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

The decisions to recruit and employ particular groups and individuals at community level will
depend on knowledge of the current workforce composition and workforce plans. At
community level it may be useful to identify the appropriate gender, age and cultural mix.
Elson and Evers checklist identifies specific questions regarding the gender balance of the
composition of the workforce in health institutions and particularly in policy-making posts
(Elson 1998). This, although untested in LMIC community contexts may be useful to strive
for the appropriate socio-cultural mix in the MNRH workforce.
Task shifting
A key strategy that has been employed to address the lack of specific skilled staff at
community level in MNRH has been task shifting. This is defined as ―the allocation of tasks
in health-system delivery to the least costly health worker capable of doing that task reliably‖
(McPake and Mensah 2008). This according to Lehmann has gained currency again mainly in
the use of community health workers (2007). However task shifting requires adequate
upgrading of competencies and supervision to ensure quality (Figueroa-Munoz. 2005;
Koblinsky. 2006). This is necessary particularly if approaches to scaling up as outlined by
Van Damm are adopted. Training institutions too will have to modify their curricula and
approaches focusing on specifically defined competency profiles and the acceleration of
training output (van Damm 2008). In addition task shifting involves the standardised
streamlining of several tasks and functions and may be opposed by professional associations
and require changes in legal frameworks. Task shifting is ―not a panacea‖ (Berer 2009) for
weak health systems which must be strengthened.
The WHO (2008) has produced number of recommendations and guidelines on task shifting
which were developed from a Addis Ababa declaration in January 2008. This emphasises the
essential requirements of quality assurance, regulatory frameworks, sustainability and the
involvement of service users. The figure below indicates the cadres that may be affected by
task shifting and the HRH considerations in the centre. Nurses, assistants, CHW and PLWHA
are those most involved in community level MNRH care and services.
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