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

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Table 15 Incentives in MNRH at community level Incentive Details Context Reference Financial Cash incentive to SBAs for attending deliveries Cash incentive to TBAs for referring to SBA & assisting Delivery fee exemption scheme Loans for private midwives in communities Profit from commodities & service Community payment fund Compensation & travel allowance for PHE Management support Internet connection & telehealth at PHC centres Mobilizing community resources to reward satisfactory performance of duties through feedback Improved management system & environment in community family planning clinics Regulatory interventions 1 year compulsory community service before registration Deregulation of maternity service provision Increase in skilled birth attendance, but lack of skilled staff greater constraint than health infrastructure to increased utilization Dukun given up to IDR 100,000 (US12$) for referral from MoH funds MoH set reimbursement rates according to the type of delivery, increased demand for public health services, sustained health worker income and morale Increased family planning services but unwieldy implementation due to scale Shasthya Sebikas profit from sales of condoms, charges for pregnancy identification as a volunteer in the community also eligible to receive a concurrent govt. second loan Sales of commercial contraceptives motivated Indigenous Medicine practitioners to offer family planning counseling Each household contributed one birr (US$0.15) a year to support the community health agents (CHAs) and TBAs. Provided stipend for all trained CHAs and TBAs & the attrition rate fell from 85% per yr to 0 76% of projects surveyed give some type of compensation, including 19% which support salaries and 52% provide travel allowances Family health worker team support in rural areas for consultation, reference and education Undertaken as part of establishing and supporting a cadre of community workers to provide home visits, detect pregnancies, assess health needs & provide primary level care; Increased employee satisfaction & motivation due to introduction of personnel policy procedures & manual Personnel files & job descriptions were updated. Supervisors were trained, PI was instituted. Doctors must complete one year of community service, usually within in a rural area before they gain their first professional post. District hospitals and community health centres received 45% of the doctors. Job descriptions, supervision & accommodation need to be improved Retired midwives re entered practice increases SBA in underserved communities but very costly to set up & access bonding contracts for 2 to 4 years of public sector employment for Drs Nepal (Barker, Bird et al. 2007; Powell-Jackson 2008) Indonesia (Analen 2007) Central & Volta regions Ghana Indonesia (Witter, Kusi et al. 2007) (The Summa Foundation 2006) Bangladesh (Ahmed 2007) India (IntraHealth 2005) Gumer District, Ethiopia (Wubneh 1999) Global (Flanagan 1996) Rural Brazil (Campos 2006) Maharashtra, India (IntraHealth 2008) Uganda (O'Neil 2008) Rural South Africa (Reid 1999; Omole 2005) Tanzania (Rolfe 2008) Rural bonding contracts Thailand (Wibulpolprasert 2003) Contracts with PHE Attrition minimised though 12-18 contracts Colombia (Senderowitz 1998) Education interventions Job aides & training Counseling cards and workshops to CHWs who also undertake family planning. Community members regularly consult activistas for family planning advice Madagascar (Gottert 2000; Bhattacharyya 2001) P a g e | 93
Many of the incentives to health workers in MNRH at community level are focused on increasing skilled birth attendance and family planning services. These range from rewarding health workers for attending births or referring women to a facility of SBA, incentives to increase SBA and Family planning service such as loans to midwives, deregulation or compulsory community service for doctors. Financial incentives to health workers have been found to increase access to services at community level but little is known if this has increase equity of access. A systematic review of the impact of pay-for-performance on health outcomes did not provide any strong evidence for the improvements in health outcomes although it may provide improved access for community services (Petersen 2006). These findings however do not address HRH in MNRH at community level in LMIC settings. Schemes aimed at the provision of incentives to service providers to improve health such as those outlined by Bitrán et. al (2003.) will also have a flow on to health workers. A case in point is a performance based reimbursement scheme developed as part of a USAID funded NGO Service Delivery Program involved in delivering primary health care services including MNRH through an umbrella of NGOs in Bangladesh (Chao 2006). In order to encourage NGOs and clinics to make significant efforts to serve the poor as well as to improve cost recovery payments were made to service equity funds and bonuses were distributed according to the services performance. The successful pilot of the scheme involved the payment of 25% of bonuses received directly to high performing health workers (Chao 2006). Another approach to performance based incentives is a programme in Zambia where high achieving teams, rather than individuals were awarded non financial performance trophies. The success of the pilot of this scheme on staff motivation differed in 2 sites according to the strong leadership and performance management systems in place. This confirms the importance of appropriate incentives alongside good HRM systems (Furth 2005). Kipp et als. study also indicates that other factors may also be influential in the success of incentive schemes such as an improved drug supply to health facilities and increased public identification with community projects in remote areas (Kipp, Kamugisha et al. 2001). There is some evidence to show that incentives such as loan repayments, direct incentives and medical residentsupport programmes to encourage rural placement have highest service completion rates and physician retention rates (Chopra 2008). Relationships with the community including feedback from them on performance is regarded as an important motivator in Vietnam (Dieleman, Cuong et al. 2003). In a community MNRH context incentives that reward innovative partnerships and action between midwives and women that involve the local community have been highlighted as critical in Cambodia (Sherratt 2006). Community inputs into the selection of health workers may also motivate workers to perform by establishing in them a sense that they are a representative of the community and creating a feeling of responsibility to the community (IntraHealth 2008). P a g e | 94
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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
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is no single prescribed set of ways
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Table 3 Classification of health ce
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Figure 5 Millennium Development Goa
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(UNICEF 2007) However, the road to
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A number of steps are purported to
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Figure 10 Overview of HRH at commun
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functions, the latter involving mob
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settings‖(ICN 2009). They may be
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Table 7 What Skilled attendants can
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Traditional healers may also be inv
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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 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: Figure 24 Motivational determinants
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
Page 139 and 140: Country / cadre Niger: Birth attend
Page 141 and 142: Country / cadre Indonesia Surabaya
Page 143 and 144: 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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