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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

H4+ High  Burden  Countries   Ini4a4ve  (HBCI):  Midwifery   workforce  assessments       Petra  ten  Hoope-­‐Bender  

Director RMNCH,  ICS  Integrare,  Barcelona,  Spain   enquiries@integrare.es    

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

Overview 1.  Background  &  methods   2.  Progress  across  countries   3.  Analysis  (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

Nigeria

40000

DemocraLc Republic  of  the  Congo  

Pakistan Sudan  

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60% Of  all     maternal  deaths  

15000 12000   10000  

Indonesia

9600

Ethiopia

9000

United Republic  of  Tanzania  

8500

Bangladesh

7200

Afghanistan

6400


H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

1.Background: H4+  High  Burden  Countries  Ini4a4ve  (HBCI)   June  2011:  The  State  of  the  World’s   Midwifery  Report   CollaboraLon  of  30  organizaLons,   exploring  midwifery  in  58  low-­‐

September 2010:  “Every  Woman,   Every  Child”     United  NaLons  Secretary-­‐General     ‘Global  Strategy  for  Women  and   Children’s  Health’      

resource countries

September 2011:  H  BCI      

GOAL: To  scale  up  midwifery  workforce  for  reaching  MDGs  5  and  4  and  deliver  on   country   commitments  to  UNSG’s    EWEC      

PURPOSE: To  support  high-­‐burden  countries  to  assess  their  midwifery  workforce  and   consider  policy  opLons  -­‐  Afghanistan,  Bangladesh,  DemocraLc  Republic  of  Congo,   Ethiopia,  India,  Mozambique,  Nigeria  and  Tanzania      

Na4onal Assessment  (tailored  to  country)  idenLfying  gaps  and  needs   Na4onal  Report  presenLng  the  situaLon  and  costed  policy  opLons  to  enhance  the   quality  of  and  access  to  the  midwifery  workforce  

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

1.Background: Research  ques4on   'What  is  the  appropriate  midwifery  workforce,  and  how  is  it  best  deployed,  to   equitably  deliver  essen0al  MNH  interven0ons  at  scale  and  quality,  and  what   (including  costs)  needs  to  be  put  into  place  to  achieve  universal  access?'     Emphasis  on  equity  –  quality  –  effecLve  coverage     Five  domains  of  interest.       EssenLal  intervenLons,  workforce,  infrastructure,  policy,  financing     In  3  phases:  Secondary  review,  primary  data  collecLon,  synthesis     To  support  policy  dialogue  and  implementaLon     `  


H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

1.Methods: In  the  context  of  WHO  frameworks  on  HSS  and  HRH   Health  Systems  Strengthening  

‘Building Blocks”  

Leadership and   Governance  

Financing

Health Workforce  

Service Delivery  

Medical products  

InformaLon

Labour markets  

Resources

Human Resources   for  Health  

‘AcLon Areas’  

Leadership and   Governance  

Strategic intelligence  

EducaLon and  Training  

DistribuLon and  retenLon  

Pre-­‐service

In-­‐service

ConLnuing EducaLon  

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

1.Methods: Assessment  process  –  country  led,  equity  focus   Research  process   secondary       data   primary       data   secondary       data  

Health Needs   Assessment     (for  MNH)  

HRH Mapping  

Developed and  tested  in  consultaLon  with  naLonal   stakeholders  

primary     data  

(for MNH)  

core data  

secondary     data  

Policy +  Financing   Context  

Disaggregated and   with  GIS  

primary     data  

scenarios

costed strategies  

(for MNH)  

Technical Report  +  Infographic  

Describe the  evidence  and  the  findings  from   the  Domains  

Explore differences   between  populaLon   need,  workforce   supply  and   government  policies  

need supply   discrepancy   Disaggregated  and   with  GIS  

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cost impact  


H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

2.Progress to  date   J  

F

M

A

M

J

J

A

S

O

N

D

Afghanistan Bangladesh   DR  Congo   Ethiopia   India   Mozambique   Nigeria   Tanzania   NaLonal  assessment  reports  

Available at:  www.integrare.es    

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

3.Assessing need  –  pregnancies  per  year  

Afghanistan

“Your place  of   birth  should   not  determine   your  right  to   life”  

Ethiopia

“If you  miss  the   poor,  you  miss   the  point”  

Tanzania

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

3.Assessing supply:  Health  labour  market  analysis   Private  

Public

Other

Exits

Health sector  

‘supply’ Unemployed  

Employed

Qualified healthcare  workers  

Healthcare educaLon  and  training  

High School  graduates  (male/female)   Source:  adapted  from  Vujicic  and  Zurn,  2006  

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‘parLcipaLon’

‘potenLal supply’  


H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

3.Assessing supply:  who  plays  what  role  in  the  midwifery  workforce?        

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

3.Assessing supply:  Educa4on  pathways,  provider  and  costs?            How  many  are  currently  prac0sing?      

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

3.Assessing supply:  urban/rural  distribu4on  -­‐  equitable?  

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

3.Modelling future  supply:  how  many  (more)  are  needed?  

Projected STOCK  

Projected NEED     OR     Projected   Need     +     service   coverage   target  

Year ‘x’  

Year ‘x’  

GAP

Exit Entry  

?

STOCK Current  

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

3.Modelling future  supply:  if  we  use  Tanahashi?      

Process of  service  provision  

Service Delivery  Goal   Target  populaLon  who  do  not  contact   services  

EffecLve Coverage  

People who  receive  effecDve  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 PopulaLon    

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

3.Modelling future  supply:  to  provide  effec4ve,  quality  coverage?      

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

Key findings Work environment •  Distribution of facilities seems to align with areas where most Health facili4es  by  expected  pregnancies   pregnancies expected, though not conclusive •  However, insufficient staffing with appropriate balance of RCH competencies •  Need for strengthening referral, commodity and equipment systems, and to find ways to improve staff motivation

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

Key findings    

Midwifery workforce   The  RCH  workforce  in  Tanzania  

•  Equitable distribution of workforce in recent years •  Recruitment and deployment processes are still issues in ensuring RCH services are equitably delivered – vacancy rates estimated between 40% to 86% •  Lack of full midwifery skills in at least one of the cadres challenges equitable coverage

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

Projected staffing  needs  and  supply  

18000

16000

Supply of  EN   Supply  of  ANO  

14000

Supply of  CO   Supply  of  AMO  

12000

Supply of  MO   Total  staffing  needs  

10000

8000 2015  

2020

2025

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H4+ ‘High  Burden  Countries  Ini4a4ve’:  Midwifery  Workforce  Assessments   `  

State of  the  World’s  Midwifery   Launched  in  2011.  Plans  for  wriLng  SoWMy2   for  publicaLon  in  2014.     First  meeLng  at  GMHC2013  to  discuss   themes,  engage  with  partners.       Proposed  to  align  with  Countdown   countries,  expand  from  progress  report  to   include  equity,  coverage,  quality  of  care.   Proposed  to  push  for  a  Commission  on  HRH.     Second  meeLng  at  Women  Deliver,  May   2013.  Finalise  the  surveys,  discuss  data   collecLon.  Start  communicaLon  processes.  

hsp://www.unfpa.org/sowmy/report/home.html   `  

Hbci overview e4a 18jan13  
Hbci overview e4a 18jan13  
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