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In September 2010 the United Nations Secretary-General launched the Global Strategy for Women’s and Children’s Health. As part of their broader responses, the UN health agencies - “H4+” (UNAIDS, UNFPA, UNICEF, World Bank, WHO) - collectively proposed to support a group of countries with some of the highest numbers of maternal and newborn mortality to strengthen evidence-based policy and its implementation. Eight countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Mozambique, Nigeria and the United Republic of Tanzania), representing nearly 60% of the global maternal and newborn deaths, have welcomed the response of the H4+. Ministers of Health, leaders of UN agencies, representatives of the UN Secretary-General’s MDG Advocates Group, civil society, private sector, partner governments and health professionals subsequently gathered at the Greentree Foundation in September 2011 to elaborate the priorities and calendar for the H4+ support. Participants concluded that the H4+ would initiate, alongside the government and development partners, national assessments of the midwifery workforce in all eight countries (including all cadres engaged, e.g. midwives, nurses, doctors, obstetricians and community health workers): as part of the H4+ High Burden Countries Initiative (HBCI). The national assessments are consistent with an ‘Operational Guidance and Assessment Framework’ (finalized in April 2012) and tailored to the context and individual needs of the countries. Modeled projections of midwifery service needs, workforce demand and supply will inform costed scenarios and policy options. These will be developed and agreed in consultation with key stakeholders. This presentation provides a short overview of progress as at October 2012.
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
Planning to address the challenge of human resources for reproduc4ve, maternal and newborn health: the “High Burden Countries Ini4a4ve” FIGO Congress 2012. Rome. Wednesday 10th October, 2012 Progress, preliminary findings and discussion points Jim Campbell Director, ICS Integrare, Barcelona, Spain [email protected]
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
The 10 countries with the greatest number of maternal deaths per year
India 56000
Nigeria 40000
DemocraNc Republic of the Congo 15000
Pakistan 12000
Sudan 10000
Indonesia 9600
Ethiopia 9000
United Republic of Tanzania 8500
Bangladesh 7200
Afghanistan 6400
Of all maternal deaths
Overview
1. Progress across countries 2. Preliminary findings
(examples) – Assessing “need” – Assessing current HRH supply – Modelling future HRH supply
3. Discussion points (AAAQ)
60%
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
J F M A M J J A S O N D
NaNonal assessment reports
Afghanistan
Bangladesh
DR Congo
Ethiopia
India
Mozambique
Nigeria
Tanzania
Available at: www.integrare.es
Progress to date
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
Assessing need – pregnancies per year
Afghanistan Ethiopia
Tanzania
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
Assessing supply: Health labour market analysis
Healthcare educaNon and training
High School graduates (male/female)
Qualified healthcare workers
Unemployed Employed Exits
Public
Other
Private
Health sector
‘potenNal supply’
‘parNcipaNon’
‘supply’
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
Assessing supply: who plays what role in the midwifery workforce?
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
Assessing supply: Educa4on pathways, provider and costs? How many are currently prac%sing?
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
Assessing supply: urban/rural distribu4on -‐ equitable?
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
Modelling future supply: how many (more) are needed?
STOCK
Entry
Projected STOCK
Projected NEED OR
Projected Need +
service coverage target
GAP
Current Year ‘x’ Year ‘x’
?
Exit
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
Modelling future supply: if we use Tanahashi?
Target populaNon who do not contact services
Availability Coverage People for whom service is available
Target PopulaNon
Accessibility Coverage People who can use service
Acceptability Coverage People willing to use the service
Contact Coverage People who use the service
EffecNve Coverage People who receive effec7ve care
Service Delivery Goal
Process o
f service provision
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
Modelling future supply: to provide effec4ve, equitable coverage?
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H4+ ‘High Burden Countries Ini4a4ve’: Midwifery Workforce Assessments
Discussion points: AVAILABILITY Benchmarks?
• PopulaNon or births for EmONC? • Normal births v complicaNons? (85/15) • Midwives / ObGyn per births? Pre-‐service educaNon (public/private) Labour market analysis; skill-‐mix
ACCESSIBILITY Deployment (rural/remote) RetenNon 24/7
ACCEPTABILITY Respecpul care; ethnicity; gender; language
CONTACT “if you build it they will come”
QUALITY EducaNon, RegulaNon, AssociaNon In-‐service training SupporNve supervision
Policy discourse: evidence, ac4on, results, resources
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