Community members have a degree of trust and confidence in them and therefore CHWs ―can become rallying points for the positive social transformation of communities‖(Were 2008). However, they are also vulnerable and their recruitment and ability to function can be constrained or dictated by power relations or sociocultural beliefs (Werner 1977; WHO/SEARO 2007). Coverage A conference in Beijing (AAAH 2007) and in Chiang Mai (WHO/SEARO 2007) indicated that CHWs are a ubiquitous cadre. However little data is available on the numbers and distribution of community health workers in the Asia Pacific region (AAAH 2008; WHO 2009). National data do not reveal coverage within countries. Density is purportedly low due to geographic constraints in some countries (PHFI 2008). Prasad (2007) states that there is diversity in coverage and asks what the optimal coverage might be bearing in mind the different care and services that CHWs provide. In Sri Lanka for example a CHW covers as little as 10 households offering a set of MCH related services (UNICEF, 2004). On the other hand, there are countries such as India, where a CHW is responsible for about 1000 households providing family planning advice. Contribution of CHWs to improving MNRH Systematic reviews of the evidence from randomized controlled trials on the effects of lay health worker (LHW) interventions in improving MCH in LMICs (Flottorp 2008; Lewin, Dick et al. 2009) found evidence of their contribution to child health. There was evidence of moderate to high quality of the effectiveness of LHWs in improving immunisation uptake in children and in reducing childhood morbidity and mortality from common illnesses, compared with usual care. This however is also the result of the successful implementation of largely vertical immunisation and IMCI programmes. LHWs are also effective in promoting exclusive breastfeeding up to six months of age. Specific program evaluations such as the Lady Health workers program in Pakistan have also found positive benefits of CHWs. Lady Health workers substantially reduced infant, child and maternal mortality within a year. They also generated positive perceptions of family planning in the communities (Barzgar 1997) and increased the use of oral contraceptive pills condoms use among rural women (Douthwaite 2005). Other studies show that contraceptives including injectable Depo Provera (depot-medroxyprogesterone acetate (DMPA)) can be safely provided by CHWs (Ministry of Health Kenya 2007; Stanback, Mbonye et al. 2007). CHWs have also been shown to have an impact upon preventing neonatal deaths (Bari, P a g e | 32
- Page 1 and 2: Human Resources for Health in Mater
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- Page 5 and 6: Collaboration with traditional and
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- Page 9 and 10: TBA T & L UNFPA UNICEF UOG UPNG USA
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- Page 13 and 14: Executive Summary Addressing the ba
- Page 15 and 16: Introduction What human resource pr
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- Page 19 and 20: Effective HRH practice and quality
- Page 21 and 22: is no single prescribed set of ways
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- Page 25 and 26: Figure 5 Millennium Development Goa
- Page 27 and 28: (UNICEF 2007) However, the road to
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- Page 31: Figure 10 Overview of HRH at commun
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- Page 37 and 38: Table 7 What Skilled attendants can
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- Page 43 and 44: Table 9 Search terms used for the s
- Page 45 and 46: findings. Differences and similarit
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of community health workers employed to provide MNRH care <strong>and</strong> services <strong>in</strong> a number of<br />
countries <strong>in</strong> the Asia <strong>and</strong> Pacific regions.<br />
Table 5 Examples of Community health workers <strong>in</strong> MNRH the Asia Pacific region<br />
Country Designation Role <strong>in</strong> MNRH Reference<br />
Bangladesh Community<br />
health worker<br />
Make ANC home visits to promote birth <strong>and</strong><br />
newborn-care preparedness, <strong>and</strong> postnatal home<br />
visits to assess newborns <strong>and</strong> refer or treat sick<br />
(Baqui 2008)<br />
neonate<br />
Bangladesh Family welfare Supply condoms <strong>and</strong> contraceptive pills dur<strong>in</strong>g<br />
assistant<br />
home visits. May act as SBAs if tra<strong>in</strong>ed by MoH<br />
Bangladesh Shasthya Sebika Female volunteers who dissem<strong>in</strong>ate family<br />
plann<strong>in</strong>g messages, register pregnancy cases<br />
Cambodia Expert patient or Peer health education<br />
advocate<br />
Nepal Female<br />
Provide family plann<strong>in</strong>g, maternal care, child<br />
Community health, vitam<strong>in</strong> A supplementation/ de-worm<strong>in</strong>g<br />
health volunteer <strong>and</strong> immunization coverage<br />
India Mitan<strong>in</strong> Female volunteers <strong>in</strong> villages tra<strong>in</strong>ed to dispense<br />
drugs ie IPTp from specially designed kit<br />
India Sahiyyas Women who facilitate <strong>in</strong>tegrated mother <strong>and</strong> child<br />
health care, encourages ANC, <strong>in</strong>stitutional delivery,<br />
<strong>and</strong> immunization. Provides family plann<strong>in</strong>g advice<br />
<strong>and</strong> first aid.<br />
Burma<br />
Vanuatu<br />
Indonesia<br />
Mobile Obstetric<br />
<strong>Maternal</strong> <strong>Health</strong><br />
Worker<br />
Peer health<br />
educator<br />
Village family<br />
plann<strong>in</strong>g<br />
volunteers<br />
Skilled birth attendants, community mobilisers<br />
(MoHFW Bangladesh<br />
2009; Mridha 2009)<br />
(Ahmed 2008)<br />
(St<strong>and</strong><strong>in</strong>g <strong>and</strong><br />
Chowdhury 2008)<br />
(Sood 2003) (Shrestha<br />
2003)<br />
(Government of India<br />
2004)<br />
(Government of India<br />
2004)<br />
(Teela, Mullany et al.<br />
2009)<br />
Deliver reproductive health <strong>in</strong><strong>for</strong>mation (Walker 1998)<br />
Promote family plann<strong>in</strong>g, organise meet<strong>in</strong>gs,<br />
provide <strong>in</strong><strong>for</strong>mation, organise <strong>in</strong>come-generation<br />
activities, give sav<strong>in</strong>gs <strong>and</strong> credit assistance, collect<br />
<strong>and</strong> report data <strong>and</strong> deliver other family welfare<br />
services<br />
(Utomo, Arsyad et al.<br />
2006)<br />
Indonesia Peer health Deliver reproductive health <strong>in</strong><strong>for</strong>mation (Senderowitz 1998)<br />
educator<br />
Indonesia kaders IMC-tra<strong>in</strong>ed community health workers (Bowen 2006)<br />
(Bailey 1996)<br />
<strong>Health</strong> assistants <strong>Health</strong> promotion (Keni 2006)<br />
Marshall<br />
Isl<strong>and</strong>s<br />
The roles outl<strong>in</strong>ed <strong>in</strong> Table 5 <strong>in</strong>dicate the broad range of tasks that CHWs undertake <strong>in</strong><br />
MNRH which can be classified as curative, preventive <strong>and</strong> promotive functions. These<br />
<strong>in</strong>clude health education <strong>and</strong> promotion, advocacy, community mobilisation, dispens<strong>in</strong>g<br />
reproductive health commodities <strong>and</strong> drugs, <strong>and</strong> basic cl<strong>in</strong>ical <strong>in</strong>terventions <strong>and</strong> referral.<br />
CHWs may be employed to per<strong>for</strong>m a mix of tasks or focus on one particular area. For<br />
example, CHWs may focus on support<strong>in</strong>g pregnant women <strong>and</strong> / or assist<strong>in</strong>g dur<strong>in</strong>g labour<br />
<strong>and</strong> <strong>in</strong> the postnatal period <strong>and</strong> / or may have a role <strong>in</strong> reproductive care as well. Some CHWs<br />
may assist dur<strong>in</strong>g births, some without tra<strong>in</strong><strong>in</strong>g <strong>and</strong> legislative m<strong>and</strong>ate, <strong>and</strong> others with<br />
specialised midwifery tra<strong>in</strong><strong>in</strong>g. Female CHWs may direct more attention to maternal <strong>and</strong><br />
child health <strong>and</strong> family plann<strong>in</strong>g, while males take care of other functions (Ofosu-Amaah<br />
1983). In addition, CHWs per<strong>for</strong>m a mix of health service functions <strong>and</strong> development<br />
P a g e | 31
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