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

manage selected obstetric and neonatal complications. A number of studies have found TBAs
to lack the ability to adequately recognise and manage complications and refer (Darmstadt
2008; Thatte, Mullany et al. 2009). The poor non clinical skills of all community providers
including TBAs, VHWs and CHWs are also well reported in the literature. These range from
a lack of record keeping skills (Chaulagai 1993; Umar 2003), advocacy and negation skills
(FIGO 2009), local language skills (Replogle 2007). Howver central to clinical and non
clinical roles of providers at community level are communication skills which have been
found to be lacking in a number of studies (Tlebere, Jackson et al. 2007) (QAP 2000;
Bossyns and Van Lerberghe 2004; FCI 2005). Health workers need to maintain and upgrade
their skills through practice and in service education and training. In PNG CHWs and SBAs
in Indonesia have reportedly lost their clinical skills due to a lack of case load which has been
the result of the less than optimum deployment of these staff (Ashwell and Freeman 1995;
Utomo 2008) despite their skills being in high demand at community level.
Provider attitudes towards women are critical to equitable access and quality care. A
systematic review of obstetric care in LMIC found that women were dissatisfied with care as
skills are perceived as lacking and patient provider relationships are poor. This affects the
care seeking behaviour of women. Other health worker attitudes such as a fear of HIV
infection (Dovlo 2005; Nguyen, Oosterhoff et al. 2009) and judgemental attitudes concerning
STI (Passey 1996 ) also affect the delivery of care. Authoritarian attitudes of staff were found
to negatively impact upon referral. In a study in rural Niger Health workers were reluctant to
refer and encourage patients to act upon referral for fear of loss of power and prestige
(Bossyns and Van Lerberghe 2004; PNG NDoH 2009). At the extreme end of the scale health
worker attitudes were found to manifest in violence towards women (d'Oliveira 2002).
Working with the community
The community remains one of the major stakeholders in need of inclusion. Often lacking are
formalised arrangements for community representatives to monitor activities at the facility
level and demand feedback on service provision. This represents a serious limitation in the
quest for accountable, quality health care delivery, both in terms of human resource
performance and the management of medical resources (Dussault 2009). Community
knowledge of HRH is often low. Sherrat for example found that community members in
Cambodia did know what a professional midwife was and, what midwives do and did not
know that there was a shortage in midwives (2006). Low levels of knowledge are often the
result of the lack of community involvement in decision making processes including policy
making and health sector reform. The lack of community involvement in health sector
reforms has been found to impact upon poor sexual and reproductive health service
accountability and inequitable service provision(Murthy 2004).
P a g e | 55