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

helpful to increasing the rural workforce (Playford, Larson et al. 2006). There is consistent
finding from observational studies but no controlled or randomised trials in this area (Chopra
2008). Administrative mechanisms can also be used in order to ensure recruitment of staff to
rural areas. Thailand‘s experiences of bonding contracts for 2 to 4 years of public sector
employment that were used for doctors but they could also be applied to nurses and midwives
(Wibulpolprasert 2003). However there is no conclusive evidence concerning the success of
compulsory placements of health professionals in rural community locations (Chopra 2008).
The study of motives may be useful for the recruitment and retention of participants in
community mobilization. A study of CHWs in Mexico found that women's CHNs motives
fall into four categories: getting out, serving, learning, and women's betterment. These
motives blend personal and public motives (Ramirez-Valles 2001) and could be used to
promote careers in MNRH at community level.
A common mechanism used to select CHWs is the village health committee (VHC)
(Lehmann 2007). In India for example Sahiyyas are democratically selected by the
community and approved by the VHC (Government of India 2004). However clear criteria
guiding the selection of CHW is necessary (Were 2008). In cases where CHWs have become
unemployed usually as the result of funding shortage or the completion of a project the
retraining and reactivation of existing groups of community health workers was found to be a
useful strategy in a RH programme in Kenya (Csaey 2005). Priority was given to CHWs who
had demonstrated ability in working effectively and building good relations within their
community. Many were recommended by local health facilities and were already involved in
community activities. According to a WHO document the motivation of individuals for
community service should be included in the selection criteria of CHWs (WHO 1989).
Recommendation 6 from this report calls for the establishment of national selection
guidelines that encourage the long term commitment of CHWs to their tasks and providing
access to vulnerable groups.
A report outlining the lessons learned from a Community Midwives (CMWs) Programme in
Uttar Pradesh highlighted that the selection criteria for CMWs must be strong and give a bias
to those with health service experience. The report also recommended that they pay a deposit
for the course ensuring they do not drop out, repayable after they serve their community for a
certain time. In addition the involvement of the community was necessary in the selection
process and the applicant‘s residency in the community should be verified by an independent
authority (PROD 2009). Lady Health Workers in Pakistan must have a class 8 education in
order to qualify for selection and demonstrate motivation for the job. A community
representative is appointed to the selection committee. An evaluation of the programme
showed that there was compliance with this criteria (Oxford Policy Management 2002).
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