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

More documents

Recommendations

Info

Outlawing TBA practice for example in rural Costa Rica may have improved maternal mortality but it also affected links with the community and led to loss of cultural support approaches (Jenkins 2003). One of the barriers to the successful shifting of tasks to lower cadres such as moving the responsibility of injecting contraceptive to CHWs has been a lack of both a regulatory framework and proper financial mechanisms to sustain it. A regulatory framework is essential to ensure government support, protection of patients and health workers and sustainability as well as resource flow. According to a WHO consultation the existing barriers to task shifting must be identified and minimised (WHO 2007). Challenging working environments The delivery of quality care and services depends upon the support of partnerships between members in a PHC team, or across the health care sector with state and non state providers, cultural or traditional providers or at various levels linking the community to facilities. A review of CHWs identified few studies that have brought out the importance of building healthy ―inter-relationships‖ and ―trust‖ among health professionals in building an effective feedback and referral systems in place (Prasad 2007). There are however a number of studies that have highlighted various problems in teams and partnerships. Poor PHC team work has been found to be affected by low levels of HR trust in CHWs which has led to poor intersectoral collaboration (Sauerborn 1989; Cruse 1997). Midwife and nurse cadres attitudes towards CHWs and TBAs has been documented as disrespectful (Iyun 1989; Replogle 2007) and paternalistic (Walt, Perera et al. 1989) which contributes to poor communication and the perceived low status of these cadres (Walt 1990; FIGO 2009). Low levels of traditional and biomedical collaboration have been documented particularly between midwifes and TBAs (Kaboru 2006). In Indonesia this is affected by competition between midwifes and TBAs (Utomo 2008). The socio-cultural context of the community can pose a number of challenges to health workers. Authors have outlined a number of gender-based barriers to primary health care provision in Pakistan which includes harassment of female workers and the imposition of conditions on their practices such as the need to be accompanied by a male relative (Mumtaz, Salway et al. 2003). Health workers at community level may also face challanges delivering services that deal with sensitive issues that may not normally be discussed or are not acceptable. For example a survey of the status of community-based postpartum care and postpartum family planning services implemented by MotherNewBorNet member organizations in the Asia Near East region found that health care workers in some contexts are afraid to discuss family planning with some clients because of fear that they will tell their P a g e | 51
husbands who oppose family planning use (ESD Project 2008). The geo-political environment may also pose difficulties to health workers including conflict and long or hazardous distances that must be traversed with poor transport. The functionality of the health system determines health worker access to drugs and equipment that are frequently not available at community level (Sauerborn, Nougtara et al. 1989; Tsu and Free 2002). There is a lack of workplace policies and guidelines that consider the health and welfare of staff or endeavour to provide family friendly work places. Despite HIV/AIDS being a major health issue in Zambia there are no guideline on care and support for nurses and midwives with HIV/AIDS. There are no light duties for chronically ill nurses and midwives, care or support facilities in HIV/AIDS that currently incorporates nurses (Chikampa 2003). According to WHO more than 70% of workers are not covered by occupational health provisions (WHO/SEARO 2008). Difficult working environments impact upon health worker retention. In PNG for example the most common reason for village midwives ceasing work is family pressure or lack of support (Bettiol 2004). A lack of workplace support includes poor supervision and high workloads which are often the result of low numbers of qualified staff and high case loads. In addition there may be added pressure resulting from the integration of MNRH with HIV and IMCI and various other programs. Research in this area is scant and requires attention. Weak HRH leadership and management systems Without efficient management of the workforce quality services and care at community level is compromised which affects equity and access to MNRH. Human resources for health management (HRM) is often implemented in a ―less than optimum‖ way (Dussault & Dubois, 2003), because of a lack of knowledge and skills in HRM among health care managers and the use of a traditional personnel management approach to HRM. Current human resources management need to be improved and a reorientation towards a comprehensive approach to addressing staff supply, performance management and personnel relations. Tools and skills are also needed to implement human resources management activities.(Dieleman 2006). Some examples of key barriers and constraints in HRM are outlined below. Comprehensive performance improvement processes that include performance management of staff have been cited as a major constraint to improving health (IntraHealth International 2008). A study that included nurses working at community level in Malawi found that the weak performance management resulted in: inadequate continuous education and career progression strategies, a lack of performance appraisal and the provision of job descriptions as well as inadequate supervision and little feedback on performance. Health workers reported that this had a major impact upon their motivation levels however managers were P a g e | 52
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 and 50: PHEs. In the Pacific the density of
Page 51: partum services as being from 1:60
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
Page 101 and 102: Initiative focus Details Context Re
Page 103 and 104:
informal, mutual-help action groups
Page 105 and 106:
Building relationships with cultura
Page 107 and 108:
groups; encouraging recruitment thr
Page 109 and 110:
Summary This section has identified
Page 111 and 112:
encouraging midwives to proactively
Page 113 and 114:
Facilitation & attendance at MOH/ N
Page 115 and 116:
of community leaders improved the c
Page 117 and 118:
Table 19 Examples of initiatives in
Page 119 and 120:
information and advice from peers (
Page 121 and 122:
esources to provide clinical and ma
Page 123 and 124:
Strengthening Education and compete
Page 125 and 126:
Table 20 Examples of Partnership ap
Page 127 and 128:
Table 21 Learner needs analysis and
Page 129 and 130:
Table 22 Some approaches to the des
Page 131 and 132:
Participants/ Method / document typ
Page 133 and 134:
strengthening and establishing accr
Page 135 and 136:
Participants / context LMICs method
Page 137 and 138:
alongside health service improvemen
Page 139 and 140:
Country / cadre Niger: Birth attend
Page 141 and 142:
Country / cadre Indonesia Surabaya
Page 143 and 144:
Lessons learned from countries that
Page 145 and 146:
Malaysia The sharp decline in mater
Page 147 and 148:
although supplemented with epidemio
Page 149 and 150:
A technical meeting in Bangkok in 2
Page 151 and 152:
Development approach is an example
Page 153 and 154:
flexibility in order to overcome ge
Page 155 and 156:
up skilled birth attendance‖. The
Page 157 and 158:
Scaling up of the Navrongo service
Page 159 and 160:
conditions (Walt, Perera et al. 198
Page 161 and 162:
Figure 37 Critical success factors
Page 163 and 164:
Health system standards are explici
Page 165 and 166:
prevalence rate, however in order t
Page 167 and 168:
(Dieleman 2006) Selected key indica
Page 169 and 170:
In order to determine the answers t
Page 171 and 172:
Summary of findings This narrative
Page 173 and 174:
Health worker performance is theref
Page 175 and 176:
Discussion and Recommendations What
Page 177 and 178:
outlines how the HRH information ba
Page 179 and 180:
communities. A collaborative approa
Page 181 and 182:
Table 29 Examples of HRH performanc
Page 183 and 184:
Appendices Appendix 1. MDG5 Country
Page 185 and 186:
World Health Statistics http://www.
Page 187 and 188:
Appendix 3. Sources of all material
Page 189 and 190:
Data source Keywords used in search
Page 191 and 192:
Page 193 and 194:
Page 195 and 196:
Page 197 and 198:
Page 199 and 200:
Appendix 4: Barriers and Constraint
Page 201 and 202:
Area Barriers & constraints in MNRH
Page 203 and 204:
Area Barriers & constraints in MNRH
Page 205 and 206:
Appendix 5 Literature that document
Page 207 and 208:
P a g e | 206
Page 209 and 210:
IMNCI PMTCT Perinatal Period Postna
Page 211 and 212:
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
Page 219 and 220:
Elson, D., Evers, B. (1998). Sector
Page 221 and 222:
Flanagan, D., Williams, C., Mahler,
Page 223 and 224:
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
Page 229 and 230:
Kroll, D., Dwyer, D. (1994). "Postn
Page 231 and 232:
Manandhar, D. S., D. Osrin, et al.
Page 233 and 234:
Morisky, D. E. (1985-86). "Evaluati
Page 235 and 236:
O‘Brien-Pallas, L., Irvine, D., P
Page 237 and 238:
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
show all

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

Create successful ePaper yourself

Delete template?

Save as template?