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

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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
Supportive HRH strategies and approaches in MNRH at community level This section is concerned with proposed strategies as well as implemented and evaluated interventions to address the range of HRH issues in MNRH at community level. The complex nature of MNRH at community level and the multiple issues that affect of HR practice demand a multifaceted approach. Health worker performance and health outcomes can be improved by interventions such as supervision and audit (Rowe 2005) as well as training in combination with defined roles and tasks, incentives and community support (Haines, Sanders et al. 2007). Haines identifies several gaps in health systems knowledge in reference to CHWs and child survival. This includes a poor understanding of the conditions under which programmes for CHWs be implemented. This chapter will also identify the contextual factors that impact upon the success of HRH interventions at community level. Strategies are described under six broad areas and case studies from research studies are presented in order to provide evidence based examples of approaches in situ designed to improve HR management practice and health worker performance. Approaches to strengthening HRH in MNRH at community level The Capacity Project, a five year USAID funded project led by IntraHealth has developed an approach to strengthening HRH. This is based on 1. Improving workforce planning and leadership to ensure that the right type and number of health workers are deployed to the right locations, 2. Developing better education and training programs so that health workers have the knowledge and skills to meet the needs of their communities, 3. Strengthening systems to support workforce performance and encourage workers to remain on the job. This is outlined in the Figure below and indicates areas of action and potential strategies that also apply to HRH in MNRH at community level. P a g e | 56
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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 and 52: partum services as being from 1:60
Page 53 and 54: husbands who oppose family planning
Page 55: Remuneration for CHWs, nurse and mi
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
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groups; encouraging recruitment thr
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Summary This section has identified
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encouraging midwives to proactively
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Facilitation & attendance at MOH/ N
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of community leaders improved the c
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Table 19 Examples of initiatives in
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information and advice from peers (
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esources to provide clinical and ma
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Strengthening Education and compete
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Table 20 Examples of Partnership ap
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Table 21 Learner needs analysis and
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Table 22 Some approaches to the des
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Participants/ Method / document typ
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strengthening and establishing accr
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Participants / context LMICs method
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alongside health service improvemen
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Country / cadre Niger: Birth attend
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Country / cadre Indonesia Surabaya
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Lessons learned from countries that
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Malaysia The sharp decline in mater
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although supplemented with epidemio
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A technical meeting in Bangkok in 2
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Development approach is an example
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flexibility in order to overcome ge
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up skilled birth attendance‖. The
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Scaling up of the Navrongo service
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conditions (Walt, Perera et al. 198
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Figure 37 Critical success factors
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Health system standards are explici
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prevalence rate, however in order t
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(Dieleman 2006) Selected key indica
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In order to determine the answers t
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Summary of findings This narrative
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Health worker performance is theref
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Discussion and Recommendations What
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outlines how the HRH information ba
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communities. A collaborative approa
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Table 29 Examples of HRH performanc
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Appendices Appendix 1. MDG5 Country
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World Health Statistics http://www.
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Appendix 3. Sources of all material
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Data source Keywords used in search
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Appendix 4: Barriers and Constraint
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Area Barriers & constraints in MNRH
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Area Barriers & constraints in MNRH
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Appendix 5 Literature that document
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P a g e | 206
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IMNCI PMTCT Perinatal Period Postna
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Ambegaokar, M., Lush, L. (2004). "F
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Barrett, B., J. Ladinsky, et al. (2
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University South Africa with the Re
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Cruse, D. (1997). Community Health
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Elson, D., Evers, B. (1998). Sector
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Flanagan, D., Williams, C., Mahler,
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Greenwood, A. M., Bradley, A.K., By
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Howard, G., Bogh, C., Goldstein, G.
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Jhpeigo (1998). Participatory techn
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Kroll, D., Dwyer, D. (1994). "Postn
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Manandhar, D. S., D. Osrin, et al.
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Morisky, D. E. (1985-86). "Evaluati
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O‘Brien-Pallas, L., Irvine, D., P
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Pfeiffer, J. and J. Pfeiffer (2003)
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Replogle, J. (2007). "Training Trad
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Shankar, A., S. Sebayang, et al. (2
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Teela, K. C., L. C. Mullany, et al.
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van Damm, W., et. al (2008). "Scali
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WHO (2008). Global Standards for In
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