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

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conducts monthly or bi-monthly meetings with all CHW Supervisors, again, for reporting, planning and continuous refresher training (Csaey 2005). Supervision of voluntary cadres is often weak and vulnerable to changes caused by reform. A study in Indonesia revealed that after decentralisation family planning field staff chose to move to other government positions with better status and payment. This left village family planning volunteers with no supervisors or on-going training. (Utomo, Arsyad et al. 2006) The supervision of these cadres should be considered in any reform which may be assisted by clear, available and up to date information of the supervisory structures at this level. A FHI standards toolkit provides some guidance for the supervision of PHEs. It calls for supervisor training and the need for supervisors to ensure that PHEs have received adequate preparation (through training and skills acquisition/practice), that motivation and ethical behaviour is continually reinforced, group dynamics are managed and team building is encouraged and that responsibility is shared with PHEs (Family Health International 2005). The supervision of TBAs can vary and depends on the amount of government support they receive. Various models include supervision can be undertaken by the community such as in some African countries where the TBA participates in a village health committee. In the Philippines some well performing TBAs have been trained as supervisory staff, while in Brazil and to an extent in Senegal, literate TBAs staff maternity centres (Walt 1986). Educated health professionals normally perform a supervisory role in the formal health sector. Examples are the supervision of village dais by auxiliary nurse midwives in the Varanasi District of Uttar Pradesh, India (IntraHealth 2002). Supervision and health worker performance According to the Cochrane database a systematic study is currently being undertaken to assess the impact that supervision outreach visits have on the quality of primary health care in low- and middle-income countries. However no results are available as yet (Bosch-Capblanch and Garner 2009). Despite this the findings of various studies and evaluations suggest that health worker performance is improved when supervision is linked to a range of supportive activities. A review of issues relating to the performance of community-level health and nutrition functionaries in India found that the quality of their work improved when supervision is: undertaken as an extension of training and supports the training content, provided by monthly review meetings focused on well-defined output indicators for effective monitoring, P a g e | 71
eceived from outside the routine public health system, such as from NGOs or community groups, monitored through a system that holds supervisors and those above them responsible and accountable (IntraHealth 2008). The connection to education and training is also reported by other studies. The combination of on the job training and supervision has been found to improve the confidence and maintain the skills of auxiliary nurse midwives in a Prime II project in India (IntraHealth 2001) and CHWs engaged in a child health project in rural Boliva (Charleston 1994). In crisis contexts harnessing opportunities for supervisory activities include staff meetings, observations and field visits, one-on-one meetings, and group supervision (Ehrlich 2004). In Samoa supervision is promoted by linking it to accreditation required for all PHC health staff, so there is a strong imperative to be involved in in-service training (Burnet Institute 2007). Suh et al. found in Senegal that formative supervision can improve the quality of reproductive health services, especially in areas where there is on-site skill building and refresher training. This approach can also mobilize communities to participate in improving service quality. (2007). Supervisors themselves require training in the provision of appropriate support and guidance and the management of the performance system. Were states that CHW ―supervisors should have training on monitoring processes, relationships, inputs (whether information or materials) as well as outputs indicative of an improving situation‖ (2008). Clear criteria have been developed for the selection of supervisors of community level staff in MNRH. The supervisors of lady health workers in Pakistan require at least an intermediate (Class 12) pass, however in practice most supervisors are considerably better qualified. More than half of the supervisors have graduated or completed higher degrees (Oxford Policy Management 2002). The need for regular, on-going constructive feedback emerged from a Tanzanian study at PHC level. One auxiliary respondent stated: When the re-supervision is done for the second time, there should be feedback from the first supervision so that we can recognize where we went wrong and correct our mistakes. There should also be feedback of the problems identified from the previous supervision. It is not easy to think the supervisors are useful when reported problems remain and no feedback is given (Manongi, Marchant et al. 2006) The recognition of good performance by supervisors during feedback sessions contributes to health worker morale and motivation and is therefore critical (Willis-Shattuck, Bidwell et al. 2008). P a g e | 72
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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
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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 and 70: The Health and Family Planning Mana
Page 71: as a guide to mentoring, delegation
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 (
Page 121 and 122: 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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