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 ...
Mannan et al. 2006; Baqui 2008; Baqui, El-Arifeen et al. 2008) and recovery rates of mothers who had post natal depression (Rahman, Malik et al. 2008). In addition CHWs have been shown to effectively retain health records (Kuhn and Zwarenstein 1990) and show adherence to simple clinical practice guidelines (Haines, Sanders et al. 2007). Peer health educators have also been found in some studies to contribute to increased health knowledge and to some extent improved attitudes and sexual behaviours (Maticka-Tyndale 2006). A study of adolescent girls peer health educators (PHE) in a factory in Thailand, for example, demonstrated improvements in knowledge and enabling skills (such as discussing contraception and the need to take responsibility for it). There efforts were more successful than those of their counterparts in either adult health educator-led sessions or in sessions using materials only. The peer-led group also exhibited the largest increase in perceived vulnerability to HIV infection, but the smallest degree of fear because they learned how to protect themselves (Weiss 1996; Cash 1997). There is a large literature in this area that describes various levels of success with respect to the effectiveness of PHEs. Nursing and midwifery personnel The nursing and midwifery cadres are central to community health. In Kiribati and PNG nurses are the only health workers in the rural and remote areas; in Samoa 99.5% of all health care is provided by nurses (WHO 2001; Duffield 2008). ―Nursing and midwifery personnel is a collective term used for a wide variety of health workers‖ (WHO/SEARO 2003). Table 6 below outlines the range of titles, each of which represents a different role and training. For example, a nurse practitioner in Fiji must hold a 3 year diploma while a Certified Nurse Practitioner undertakes a 4 month training program. Table 6 Examples of nursing and midwifery cadres in the Asia and Pacific regions Country Designation Reference Fiji Nurse Practitioners http://www.anmc.org.au/wpsear Thailand Certified Nurse Practitioner Vanuatu General nurse http://www.anmc.org.au/wpsear Auxiliary nurse Mongolia Feldsher (community nurse) http://www.anmc.org.au/wpsear India Village health nurse (Government of India 2004) Nepal Auxiliary nurse midwife (Piedade 2004) Solomon Registered nurse midwife, Clinical http://www.anmc.org.au/wpsear Islands nurse midwife Cambodia Primary midwife, Secondary midwife http://www.anmc.org.au/wpsear/ The term nurse is a broad one and ―encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well and in all P a g e | 33
settings‖(ICN 2009). They may be involved in the provision of MNRH care and services, but are not necessarily in attendance at births. Midwives are engaged in the provision of support, care and advice during the pre-pregnancy period, as well as during pregnancy, labour and the postpartum period. This includes attending births in normal and complicated situations and providing counselling, education and family planning services. A midwife is someone who has successfully completed a course in midwifery and who is legally licensed to practice (ICM 2005). Auxiliary or assistant midwives provide more ―indirect patient care activities‖ (Hasson 2005). They are often the first formally trained midwife cadre that women see at community level and can provide a bridge between traditional and biomedical models of care (Warren 2007). Midwifery practitioners are skilled birth attendants (SBAs), however, not all nurses have midwifery skills and are therefore not automatically classified as SBAs. The term SBA is defined as: an accredited health professional — such as a midwife, doctor or nurse — who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications in women and newborns (WHO ICM FIGO 2004) Traditional birth attendants (TBAs) (described in more detail below), whether trained or not, are excluded from the category of skilled health workers (World Health Organization, 2004). Minimum and additional skills have been specified for SBAs which have improved understanding of training requirements and the broader context required for skilled attendants to function effectively (Safe Motherhood Inter-Agency Group 2000; WHO ICM FIGO 2004). Contribution of SBAs to improving MNRH SBAs have been shown to be critical to improving maternal health outcomes. A systematic review conducted in developed countries found that, compared to other models of care, midwife-led care: Leads to fewer antenatal hospitalisations and instrumental vaginal deliveries Decreases the use of pain killers during labour Leads to more spontaneous vaginal births, and Probably has little or no effect on foetal and neonatal deaths, augmentation or induction of labour, Caesarean sections, and postpartum haemorrhage (Hatem 2008). However this review was undertaken in HIC and availability and quality training needs to be taken in consideration when understanding this in the context of LMIC.For example where EmOC is not accessible for women who birth at home in a LMIC context, antenatal hospitalisations for high risk women may be a useful step. P a g e | 34
- 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 and 30: A number of steps are purported to
- Page 31 and 32: Figure 10 Overview of HRH at commun
- Page 33: functions, the latter involving mob
- 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
- Page 77 and 78: progress over time. This tool and t
- Page 79 and 80: At national level, countries may ha
- Page 81 and 82: evaluating and adjusting the size a
- Page 83 and 84: There are a number of difficulties
Mannan et al. 2006; Baqui 2008; Baqui, El-Arifeen et al. 2008) <strong>and</strong> recovery rates of mothers<br />
who had post natal depression (Rahman, Malik et al. 2008). In addition CHWs have been<br />
shown to effectively reta<strong>in</strong> health records (Kuhn <strong>and</strong> Zwarenste<strong>in</strong> 1990) <strong>and</strong> show adherence<br />
to simple cl<strong>in</strong>ical practice guidel<strong>in</strong>es (Ha<strong>in</strong>es, S<strong>and</strong>ers et al. 2007).<br />
Peer health educators have also been found <strong>in</strong> some studies to contribute to <strong>in</strong>creased health<br />
knowledge <strong>and</strong> to some extent improved attitudes <strong>and</strong> sexual behaviours (Maticka-Tyndale<br />
2006). A study of adolescent girls peer health educators (PHE) <strong>in</strong> a factory <strong>in</strong> Thail<strong>and</strong>, <strong>for</strong><br />
example, demonstrated improvements <strong>in</strong> knowledge <strong>and</strong> enabl<strong>in</strong>g skills (such as discuss<strong>in</strong>g<br />
contraception <strong>and</strong> the need to take responsibility <strong>for</strong> it). There ef<strong>for</strong>ts were more successful<br />
than those of their counterparts <strong>in</strong> either adult health educator-led sessions or <strong>in</strong> sessions<br />
us<strong>in</strong>g materials only. The peer-led group also exhibited the largest <strong>in</strong>crease <strong>in</strong> perceived<br />
vulnerability to HIV <strong>in</strong>fection, but the smallest degree of fear because they learned how to<br />
protect themselves (Weiss 1996; Cash 1997). There is a large literature <strong>in</strong> this area that<br />
describes various levels of success with respect to the effectiveness of PHEs.<br />
Nurs<strong>in</strong>g <strong>and</strong> midwifery personnel<br />
The nurs<strong>in</strong>g <strong>and</strong> midwifery cadres are central to community health. In Kiribati <strong>and</strong> PNG<br />
nurses are the only health workers <strong>in</strong> the rural <strong>and</strong> remote areas; <strong>in</strong> Samoa 99.5% of all health<br />
care is provided by nurses (WHO 2001; Duffield 2008). ―Nurs<strong>in</strong>g <strong>and</strong> midwifery personnel is<br />
a collective term used <strong>for</strong> a wide variety of health workers‖ (WHO/SEARO 2003). Table 6<br />
below outl<strong>in</strong>es the range of titles, each of which represents a different role <strong>and</strong> tra<strong>in</strong><strong>in</strong>g. For<br />
example, a nurse practitioner <strong>in</strong> Fiji must hold a 3 year diploma while a Certified Nurse<br />
Practitioner undertakes a 4 month tra<strong>in</strong><strong>in</strong>g program.<br />
Table 6 Examples of nurs<strong>in</strong>g <strong>and</strong> midwifery cadres <strong>in</strong> the Asia <strong>and</strong> Pacific regions<br />
Country Designation Reference<br />
Fiji Nurse Practitioners http://www.anmc.org.au/wpsear<br />
Thail<strong>and</strong> Certified Nurse Practitioner<br />
Vanuatu General nurse http://www.anmc.org.au/wpsear<br />
Auxiliary nurse<br />
Mongolia Feldsher (community nurse) http://www.anmc.org.au/wpsear<br />
India Village health nurse (Government of India 2004)<br />
Nepal Auxiliary nurse midwife (Piedade 2004)<br />
Solomon Registered nurse midwife, Cl<strong>in</strong>ical http://www.anmc.org.au/wpsear<br />
Isl<strong>and</strong>s nurse midwife<br />
Cambodia Primary midwife, Secondary midwife http://www.anmc.org.au/wpsear/<br />
The term nurse is a broad one <strong>and</strong> ―encompasses autonomous <strong>and</strong> collaborative care of<br />
<strong>in</strong>dividuals of all ages, families, groups <strong>and</strong> communities, sick or well <strong>and</strong> <strong>in</strong> all<br />
P a g e | 33
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