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

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In almost all countries where SBAs attend more than 80% of births, MMR is less than 200 per 100,000 (World Bank 1999). However about 61% of women still deliver their babies without a SBA. The importance of this correlation has led to the adoption of the proportion of births attended by a SBA as a MDG 5 indicator with the target defined at the ICPD+5(1999). Figure 11 below illustrates the probability of survival by density of workforce. The effects of this on maternal mortality is greater than in child survival even with low numbers of health workers due to the intervention of SBAs (Anand and Bärnighausen 2004-2005). Caution must be exercised in the correlation between maternal mortality and skilled attendance. Reductions in MMR have not occurred in Malawi for example where rates of institutional delivery have increased to 57% but MMR has risen almost three fold since 1990. This is partly due to HIV infection and improved reporting of death (Costello, Azad et al. 2006). Figure 11 The relationship between density of health workers and child, maternal and infant survival The percentage of maternal mortality that a SBA can prevent has been calculated according to various causes as outlined in Table 7 below. P a g e | 35
Table 7 What Skilled attendants can do to prevent and manage direct causes of maternal mortality Causes of maternal mortality Post-partum hemorrhage What SBAs can do Active management of third stage What SBAs can do to manage Oxytocics, uterine massage, manual removal of placenta, fluids & blood % mortality prevented by SBA 30% Eclampsia Early identification & management of preeclampsia Magnesium sulphate antihypertensive, delivery 20% Obstructed labour Use of partograph Caesarean section,* symphysiotomy Puerperal sepsis Use aseptic technique Antibiotic therapy, removal of infected material 70% 50% (Safe Motherhood Inter-Agency Group 2000) *This intervention is not likely to occur at community level. Two models of maternal care at the time of birth are potentially available in most communities (Koblinsky, Campbell et al. 1999). Deliveries may be conducted at home by a community member who has received brief training or deliveries may take place at home but are performed by a skilled professional. In very well resourced environments deliveries may also take place in a basic essential obstetric care facility overseen by a skilled professional. The ideal relationship between the provision of essential obstetric functions and midwifery is presented in the schematic model below (WHO 1990). Midwifery is centred on the health centre with some services available at community and hospital level. However, in most low and middle income countries the ideal pyramidal representation in the figure below is more of an hour glass, with receding midwifery at the mid level, increasing prenatal, maternal, perinatal, and family planning services at the community and decreasing emergency obstetric function (Kwast 1995). P a g e | 36
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 and 34: functions, the latter involving mob
Page 35: settings‖(ICN 2009). They may be
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
Page 85 and 86: Figure 23 The Task Shifting Process
Page 87 and 88:
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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Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
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
Page 209 and 210:
IMNCI PMTCT Perinatal Period Postna
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Ambegaokar, M., Lush, L. (2004). "F
Page 213 and 214:
Barrett, B., J. Ladinsky, et al. (2
Page 215 and 216:
University South Africa with the Re
Page 217 and 218:
Cruse, D. (1997). Community Health
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Elson, D., Evers, B. (1998). Sector
Page 221 and 222:
Flanagan, D., Williams, C., Mahler,
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Greenwood, A. M., Bradley, A.K., By
Page 225 and 226:
Howard, G., Bogh, C., Goldstein, G.
Page 227 and 228:
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
Page 235 and 236:
O‘Brien-Pallas, L., Irvine, D., P
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Pfeiffer, J. and J. Pfeiffer (2003)
Page 239 and 240:
Replogle, J. (2007). "Training Trad
Page 241 and 242:
Shankar, A., S. Sebayang, et al. (2
Page 243 and 244:
Teela, K. C., L. C. Mullany, et al.
Page 245 and 246:
van Damm, W., et. al (2008). "Scali
Page 247 and 248:
WHO (2008). Global Standards for In
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