Human resources for maternal, newborn and child health: from global reporting to improved local performance and health outcomes WOMEN DELIVER 7-9 June 2010, Washington DC Human resources for maternal, newborn and child health: opportunities and constraints in the Countdown priority countries Neeru Gupta Health Workforce Information and Governance World Health Organization
Monitoring human resources for improved MNCH outcomes Core health workforce indicators being tracked by the Countdown initiative in 68 countries that account for over 90% of maternal & child deaths worldwide: Human resources availability: numbers and distribution of physicians, nurses and midwives (WHO Global Atlas of the Health Workforce) Competencies and regulation: midwives and other trained personnel authorized to perform signal functions of emergency obstetric care (special survey of ministries of health) Governance: existence of a national HR strategic plan (special survey)
Human resources availability: selected findings 53 (78%) of 68 countries have a density of doctors, nurses & midwives below the critical threshold (23 per 10,000 population) established by WHO as generally necessary to obtain target coverage rates for priority MNCH interventions Density of doctors, nurses and midwives in the 68 Countdown priority countries Azerbaijan Dem People's Rep of Korea Philippines Tajikistan Turkmenistan Mexico Sw aziland Egypt Gabon Guatemala South Africa Brazil Bolivia Botsw ana China Nigeria India Peru Cameroon Iraq Uganda Angola Myanmar Morocco Lao People's Dem Rep Kenya Sudan Pakistan Ghana Cambodia Yemen Indonesia Congo Zimbabw e Equatorial Guinea Benin Mauritania Burkina Faso Zambia Djibouti Afghanistan Nepal Lesotho Dem Rep of the Congo Eritrea Côte d'ivoire Gambia Guinea-Bissau Papua New Guinea Bangladesh Central African Republic Senegal Madagascar Rw anda Haiti Mozambique Togo Chad Malaw i Liberia Mali Ethiopia Tanzania Burundi Sierra Leone Niger Somalia Guinea critical thresho ld=23 doctors, nurses & midwives per 10,000 0 20 40 60 80 100 120 Doctors, nurses and m idw ives per 10,000 population
Percentage of births attended by skilled health personnel Human resources availability: findings and implications 100 Density of doctors, nurses and midwives versus coverage of skilled birth attendance, 68 Countdown countries Greater supply of doctors, nurses and midwives in countries strongly and positively correlated with improved coverage of deliveries by skilled health personnel but supply alone not necessarily the main limitation to improved MNCH outcomes 80 60 40 20 0 y = 13.3Ln(x) + 25.1 R 2 = 0.42 0 20 40 60 80 100 120 Doctors, nurses and midwives (per 10,000 population)
Ratio of urban:rural density of doctors and nurses/midwives Human resources availability: geographical distribution within countries 20 Urban:rural distribution of doctors and nurses/midwives in 26 Countdown countries 15 10 5 0 Tanzania Gabon Equal distribution Benin Gambia Cameroon Mauritania Iraq Ghana Dem Rep of the Congo Uganda Guinea-Bissau Djibouti Liberia Chad Burundi Pakistan Togo Guinea Swaziland Brazil Eritrea Rwanda Mali Côte d'ivoire Niger Yemen Source: WHO Global Atlas of the Health Workforce and autho rs' calculatio ns
Monitoring human resources for improved MNCH outcomes how to assess capacity of health systems in making efficient use of human resources? roles of different categories of health workers in relation to regulation of provision of MNCH interventions signal functions for basic and comprehensive emergency obstetric care and post-natal care for newborns community-based management of pneumonia with antibiotics 60 50 40 30 20 10 0 Countries with policy allowing community-based health workers to manage pneumonia with antibiotics 18 2008 2010 29
Percent of countries Human resources competency frameworks: who is independently performing signal functions of Who is independently emergency performing obstetric the signal functions for & basic post-natal and comprehensive care emergency obstetric and neonatal care in the Countdown countries 100% 88% 100% 100% 100% 100% 100% 92% 92% 87% 96% 100% 100% 80% 73% 74% 70% 70% 70% 68% 65% 65% 60% 59% 59% 57% 59% 55% 52% 52% 50% 48% 57% 52% 40% 35% 33% 26% 27% 20% 19% 10% 10% 0% Administer injection Administer oxytocin for Administer injectable Perform manual removalperform manual vacuum Prescribe oxytocin for Ventilation of depressed magnesium sulphate for prevention of antibiotics for sepsis in of placenta aspiration of products induction/augmentation newborn with selfinflating severe preeclampsia and eclampsia postpartum haemorrhage mother of conception of labour bag and mask 0% 0% Perform Caesarean section Midwives Nurse-midwives Nurses Doctors Others Source: WHO data 2010 (N =24 Countdown countries)
Monitoring human resources for improved MNCH outcomes governance and leadership: how to assess technical and institutional capacity of ministries of health to design and lead the implementation of HR policies? existence of a documented plan for HR management and development No national HR plan (22%) National HR plan exists (78%)
Human resources planning for MNCH Human in resources Countdown planning for priority maternal, newborn countries and child health in Countdown priority countries Source: WHO data 2010 (N=23 countries reporting) National HRH plan exists (% of countries) 26% No national HRH plan exists 22% 78% 39% HRH plan covers MNCH generally 13% HRH plan specifically addresses need for SBAs HRH plan does not cover MNCH
Summary and conclusions In the overall context of the Countdown countries, key priorities for developing human resources for improved MNCH outcomes may include: rapidly increasing the outputs of health professions education programmes in countries with critical shortage measures to improve the overall quality and technical capacity of health workers strategies to address imbalances in workforce distribution and skills mix, including improving retention of workers in rural and underserved areas strengthened HR information and monitoring systems to support evidence-based decision making Execution of HR strategies requires partnership and stakeholder engagement