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

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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 P a g e | 95
files suggests that more careful attention needs to be paid in international survey programmes to accurately classify the type of health care provider and type of health care facility used for delivery. This is especially true where country-specific cadres of providers and facilities (such as doctor‘s assistants and clinical officers, or maternities and dispensaries) are used. The skills and training of various cadres of providers, as well as the basic or comprehensive obstetric care capacity of various types of facilities, should be documented to assist in the assessment of birth attendants as ‗skilled providers‘ as defined by WHO. (Stanton, Blanc et al. 2006) Leadership Managers are required to enable staff to deal with challenges in complex conditions. The personal attribute that facilitates this is referred to as leadership. Leadership approaches are often culturally determined and very influential at community level. A review of leadership models in the Pacific provides insight into the context that affects decision making in community health practice(Mcleod 2007). No specific HR leadership programmes in MNRH at sub district level could be identified in this review. There are however a number of programmes that have been implemented at district and national level which have had an impact upon the community health workforce. The Partnership for Maternal Newborn and Child Health has produced as document that presents various case studies of successful leadership at country level (PMNCH 2008). It is intended to inspire leaders to take action towards MDGs 4 and 5 and mentions community mobilisation and training in Nepal and Senegal. However there is no information regarding community level leadership and the contribution of HRH at this level. A key international programme in leadership is the ICN ―Leadership for Change‖ initiative. This is aimed at assisting senior nurses at a country or organisational level to influence health policy and decisions; be effective leaders and managers in nursing and health services; and prepare other future nurse managers and leaders for changing health services. The programme is based on action-learning principles. The LFC programme has been implemented in various regions including the South Pacific, Bangladesh, Myanmar, Nepal, Mongolia, Vietnam, Singapore. The principles of effective leadership espoused by this programme are outlined in a newly published book (Shaw 2007). Shaw argues that leadership development programmes should be evaluated according to the three criteria of relevancy, effectiveness and efficiency. A list of potential outcomes of effective leadership programmes in nursing are provided and illustrated in the figure below. P a g e | 96
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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
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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 and 94: Figure 24 Motivational determinants
Page 95: Many of the incentives to health wo
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
Page 145 and 146: 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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