Jim Campbell: H4+ HBCI - Midwifery Workforce Assessments (October 2012)


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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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Jim Campbell: H4+ HBCI - Midwifery Workforce Assessments (October 2012)

  1. 1. `  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   enquiries@integrare.es     `  
  2. 2. `  H4+  ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments  Overview  1.  Progress  across  countries  2.  Preliminary  findings   (examples)   –  Assessing  “need”   –  Assessing  current  HRH  supply   –  Modelling  future  HRH  supply   The  10  countries  with  the  greatest  number  of  maternal  deaths  per  year   India   56000  3.  Discussion  points  (AAAQ)   Nigeria   40000   DemocraNc  Republic  of  the  Congo   15000   60%   Pakistan   Of  all     12000   maternal  deaths     Sudan   10000   Indonesia   9600   Ethiopia   9000   United  Republic  of  Tanzania   8500   Bangladesh   7200   Afghanistan   6400   `  
  3. 3. `  H4+  ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments  Progress  to  date   J   F   M A   M J   J   A   S   O   N   D   Afghanistan   Bangladesh   DR  Congo   Ethiopia   India   Mozambique   Nigeria   Tanzania   NaNonal  assessment  reports   Available  at:  www.integrare.es     `  
  4. 4. `  H4+  ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments  Assessing  need  –  pregnancies  per  year   Afghanistan   Ethiopia   Tanzania   `  
  5. 5. `  H4+  ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments  Assessing  supply:  Health  labour  market  analysis   Public   Private   Other   Health  sector   ‘supply’   Exits   Employed   Unemployed   ‘parNcipaNon’   ‘potenNal   Qualified  healthcare  workers   supply’   Healthcare  educaNon  and  training   High  School  graduates  (male/female)   `  
  6. 6. `  H4+  ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments  Assessing  supply:  who  plays  what  role  in  the  midwifery  workforce?         `  
  7. 7. `  H4+  ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments  Assessing  supply:  Educa4on  pathways,  provider  and  costs?            How  many  are  currently  prac%sing?       `  
  8. 8. `  H4+  ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments  Assessing  supply:  urban/rural  distribu4on  -­‐  equitable?   `  
  9. 9. `  H4+  ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments  Modelling  future  supply:  how  many  (more)  are  needed?   Projected   GAP   NEED     OR     Exit   Projected   Need     Entry   +     ?   service   Projected   coverage   STOCK   target   STOCK   Current   Year  ‘x’   Year  ‘x’   `  
  10. 10. `  H4+  ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments  Modelling  future  supply:  if  we  use  Tanahashi?       Service  Delivery  Goal   Target  populaNon  who  do  not  contact   EffecNve  Coverage   services   Process  of  service  provision   People  who  receive  effec7ve  care   Contact  Coverage   People  who  use  the  service   Acceptability  Coverage   People  willing  to  use  the  service   Accessibility  Coverage   People  who  can  use  service   Availability  Coverage   People  for  whom  service  is  available   Target  PopulaNon     `  
  11. 11. `  H4+  ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments  Modelling  future  supply:  to  provide  effec4ve,  equitable  coverage?       `  
  12. 12. `  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   `