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

Management autonomy at community level as demonstrated in two Puskesmas in
Indonesia can lead to human resources skill and overall system performance.
Performance management tools such as Clinical Performance Development and
Management System for nurses and midwives (CPDMS), the CHWs Performance
management tool (Crigler 2009) and the FHI Performance Improvement for
PHEs(FHI 2006) may have wider applicability and further evaluation is required.
Supervision should be linked to a number of supportive activities and involving mid
level cadres who are attached to the first referral facility in order to ensure health
worker access to support and guidance and links for referral. In addition participatory
approaches may be appropriate at community level involving community members
and peers. Training for supervisors is required and a number of tools may be adapted
for use at community level in MNRH.
Improved data collection is required at community level in order to enhance
workforce planning. Training and participatory approaches will improve the quality of
information and engage health workers and communities in MNRH decision making
The recruitment and early placement of health workers from the local community has
been found to lead to better retention. Selection criteria should be transparent and
bonding arrangements may be useful.
Shifting tasks to lower cadre workers that involve small extensions of their current
remit along with supportive training, incentives, supervision and legislation may
improve MNRH service.
Appropriate compensation for health workers leads to increased productivity. Bundles
of financial and non financial incentives may be used based on good knowledge of
health worker motivational drivers and MNRH service imperatives.
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