Human Resources for Health in Maternal, Neonatal and - HRH ...
Human Resources for Health in Maternal, Neonatal and - HRH ... Human Resources for Health in Maternal, Neonatal and - HRH ...
New Cadres The establishment of new cadres in MNRH at community level has often resulted when task shifting cannot be undertaken or delegation or the substation of one cadres for another is not possible. This is often necessary when programmes are being expanded or new ones initiated such as in scaling up operations in order to address high MMR. A number of lessons can be identified from the experiences of establishing new cadres in MNRH at community level. These include the need for wide consultation, formative evaluation and on-going monitoring. A new cadre of private providers at the community level: the Community Midwives (CMW) was established in 4 districts of Uttar Pradesh. Early involvement and partnership with regulatory bodies responsible for the curriculum, such as the state nursing council, proved essential for success (IntraHealth 2004). In Tanzania, as part of an expansion of family planning and reproductive health services, an extensive pilot was undertaken to formulate a strategy for the effective participation of a new cadre of family planning and reproductive health (Yumkella 1996). A needs assessment found a number of factors that could be adapted to assess workforce suitability in MNRH at community level. It was found that health attendants due to their residence in communities and long service experience would form a stable and dependable work force. Most health attendants had undertaken half of a 2 year course in family planning and reproductive health demonstrating their commitment to the area and training as well as the existence of an establish course and institution that could undertake training in. In addition there was a balance of male and female attendants, and appropriate skills mix. They were well received by community members and favourably recommended by family planning providers. Other important service delivery factors were also present such as the existence of a local family planning and reproductive health infrastructure and the potential for integration with other services as a result of networks and relationships. An evaluation of a new cadre of SBAs known as Health Extension Workers (HEWs) introduced as part of the Health Service Extension Programme (HSEP) in Ethiopia showed promising results from the perspective of the community (Negusse, McAuliffe et al. 2007). A structured interview survey of 60 female heads-of-households indicated that HEWs were preferred over Traditional Birth Attendants for assistance with labour. However knowledge was poor regarding major communicable diseases indicating a need for continued health promotion and behaviour change communication approaches. When a Basic Package of Health Services (BPHS) was rolled out in Afghanistan in 2003 community Midwives were introduced to undertake a key role in MNRH (Health and Fragile States Network 2009). CMWs undertake an18-month standardised, competency-based preservice training course. After graduation, CMWs follow a competency based job description P a g e | 87
which was developed in 2002. This was finalised and approved in 2004 by the Ministry of Public Health (MoPH) and accredited by the National Midwifery Education and Accreditation Board in 2005. Currently 21 community midwifery training programmes are being implemented by various NGOs in collaboration with MoPH. After an initial pilot was completed in 2004, the first official training round was completed in 2006, tripling the number of midwives to 1500. By 2009 Afghanistan had increased the number of CMWs to 2,300 still far short of the 5000 midwives required. CMWs play a pivotal role in the provision of essential obstetric and newborn care and thereby reducing maternal and neonatal mortality. According to the 2006 Household Survey, antenatal care increased from 4.6% in 2003 to 30.3%, skilled birth attendance increased from 6% in 2003 to 18.9 % and the contraceptive prevalence rate from 5.1% in 2003 to 15.4%. Another approach that has been utilised in order to improve the coverage of midwives has been to encourage the retired workforce to return to practice. In Malawi the retired workforce was encourage back into the public system (MoH Malawi 2004) while in Tanzania private practice was initiated. Deregulation of midwifery practice in Tanzania allowed ‗new‘ workforce of ‗later life entrepreneurs‘ including retired government employed nursing officers or those approaching retirement to establish their own facility-based services. (Rolfe 2008). In 2007 there were approximately 60 ‗maternity homes‘ located mainly in rural or peri-urban areas. Despite bringing increased services to communities which was of comparable quality to those provided by the government communities were reluctant to pay for it. Private midwives also found the costs associated with start up, maintenance and registration prohibitive. The authors suggest possible solutions such as on-going financing arrangements such as micro-credit, contracting, vouchers and franchising models require consideration. One approach to supporting private midwifes to undertake a particular function is the development of revolving loans. The Summa Foundation was created as part of USAID‘s Promoting Financial Investments and Transfers (PROFIT) project (1991-1997) to facilitate private sector involvement in family planning. In Indonesia. The project created a revolving loan fund that provided loans to midwives for the expansion and establishment of their private practices to provide family planning and reproductive services. The collaboration between the public and private sector included the Indonesia Midwives Association (IBI), Bank Rakyat Indonesia (BRI), and the National Family Planning Coordination Board (BKKBN) (The Summa Foundation 2006). The programme was successful in sustain lending to midwives and shift family planning clients from the public to private sector. However the wide reach from national to community levels and the multiple partners involved in the programme proved challenging. This approach may be transferable to other contexts to support private HRH to increase MNRH care and services at community level. P a g e | 88
- 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 and 72: as a guide to mentoring, delegation
- 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: Substitution Substitution is differ
- 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
- Page 123 and 124: Strengthening Education and compete
- Page 125 and 126: Table 20 Examples of Partnership ap
- Page 127 and 128: Table 21 Learner needs analysis and
- Page 129 and 130: Table 22 Some approaches to the des
- Page 131 and 132: Participants/ Method / document typ
- Page 133 and 134: strengthening and establishing accr
- Page 135 and 136: Participants / context LMICs method
- Page 137 and 138: alongside health service improvemen
New Cadres<br />
The establishment of new cadres <strong>in</strong> MNRH at community level has often resulted when task<br />
shift<strong>in</strong>g cannot be undertaken or delegation or the substation of one cadres <strong>for</strong> another is not<br />
possible. This is often necessary when programmes are be<strong>in</strong>g exp<strong>and</strong>ed or new ones <strong>in</strong>itiated<br />
such as <strong>in</strong> scal<strong>in</strong>g up operations <strong>in</strong> order to address high MMR. A number of lessons can be<br />
identified from the experiences of establish<strong>in</strong>g new cadres <strong>in</strong> MNRH at community level.<br />
These <strong>in</strong>clude the need <strong>for</strong> wide consultation, <strong>for</strong>mative evaluation <strong>and</strong> on-go<strong>in</strong>g monitor<strong>in</strong>g.<br />
A new cadre of private providers at the community level: the Community Midwives (CMW)<br />
was established <strong>in</strong> 4 districts of Uttar Pradesh. Early <strong>in</strong>volvement <strong>and</strong> partnership with<br />
regulatory bodies responsible <strong>for</strong> the curriculum, such as the state nurs<strong>in</strong>g council, proved<br />
essential <strong>for</strong> success (Intra<strong>Health</strong> 2004). In Tanzania, as part of an expansion of family<br />
plann<strong>in</strong>g <strong>and</strong> reproductive health services, an extensive pilot was undertaken to <strong>for</strong>mulate a<br />
strategy <strong>for</strong> the effective participation of a new cadre of family plann<strong>in</strong>g <strong>and</strong> reproductive<br />
health (Yumkella 1996). A needs assessment found a number of factors that could be adapted<br />
to assess work<strong>for</strong>ce suitability <strong>in</strong> MNRH at community level. It was found that health<br />
attendants due to their residence <strong>in</strong> communities <strong>and</strong> long service experience would <strong>for</strong>m a<br />
stable <strong>and</strong> dependable work <strong>for</strong>ce. Most health attendants had undertaken half of a 2 year<br />
course <strong>in</strong> family plann<strong>in</strong>g <strong>and</strong> reproductive health demonstrat<strong>in</strong>g their commitment to the<br />
area <strong>and</strong> tra<strong>in</strong><strong>in</strong>g as well as the existence of an establish course <strong>and</strong> <strong>in</strong>stitution that could<br />
undertake tra<strong>in</strong><strong>in</strong>g <strong>in</strong>. In addition there was a balance of male <strong>and</strong> female attendants, <strong>and</strong><br />
appropriate skills mix. They were well received by community members <strong>and</strong> favourably<br />
recommended by family plann<strong>in</strong>g providers. Other important service delivery factors were<br />
also present such as the existence of a local family plann<strong>in</strong>g <strong>and</strong> reproductive health<br />
<strong>in</strong>frastructure <strong>and</strong> the potential <strong>for</strong> <strong>in</strong>tegration with other services as a result of networks <strong>and</strong><br />
relationships.<br />
An evaluation of a new cadre of SBAs known as <strong>Health</strong> Extension Workers (HEWs)<br />
<strong>in</strong>troduced as part of the <strong>Health</strong> Service Extension Programme (HSEP) <strong>in</strong> Ethiopia showed<br />
promis<strong>in</strong>g results from the perspective of the community (Negusse, McAuliffe et al. 2007). A<br />
structured <strong>in</strong>terview survey of 60 female heads-of-households <strong>in</strong>dicated that HEWs were<br />
preferred over Traditional Birth Attendants <strong>for</strong> assistance with labour. However knowledge<br />
was poor regard<strong>in</strong>g major communicable diseases <strong>in</strong>dicat<strong>in</strong>g a need <strong>for</strong> cont<strong>in</strong>ued health<br />
promotion <strong>and</strong> behaviour change communication approaches.<br />
When a Basic Package of <strong>Health</strong> Services (BPHS) was rolled out <strong>in</strong> Afghanistan <strong>in</strong> 2003<br />
community Midwives were <strong>in</strong>troduced to undertake a key role <strong>in</strong> MNRH (<strong>Health</strong> <strong>and</strong> Fragile<br />
States Network 2009). CMWs undertake an18-month st<strong>and</strong>ardised, competency-based preservice<br />
tra<strong>in</strong><strong>in</strong>g course. After graduation, CMWs follow a competency based job description<br />
P a g e | 87
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