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

unaware of these deficiencies in the system (Manafa, McAuliffe et al. 2009). A lack of
clearly defined roles and responsibilities has been identified by a number of studies (Campos
2004; Creati, Saleh et al. 2007; ESD Project 2008). This has led to confusion in the
community with low levels of knowledge reported regarding the scope of practice of various
health workers in Bangladesh (Pathfinder International 2005).
Workforce planning is an essential part of HRM but plans are often poorly conceived and
implemented. In 2001, the Bangladesh MoH initiated a programme to train the Government‘s
community workers (Family Welfare Assistants and Female Health Assistants) to provide
skilled birthing care in the home. However, these plans have been too meagre, and their
implementation is too weak to fulfil expectations in terms of increasing the use of skilled
birth attendants, especially for poor rural women.(Mridha 2009). HRH planning is not always
undertaken in an integrated manner. Mridha (2009) describes the problems with the lack of
attention to HRH in the roll out of the Health, Nutrition and Population Sector Program
(HNPSP) in Bangladesh. In the first phase of the HNPSP (2003-2006), the Family Planning
and Health Services wings were separated after previously being integrated, and the
community clinics were closed. Their separation prevented integration and left grassrootslevel
workers of both the wings in a state of confusion about their roles and responsibilities.
(Mridha 2009). Other examples of HR planning disconnect at community level can be
illustrated from experience in Indonesia. A large World Bank study found that community
health or Puskesmas facility improvements and even construction of new facilities are not
linked to central staff planning and supervision and the provision of supplies. The report
questions whether there is really a need for more facilities, or whether the needs relate to
improving efficiency since a large number of Puskesmas are underutilized (World Bank
2008b) in (Rokx 2009).
Marquez and Keene (2002) outline the typical barriers to effective supervision including
community level workers in developing-country health systems. They report that health
workers are often supervised by staff at facilities who do not always visit the community.
This may be the result of poor management support including the lack of available transport
for visits to the field. In PNG for example, the provincial health office does not provide
support to districts to undertake supervision, and districts do not provide support to the
community and health post level (Burnet Institute 2007). Funding for supervision is therefore
necessary however 43% of respondents in a survey of Community-Based Postpartum Care
Services in MotherNewBorNet Member Programs reported that there were no funds or
resources for supervision of outreach providers. (ESD Project 2008). Supervision can also be
seen as a method of control or inspection rather than supportive and educational performed
by a colleague or member of the PHC team. Staff may not know who their supervisors are or
they may be inappropriate. For example in Bangladesh FWAs are female and all familyplanning
inspectors are male, who have never worked as FWAs. As a result they have
difficulty supervising the FWAs in their day-to-day home-visit activities.(Mridha 2009)
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