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

there are interrelationships between an individual and the organizational culture, policies and
structures, and enabling strategic capacity for linkages between a number of issues such as
information, ethics, awareness, motivation and behaviour. There is however no discussion of
how this can be implemented and the implications for HRH at community level. A pilot of
the use of this framework in MNRH at community level may be useful.
Figure 20 Conceptual framework for effective management of nursing and midwifery
(WHO/SEARO 2003)
Management from the provider or facility perspective
The management of health workers and services within the state system is largely driven by
the way in which the health system is organised which is often hierarchical. In Vanuatu for
example 180 active Aid Posts in villages are staffed by volunteers and supervised by a
general nurse at the dispensary level who in turn is supervised by a nurse practitioner, who
also acts as manager, a midwife and general nurse in the Health Centre (Ministry of Health
Vanuatu 2004).
In Indonesia Integrated Service Posts (Posyandu) are managed by staff from the community
(kader desa); the Village Maternity Clinics (Polindes) are managed by the village midwife
(bidan desa) and the Community Health Centers (Puskesmas) by a doctor if available or
midwife. Puskesmas are affected by insufficient resources and a lack of management
autonomy. A recent research project sought to explore the effects of autonomy on
performance (Adyas 2009). A management model was developed that consists of 3
components: (a) financial, human resources, facility, (b) organizational structure and (c)
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