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

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A broader tool for Performance management developed for family planning and reproductive settings but not specifically the community level is the PRIME II Performance Improvement (PI) tool. PI helps to ensure that selected interventions are supported and sustained by involving a stakeholder group from the start of the process and ensuring staff actively participation in each step of the process. The steps are summarized in the figure below. The PI facilitator considers the entire human performance system by looking at the desired performance of workers and the organizations they work for. Figure 22 Steps in the PRIME II Performance Improvement process (Crigler 2009) The PI approach has been employed at community level in a number of settings. PRIME II partnered with BASICS, JHPIEGO, MSH, Population Council and other agencies in Senegal and the West Africa region to apply PI in IMCI, community-based family planning and PAC programs. (Blyth 2001). Another project at community level used the PI approach to develop functioning partnerships between primary providers and the communities they serve in order to scale-up prevention of mother-to-child transmission (PMTCT) of HIV services (Cooney 2003). The Health and Family Planning Manager‘s Toolkit Performance Management tool was developed for a family planning context and examples of job descriptions of HR at the community level are provided in the kit. No comprehensive independent evaluations or reports on the use of this tool could be located. The FHI Performance Improvement: A Resource for Youth Peer Education Managers is a unique resource in that it targets the often voluntary community based cadre of PHEs. The tool kit contains a guide to the six steps of PI that are no dissimilar from the PRIME II model above and provides a tool for self-assessment, group resolution, and action planning with sample activities from the field. It also includes notes on management activities for PHE such as clarifying job responsibilities and facilitating recognition and career development, as well P a g e | 69
as a guide to mentoring, delegation, encouraging teamwork and leadership. Documentation detailing experiences using this tool were not found in this study. Supervision The role of a supervisor is to motivate staff to achieve goals and support them through a process of change in order to realize quality care and services and meet client‘s needs. This supportive approach to supervision is ―a process that promotes quality at all levels of the health system by strengthening relationships within the system, focusing on the identification and resolution of problems, and helping to optimize the allocation of resources promoting high standards, teamwork, and better two-way communication‖ (Marquez and Kean 2002). There are a number of general reviews of supervision in International health contexts but few of them focus at community level or include research studies indicating a need for more rigorous studies in this area. A comprehensive overview by Marquez at al reviews the function, process, barriers and approaches to improving supervision (2002). Another review highlights methods of supportive supervision at PHC level and the need for flexible supervisory materials that address the participatory nature of PHC (Rohdes 2006). PHC and services in MNRH are generally managed from the district level and supervision may involve visits to PHC facilities and community sites. Were (2008) describes the optimum structure for CHWs supervision in the public system involving mid level cadres who are attached to the first referral facility in order to ensure CHW access to support and guidance and links for referral. On site supervision is not always possible at community level however for those attached to community health facilities this may be required depending on the services offered. An evaluation of reproductive health services in Kenya found that supervision was considered to be adequate if there was an on-site supervisor actively overseeing family planning and reproductive health service delivery and the site had received an external supervision visit in the last year (Rawlins 2003). The supervisory structure in the non state sector may be very different. A Pathfinder report describes an NGO approach in Kenya where an NGO employs a small cadre of CHW supervisors, most of whom started as CHWs themselves. Each supervisor oversees from 10 to 20 CHWs, accompanying them on home visits or in groups during public events and facilitating monthly oversight meetings, in which progress is reviewed, reports are compiled, plans are developed and refresher training is provided as needed. The Project Coordinator or Director for each NGO often joins the supervision meetings and visits, in addition to conducting periodic, direct supervision of CHWs. Additionally, the Coordinator/ Director P a g e | 70
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Human Resources for Health in Mater
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What human resource practices in ma
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Collaboration with traditional and
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Acronyms AAAH Asia and Pacific Acti
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TBA T & L UNFPA UNICEF UOG UPNG USA
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Figure 34 Potential gain in percent
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Executive Summary Addressing the ba
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Introduction What human resource pr
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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 and 56: Remuneration for CHWs, nurse and mi
Page 57 and 58: Supportive HRH strategies and appro
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: The Health and Family Planning Mana
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
Page 107 and 108: groups; encouraging recruitment thr
Page 109 and 110: Summary This section has identified
Page 111 and 112: encouraging midwives to proactively
Page 113 and 114: Facilitation & attendance at MOH/ N
Page 115 and 116: of community leaders improved the c
Page 117 and 118: Table 19 Examples of initiatives in
Page 119 and 120: 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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