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

Remuneration for CHWs, nurse and midwifes in the public sector is regarded as low and
there can be frequent delays in receiving pay (Oxford Policy Management 2002) which
impacts upon motivation and retention (Ofosu-Amaah 1983; WHO/SEARO 2003; McCoy,
Bennett et al. 2008; Pillay and Mahlati 2008). This has led some health workers to obtain
employment in other sectors resulting in dual practice (Ferrinho, Van Lerberghe et al.
2004)which has implications for work load and practice. There are also a number of issues
related to incentives for health workers at community level. In terms of financial incentives
many allowances such as those given for petrol, clothing allowance have been perceived by
CHNs to be inadequate(Kingma 2003). Peer health educators have reported that their
performance has been affected by too many out of pocket expenses that have not been
reimbursed or where there has been a long delay (Senderowitz 1998). Non-financial
incentives on the other hand have not always accounted as a motivating factor for
performance among CHWs (Dieleman, Cuong et al. 2003).
Education and competencies
The quality of pre and in service education and training is a major contributor to health
worker competence. Many authors have identified poor quality education and training
programmes in a number of countries (UNFPA 1996; Hull 1998; Khanum 2008; Wakabi
2008; FIGO 2009; Manafa, McAuliffe et al. 2009). The non standardisation of training
contributes to this (Doherty 2005) along with poor selection and recruitment of students.
(Stekelenburg 2003) / (WHO/SEARO 2003).
Several countries have experienced changes in the in the training of various cadres that has
had major implications for MNRH care and services at the community level. In Bangladesh
the recruitment and training of FWVs and FWAs were stopped in 1994 (Mridha 2009) and
both primary and secondary midwifery courses were stopped from 1996 to 2002 in Cambodia
(Sherratt 2006). This resulted in staff shortages and increased workloads for those remaining
providers. In PNG a number of problems arose when midwife training was transferred to
university level. Clinical experience was downgraded with clinical/classroom ratio changing
from 70/30 to 15/85. The PNG nursing council refused to register the graduates as midwives
as they did not fulfill the statutory (legal) requirements for registration in terms of the
numbers and diversity of procedures they had performed under supervision during their
training. There are currently 9 graduating classes with this midwifery degree program who
cannot be registered by the Nursing Council. After considerable negotiation the University of
Papua New Guinea has agreed to revise curriculum (Natera 2009).
There are a number of studies that have documented poor SBA competence (Harvey 2004;
Srinivasan K 2006; Harvey, Blandon et al. 2007; Darmstadt 2008; Hatt, Stanton et al. 2009).
These studies of SBA skills and knowledge in Egypt, Indonesia, Benin, Ecuador, Jamaica and
Rwanda indicate a gap between current evidence-based standards and provider competence to
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