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

There are a number of untried incentive proposals for improving coverage at community
level which would impact upon MNRH. Lu for example outlines a micro credit system of
supporting programmes that could be used to develop resources to recruit and provide more
health professionals directly to the community level. This could involve the capacity building
of health training institutions in low income countries and community involvement in the
training, employment and retention of health workers (Lu 2009). Surveys of health workers
provide insight into what incentive might attract personnel to remote and underserved areas.
A study in Indonesia indicated that midwives felt that they were able to sustain an adequate
income in remote areas but non financial issues were the major factor in relocation such as
husbands work, children‘s school and separation from family (Ensor, Quayyum et al. 2009).
The authors suggest that the focus of incentive policy should be on developing contracts for
midwives who are from underserved communities or who may not yet be settled in a
community with a husband and children. Another study indicated that opportunities to
upgrade professional qualifications, government housing and the increases in net monthly pay
had the greatest impact on nurses‘ employment choices in Malawi (Mangham and Hanson
2008). Kingma‘s study of Community health nurses in Geneva and London demonstrates
how complex the issue of incentives is and differs according to context (2003). While
financial rewards are important so are subsidized sabbatical/study leave and tuition indication
that a package or bundle of incentives need to be considered.
HRH Information systems
Data on community level providers is scarce and aggregating this data according to role and
function in MNRH is difficult. The WHO Atlas on health workers provides incomplete data
on CHWs (WHO 2009; WHO 2009). Some information is available from a small number of
countries indicating the distribution of midwives and nurses by rural or urban location but no
data is available on PHC workers. Ministries of Health do not always include data on CHWs.
For example the MoH in India has excluded from their estimates of HRH roughly 1.5 million
CHWs , for whom a distinct occupational code is not included in the current classification
(although it is possible that some of these workers are assimilated under nursing and
midwifery personnel) (Dal Poz 2009). The recent development of minimum data set for HRH
(WHO UTS 2008) identifies the PHC level although this focuses on nursing and midwifery
cadres and excludes CHWs, TBAs and VHWs.
At country level there is a great need to build national capacity in HRIS systems. The
Capacity Project (2009) has undertaken much work in this area along with the USAID Health
System 20/20 Programme (Kombe 2008) however work in MNRH and HRIS has been
limited. In Malawi there has been efforts to link information systems to track the deployment
and training of family planning/reproductive health human resources including those at
community level (Schenck-Yglesias, Lacoste et al. 2003). Stanton et al point out a number of
improvements that could be made in the collection of data on skilled attendance. Their
detailed analysis of the coding of country-specific providers and facilities in the survey data
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