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 ...
Figure 17 Trends Figure in 3: proportion Trends in of proportion births attended of births by SBAs attended 1990-2005 by skilled and health projection for 2015 in SEARO countries personnel, 1990-2005, and projection for 2015 120 100 100 97 98 97 99 97 90 87 87 84 85 98 99 94 91 1990 2000 2005 2015 80 72 67 70 68 60 *52 54 57 51 60 60 40 34 42 41 32 20 12 13 5 15 24 18.7 11 7 24 0 Bangladesh Bhutan DPR Korea India Indonesia Maldives Myanmar Nepal Sri Lanka Thailand Timor-Leste SEA Region countries Annual Health Report 2007 SEARO Source: 11 health questions about the 11 SEAR countries, WHO, SEARO, 2007 *Annual Health Bulletin 2007 The relationship between HRH coverage, service delivery and health outcomes can be illustrated in Bangladesh where the attrition of Family welfare workers (FWW) and Family welfare assistants (FWA) has been accompanied by a reduction in the contraceptive prevalence rate for modern methods and household-visits by FWVs or FWAs (Mridha 2009). There is a shortage of SBAs in Bangladesh and despite a new initiative designed to bolster numbers by training FWAs as community skilled birth attendants (CSBAs) the gap will not be filled by 2015 given the slow production of CSBAs and relatively-low usage by women for delivery (Mridha 2009). In 2006, it was calculated that, if Bangladesh continues to develop CSBAs at the current rate and deploy them in the community, the CSBAs will be able to cover only 5% of all births in 2015 (Koblinsky, Matthews et al. 2006; Mridha 2009). Despite there being shortages in some countries others identify surplus health workers that form part of the export market as in the cases of Philippines or the result of weak workforce planning. In Indonesia for example there are differences in availability and need with the projection of HRH between 1982-2010 indicating a surplus of 15,00 nurses per year (Suwandono 2005). There are also differences in distribution of health workers with particular skills at community level. This affects the skills mix of the health team and the care and services that they are able to provide. Such differences in distribution of staff may reflect differences in health needs or inequitable access to MNRH. Wide ranges in the proportion of staff to population have been reported. For examples the home visits by CHWs with health facility support in the Asia Near East Region to population ratio was reported in a study of post P a g e | 49
partum services as being from 1:60 to 1:5000 (ESD Project 2008). Another study in northern Tanzania of staff with emergency obstetric skills found that the most qualified staff are concentrated in a small number of centralized locations, while those remaining are inequitably and inefficiently distributed in rural areas and in lower-level services. Voluntary agency facilities in rural districts were found to have more staff than the government facilities. A statistical correlation was identified between availability of qualified human resources and use of services, but the availability of qualified human resources did not translate into higher availability of qualified emergency obstetric care services. The authors call for increasing access to high-quality health care through increasing the numbers of qualified staff instead of distributing low-quality services widely. Weak policy, legislation and regulation According to the WHO there is an evidence–policy gap in HRH. Policymakers are not fully using existing evidence on the effectiveness of nursing and midwifery services to target individual and community interventions (WHO 2001). As a result many HRH policies are not evidence informed or inclusive of the community level. However other authors have indicated that HRH policy development is also limited by a lack of HRH data and evidence of what works (Pick 2008). Clearly there is a need for an increase in the high quality evidence that must be made available to decision makers for policy development. Gender has been highlighted as an area of neglect in HRH policy (Standing 2000) as well as the lack of coordination between policies. For example the introduction of new drug policy in Kenya was not aligned with HRH capacity building. A study of health workers in communities in rural Kenya revealed confusion about appropriate timing, and lack of direct observation of IPTp highlighting the need for training (Ouma, Van Eijk et al. 2007). WHO has identified the lack of involvement of CHWs nurses and Midwives in policy and planning (WHO 1989; WHO/SEARO 2003). Involving staff in policy development helps ensure buy in and ownership of policy which facilitates the implementation and evaluation of policies. The lack of legally binding conditions for health professionals affects the ability of professional associations and the government to regulate practice and apply quality control at community level. In Indonesia regulation has been affected by health reform. The ability of Indonesia Ministry of Health‘s to regulate midwifery training and practice has declined since decentralization in 2001(Harvey, Blandon et al. 2007). This is due to the rise of private solo nurse practitioners who practice illegally at community level (Heywood and Harahap 2009). Delays in legislation process can also affect the progress of continuing health education. Despite the establishment of a code of ethics by the Medical Council of India stating that members should complete 30 hours of continuing medical education every five years in order to re-register as doctors, only 20% of India's doctors follow comply as it is not legally binding (Majumder 2004). New laws can have a detrimental effect on service delivery. P a g e | 50
- 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 and 36: settings‖(ICN 2009). They may be
- 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: PHEs. In the Pacific the density of
- 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
- Page 89 and 90: which was developed in 2002. This w
- Page 91 and 92: al. 2008). Dual practice is another
- Page 93 and 94: Figure 24 Motivational determinants
- Page 95 and 96: Many of the incentives to health wo
- Page 97 and 98: files suggests that more careful at
- Page 99 and 100: Management autonomy at community le
Figure 17 Trends Figure <strong>in</strong> 3: proportion Trends <strong>in</strong> of proportion births attended of births by SBAs attended 1990-2005 by skilled <strong>and</strong> health projection <strong>for</strong><br />
2015 <strong>in</strong> SEARO countries personnel, 1990-2005, <strong>and</strong> projection <strong>for</strong> 2015<br />
120<br />
100<br />
100<br />
97 98 97<br />
99<br />
97<br />
90<br />
87<br />
87<br />
84 85<br />
98<br />
99<br />
94<br />
91<br />
1990<br />
2000<br />
2005<br />
2015<br />
80<br />
72<br />
67<br />
70<br />
68<br />
60<br />
*52<br />
54<br />
57<br />
51<br />
60<br />
60<br />
40<br />
34<br />
42<br />
41<br />
32<br />
20<br />
12 13<br />
5<br />
15<br />
24<br />
18.7<br />
11<br />
7<br />
24<br />
0<br />
Bangladesh Bhutan DPR Korea India Indonesia Maldives Myanmar Nepal Sri Lanka Thail<strong>and</strong> Timor-Leste<br />
SEA Region countries<br />
Annual <strong>Health</strong> Report 2007 SEARO<br />
Source: 11 health questions about the 11 SEAR countries, WHO, SEARO, 2007<br />
*Annual <strong>Health</strong> Bullet<strong>in</strong> 2007<br />
The relationship between <strong>HRH</strong> coverage, service delivery <strong>and</strong> health outcomes can be<br />
illustrated <strong>in</strong> Bangladesh where the attrition of Family welfare workers (FWW) <strong>and</strong> Family<br />
welfare assistants (FWA) has been accompanied by a reduction <strong>in</strong> the contraceptive<br />
prevalence rate <strong>for</strong> modern methods <strong>and</strong> household-visits by FWVs or FWAs (Mridha 2009).<br />
There is a shortage of SBAs <strong>in</strong> Bangladesh <strong>and</strong> despite a new <strong>in</strong>itiative designed to bolster<br />
numbers by tra<strong>in</strong><strong>in</strong>g FWAs as community skilled birth attendants (CSBAs) the gap will not<br />
be filled by 2015 given the slow production of CSBAs <strong>and</strong> relatively-low usage by women<br />
<strong>for</strong> delivery (Mridha 2009). In 2006, it was calculated that, if Bangladesh cont<strong>in</strong>ues to<br />
develop CSBAs at the current rate <strong>and</strong> deploy them <strong>in</strong> the community, the CSBAs will be<br />
able to cover only 5% of all births <strong>in</strong> 2015 (Kobl<strong>in</strong>sky, Matthews et al. 2006; Mridha 2009).<br />
Despite there be<strong>in</strong>g shortages <strong>in</strong> some countries others identify surplus health workers that<br />
<strong>for</strong>m part of the export market as <strong>in</strong> the cases of Philipp<strong>in</strong>es or the result of weak work<strong>for</strong>ce<br />
plann<strong>in</strong>g. In Indonesia <strong>for</strong> example there are differences <strong>in</strong> availability <strong>and</strong> need with the<br />
projection of <strong>HRH</strong> between 1982-2010 <strong>in</strong>dicat<strong>in</strong>g a surplus of 15,00 nurses per year<br />
(Suw<strong>and</strong>ono 2005).<br />
There are also differences <strong>in</strong> distribution of health workers with particular skills at<br />
community level. This affects the skills mix of the health team <strong>and</strong> the care <strong>and</strong> services that<br />
they are able to provide. Such differences <strong>in</strong> distribution of staff may reflect differences <strong>in</strong><br />
health needs or <strong>in</strong>equitable access to MNRH. Wide ranges <strong>in</strong> the proportion of staff to<br />
population have been reported. For examples the home visits by CHWs with health facility<br />
support <strong>in</strong> the Asia Near East Region to population ratio was reported <strong>in</strong> a study of post<br />
P a g e | 49
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