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Bibliography

To access the files referenced below, please see the Ref ID number under the citation and open the file with the same number in the Report/docs/library folder on this CD-ROM.
 

Ackerman B, Cooke P, Hutcherson A, Jokinen M, Shallow H, Walker J. Standards for Birth Centres in England: A Standards Document. London: Royal College of Midwives; 2009 Aug.
Ref ID: 41
Notes: This document sets out standards that are specifically applicable to the provision of care, staffing and environment of midwifery birth centres in England, in line with Government policy and existing regulatory and clinical standards relating to safety and quality of care for women and their babies. Seven standards are defined: safety and clinical governance, staffing, organization, family focus, public health, communication, and environment and facilities. The standards set a framework that can be used in assessments of performance levels and enable continuous improvement in the quality of care provided.

Affane S. Rapport d'Étude sur les Indicateurs de Processus pour le Suivi et la Surveillance de la Mortalité Maternelle.  2005.
Ref ID: 408
Notes: This document has been produced for the Ministry of Health, Comoros. This document presents a report of a study on process indicators for monitoring and surveillance of mortality. The report was written as part of the Union of Comoros' roadmap to meet the MDG goals, specifically MDG 5. The report indicates that the establishment of process indicators can provide essential data in the context of monitoring progress towards reducing maternal mortality. The study was based on a national survey, using a questionnaire to determine the number of services delivering essential obstetric care.

Africa Progress Panel. Maternal Health: Investing in the Lifeline of Healthy Societies & Economies - Policy Brief.  2010 Sep.
Ref ID: 189
Notes: This document is a policy brief addressing barriers to maternal health in Africa. This document is intended for African governments, policymakers, the international community and the private sector to examine issues relating to cost, access, infrastructure, quality and sustainability of care, information deficit and attitudes. The briefing calls for addressing these issues through increased budgets for maternal health, efficient financing mechanisms, and political partnerships.

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Nigeria.  2008 Oct.
Ref ID: 50
Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Nigeria.  This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Uganda.  2009 Oct.
Ref ID: 52
Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Uganda. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Swaziland.  2009 Mar.
Ref ID: 51
Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Swaziland. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Profil en Ressources Humaines pour la Santé du Congo - Guide de Rédaction du Profil en Ressources Humaines pour la Santé du Pays.  2009 Mar.
Ref ID: 44
Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in the Congo. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: The Gambia.  2009 Mar.
Ref ID: 46
Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in the Gambia. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Profil en Ressources Humaines en Santé République Islamique de Mauritanie.  2009 Sep.
Ref ID: 49
Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Mauritania. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Malawi.  2009 Oct.
Ref ID: 48
Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Malawi. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Profil en Ressources Humaines pour la Santé du Cameroun - Guide de Rédaction du Profil en Ressources Humaines pour la Santé du Pays.  2009 Mar.
Ref ID: 43
Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Cameroon. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Guinea-Bissau.  2010 Aug.
Ref ID: 47
Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Guinea-Bissau. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Ethiopia.  2010 Jun.
Ref ID: 45
Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Ethiopia. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

Agencia Sueca de Cooperación International para el Desarrollo (ASDI), Ministerio de Salud Nicaragua. Sistematizacion Proyecto "Formation de Enfermeras Obstetras" 2004-2010. Nicaragua: ALVA Consultorías y Asesorías; 2010 May.
Ref ID: 249
Notes: This document is produced jointly by the Ministry of Health, Nicaragua and ASDI (Swedish International Development Cooperation Agency). The report presents an analysis of an obstetric nurse training project undertaken in 2004-2010. The goal of this joint project was to reduce maternal and perinatal mortality and morbidity and to improve the quality of sexual and reproductive health care services in Nicaragua.

Ahmad R. Efforts of the Malaysian Government in Strengthening Midwifery in Malaysia. Symposium on Strengthening Midwifery Services (Women Deliver 11) 5-6 June 2010 Washington DC.
Notes: This is a PowerPoint presentation discussing midwifery and maternal mortality in Malaysia. It presents issues such as the use of traditional birth attendants as an ally for  cultural observances, identification and training of key personnel, knowledge and skills of staff, and nurses and midwives as the front liners in the provision of basic healthcare in the primary health care service.

Aitken I. Reproductive Health in Post-conflict Afghanistan: Case Study of the Formation of Health Services for Women in the Recovery from Twenty Years of War.  2009 Sep 4.
Ref ID: 53
Notes: This is a joint document produced with support from Escuela Andaluza de Salud Publica, Consejeria de Salud; UNFPA and WHO. This report presents an assessment of the state of reproductive health services before and after the Soviet war in Afghanistan. The report assesses issues such as available services and resources, health and reproductive health policies, human resources and other support systems such as financing and reporting, monitoring and evaluation.

Akiode A, Fetters T, Daroda R, Okeke B, Oji E. An evaluation of a national intervention to improve the postabortion care content of midwifery education in Nigeria. International Journal of Gynecology and Obstetrics 110 (2010) 186–190
Ref ID: 437

Al Salaam A. Yemen List of Essential Medicines.  15-10-2009.
Notes: This is a joint WHO and Yemeni Ministry of Public Health document providing a table of essential medicines in Yemen.

Ali AA, Rayis DA, Mamoun M, Adam I. Use of Family Planning Methods in Kassala, Eastern Sudan. BMC Research Notes 2011 Feb 28;4(1):43.
Ref ID: 305
Abstract: ABSTRACT: BACKGROUND: Investigating use and determinants of family planning methods may be instructive in the design of interventions to improve reproductive health services. FINDINGS: Across sectional community- based study was conducted during the period February- April 2010 to investigate the use of family planning in Kassala, eastern Sudan. Structured questionnaires were used to gather socio-demographic data and use of family planning. The mean +/- SD of the age and parity of 613 enrolled women was 31.1+/-7 years and 3.4+/- 1.9, respectively. Only 44.0% of these women had previously or currently used one or more of the family planning methods. Combined pills (46.7%) and progesterone injection (17.8%) were the predominant method used by the investigated women. While age, residence were not associated with the use of family planning, parity (> five), couple education ([greater than or equal to] secondary level) were significantly associated with the use of family planning. Husband objection and religious beliefs were the main reasons of non- use of family planning. CONCLUSION: Education, encouragement of health education programs and involvement of the religious persons might promote family planning in eastern Sudan.

Ally M. Commission on Information and Accountability for Women's and Children's Health: Working Group on Accountability for Resources.  2011 Jan 26.
Ref ID: 238
Notes: This document presents slides from the Working Group on Accountability for Resources. See R236 and 239 for Co-Chairs Statement pertaining to same meeting. The slides present an overview of the scope of The Commissions work, current opportunities and challenges, focus areas, recommendations and issues for the commissioners' considerations. Key focus areas are to increase accountability and tracking of government and non-government expenditures. Accountability needs to occur at country level and global level.

Anand S, Barnighausen T. Human Resources and Health Outcomes: Cross-Country Econometric Study. Lancet 2004 Oct 30;364(9445):1603-9.
Ref ID: 3
Abstract: BACKGROUND: Only a few studies have investigated the link between human resources for health and health outcomes, and they arrive at different conclusions. We tested the strength and significance of density of human resources for health with improved methods and a new WHO dataset. METHODS: We did cross-country multiple regression analyses with maternal mortality rate, infant mortality rate, and under-five mortality rate as dependent variables. Aggregate density of human resources for health was an independent variable in one set of regressions; doctor and nurse densities separately were used in another set. We controlled for the effects of income, female adult literacy, and absolute income poverty. FINDINGS: Density of human resources for health is significant in accounting for maternal mortality rate, infant mortality rate, and under-five mortality rate (with elasticities ranging from -0.474 to -0.212, all p values < or = 0.0036). The elasticities of the three mortality rates with respect to doctor density ranged from -0.386 to -0.174 (all p values < or = 0.0029). Nurse density was not associated except in the maternal mortality rate regression without income poverty (p=0.0443). INTERPRETATION: In addition to other determinants, the density of human resources for health is important in accounting for the variation in rates of maternal mortality, infant mortality, and under-five mortality across countries. The effect of this density in reducing maternal mortality is greater than in reducing child mortality, possibly because qualified medical personnel can better address the illnesses that put mothers at risk. Investment in human resources for health must be considered as part of a strategy to achieve the Millennium Development Goals of improving maternal health and reducing child mortality.

Ariff S, Soofi SB, Sadiq K, Feroze AB, Khan S, Jafarey SN, et al. Evaluation of Health Workforce Competence in Maternal and Neonatal Issues in Public Health Sector of Pakistan: an Assessment of Their Training needs. BMC Health Services Research 2010;10:319.
Ref ID: 22
Abstract: BACKGROUND: More than 450 newborns die every hour worldwide, before they reach the age of four weeks (neonatal period) and over 500,000 women die from complications related to childbirth. The major direct causes of neonatal death are infections (36%), Prematurity (28%) and Asphyxia (23%). Pakistan has one of the highest perinatal and neonatal mortality rates in the region and contributes significantly to global neonatal mortality. The high mortality rates are partially attributable to scarcity of trained skilled birth attendants and paucity of resources. Empowerment of health care providers with adequate knowledge and skills can serve as instrument of change. METHODS: We carried out training needs assessment analysis in the public health sector of Pakistan to recognize gaps in the processes and quality of MNCH care provided. An assessment of Knowledge, Attitude, and Practices of Health Care Providers on key aspects was evaluated through a standardized pragmatic approach. Meticulously designed tools were tested on three tiers of health care personnel providing MNCH in the community and across the public health care system. The Lady Health Workers (LHWs) form the first tier of trained cadre that provides MNCH at primary care level (BHU) and in the community. The Lady Health Visitor (LHVs), Nurses, midwives) cadre follow next and provide facility based MNCH care at secondary and tertiary level (RHCs, Taluka/Tehsil, and DHQ Hospitals). The physician/doctor is the specialized cadre that forms the third tier of health care providers positioned in secondary and tertiary care hospitals (Taluka/Tehsil and DHQ Hospitals). The evaluation tools were designed to provide quantitative estimates across various domains of knowledge and skills. A priori thresholds were established for performance rating. RESULTS: The performance of LHWs in knowledge of MNCH was good with 30% scoring more than 70%. The Medical officers (MOs), in comparison, performed poorly in their knowledge of MNCH with only 6% scoring more than 70%. All three cadres of health care providers performed poorly in the resuscitation skill and only 50% were able to demonstrate steps of immediate newborn care. The MOs performed far better in counselling skills compare to the LHWs. Only 50 per cent of LHWs could secure competency scale in this critical component of skills assessment. CONCLUSIONS: All three cadres of health care providers performed well below competency levels for MNCH knowledge and skills. Standardized training and counselling modules, tailored to the needs and resources at district level need to be developed and implemented. This evaluation highlighted the need for periodic assessment of health worker training and skills to address gaps and develop targeted continuing education modules. To achieve MDG4 and 5 goals, it is imperative that such deficiencies are identified and addressed.

Association des Sages-Femmes du Gabon. La Profession de Sage-Femme au Gabon.  2009 Dec.
Ref ID: 368
Notes: This document is written by the Association for Midwifery in Gabon and provides a description of the midwifery profession in the country, including the roles and responsibilities of the midwife and their professional capacity. This document also provides an overview of the role of the association itself.

Babiker ARM. National EmOC Needs Assessment. Republic of Sudan: Federal Ministry of Health; 2005.
Ref ID: 99
Notes: This is a general needs assessment conducted for the Federal Ministry of Health, Republic of Sudan, to evaluate the capability of EmOC health facilities. This report assesses the availability of trained care providers, adequate equippment and supplies and classifies the hospitals as comprehensive, basic, or suboptimal EmOC providers. The report provides recommendations to ensure improved quality of care and availability of resources such as: the creation of a well equipped and properly staffed information unit, secure links and communication throughout the system, ambulance availability, expansion of obstetric training for female doctors, and special courses on EmOC for medical officers and students.

Baeta SM, Kpegba PK, Anthony AK. Évaluation des Soins Obstétricaux et Néonatals d'Urgence au Togo.  2007 Aug.
Ref ID: 353
Notes: This is a joint Ministry of Health and UNFPA report evaluating emergency obstetric and neonatal health care in Togo. This evaluation was conducted by the Togolese Association for Public Health (AUTOSAP) by means of a national survey to determine the availability, quality and utilization of EmONC services in Togo. This study evaluated capacities of health facilities offering EmONC services and the availability of qualified personnel, equipment, supplies and medicines in this context. Findings indicate poor levels of EmONC services and low utilization.

Banu M, Nahar S, Nasreen HE. Assessing the MANOSHI Referral System: Addressing Delays in Seeking Emergency Obstetric Care in Dhaka's Slums. Dhaka: ICDDR,B. & BRAC; 2010 Jan. Report No.: MANOSHI Working Paper Series No. 10.
Ref ID: 265
Notes: This report is an assessment of the Manoshi project, developed by BRAC to establish a community based health programme targeted at reducing maternal, neonatal, and child deaths and diseases in urban slums of Bangladesh. Under the Manoshi project, BRAC established delivery centres (birthing huts) to ensure safe delivery and access to appropriate emergency obstetric care services whenever needed. This report finds that out of the three delays, the first delay was more prolonged and was significantly higher compared to the other two. Potential reasons for delaying the decision to transfer women are cited as fear of medical interventions, complications arising at midnight, traditional thinking, lack of money and inability to recognize the severity of illnesses irrespective of place of referral.

Beer KO. Tajikistan Reproductive Health Commodity Security (RHCS), Contraceptive Logistics Management Information System (CLMIS) Assessment, Social Marketing Assessment. Tajikistan: UNFPA; 2010 Feb.
Ref ID: 217
Notes: This UNFPA Tajikistan report presents an assessment of the CLMIS system and provides guidance on proper management of forms and application of forecasting mechanisms and software applications. The CLMIS assessment component focuses specifically on the UNFPA reproductive health program, and within that on distribution and logistics issues for contraceptives to public reproductive health (RH) facilities. For the Social Marketing component, the focus is on the four types of contraceptives currently supplied by UNFPA: IUDs, oral contraceptive pills, injectables and condoms.

Benton DC, Morrison A. Regulation 2020: Exploration of the Present; Vision for the Future. Geneva: International Council of Nurses; 2009.
Ref ID: 199
Notes: This ICN document as part of the ICN Regulation Series presents an argument for professional nursing regulation to become part of a complex adaptive system which seeks to find the right balance between the quality of services, access to those services and the costs of providing them. Professional regulation is seen as a central component of how the health and well-being of societies can be achieved and the practice of the nursing profession assured. Fundamental goals to this include patient safety and public protection with consumer engagement and participation as facilitators for the visibility of the profession's accountability for practice.

Bergevin Y, Attina T, Fauveau V. The Birth Cohort Method: A Simple Approach to Estimate Human Resources for Maternal and Newborn Health in Low-Income Countries.  2009.
Ref ID: 121
Notes: This paper provides details of a method used to estimate the numbers of health workers, particularly midwives, required to ensure safe deliveries and basic emergency obstetric care in low-income countries/countries with high levels of maternal mortality. The method detailed goes beyond population-based ratios and is based on differences in fertility rates for any given country. This document highlights the relative lack of attention and planning tools developed to estimate the requirements for human resources for maternal health. The tool is developed around the specific needs of each country and context. This paper identifies a gap between the current and desired number of midwives and recommends that health officials prioritize the development of a human resources plan for maternal and newborn health which it states is often non-existent in most of the high maternal mortality countries.

Bénin. Évaluation des Besoins en Soins Obstétricaux et Néonataux d'Urgence au Bénin. 2009 Dec.
Ref ID: 278
Notes: 2nd edition. This document presents an evaluation of emergency obstetric and neonatal care needs in Benin. The report provides a general overview of Benin, such as demography, characteristics of the health system, and services that are currently available. The remainder of the document provides an overview of human resources and the structure of health personnel. The purpose of the evaluation is to guide the Ministry of Health in developing strategies to strengthen the existing health system, with particular emphasis on MDG goals 4 and 5.

Bhuiyan AB, Mukherjee S, Acharya S, Haider SJ, Begum F. Evaluation of a Skilled Birth Attendant Pilot Training Program in Bangladesh. International Journal of Gynecology abd Obstetrics 2005 Jul;90(1):56-60.
Ref ID: 9
Abstract: OBJECTIVES: An evaluation of the pilot project of the Skilled Birth Attendant (SBA) training program has been undertaken to assess the strengths and weaknesses of the training program, the after training performances of the selected SBAs and to ascertain the sustainability of the program. METHODS: The study was conducted in three phases adopting both qualitative and quantitative methods: assessment of training program; evaluation of after training performances of SBAs; and evaluation of performance of providers in non-SBA areas. RESULTS: During the post-training period it was observed that on an average the SBAs performed 3-4 deliveries per month. They were able to perform different life saving skills. In the areas served by the SBAs, they performed 29% deliveries and 47% were performed by the TBAs. In control areas TBAs performed 61% deliveries. CONCLUSION: Overall, the study points to the efficacy of SBAs over traditional hands and the societal need for SBAs.

Bhutan. Organogram of Referral System.
Notes: This is a slide depicting an organogram of the referral system in Bhutan.

Bhutta ZA, Zohra S, Lassi NM. Data Abstraction: HRH for Maternal Health.  2010 Mar 29.
Ref ID: 178
Notes: This document presents a list of Bhutta et al's studies conducted as part of the systematic review on human resources for health. The tables list the studies by author/country/year, study design, description, outcome, and recommendations. It includes information regarding HR management systems, partnership, education, finance, leadership and policy.

Bhutta ZA, Lassi ZS, Mansoor N. Systematic Review on Human Resources for Health Interventions to Improve Maternal Health Outcomes: Evidence from Developing Countries. 2010 May.
Ref ID: 55
Notes: This is a systematic review addressing the HRH crisis in low and middle income countries. This review is conducted in attempt to provide a systematized account of the findings, recommendations and lessons from previous studies which is otherwise lacking. This review suggested an urgent and immediate need for formative evidence based research on effective HR interventions for improved maternal health in low and middle income countries. The study showed that educating and empowering women, alleviating poverty, establishing gender equality and providing infrastructure, equipments drugs and supplies, are just some integral parts in working towards the achievement of MDG 5 and reducing maternal mortality.

Borchert M, Bacci A, Baltag V, Hodorogea S, Drife J. Improving Maternal and Perinatal Health Care in the Central Asian Republics. International Journal Of Gynecology And Obstetrics 2010;110(2):97-100.
Ref ID: 385
Abstract: OBJECTIVE: To describe our experience of a complex training intervention to introduce effective perinatal care, evidence-based medicine, national confidential enquiries into maternal deaths, and facility-based near-miss case reviews in the Central Asian Republics. METHODS: We describe our experiences from training sessions and report on findings from data extraction from patient records, patient interviews, discussions with healthcare staff, and observation of health care during our follow-up visits. RESULTS: Many outdated practices in perinatal care have been abandoned, and several recommended approaches have been adopted in pilot facilities. Familiarity with the concept of evidence-based medicine has increased among participants. National confidential enquiries into maternal deaths are being prepared and facility-based near-miss case reviews piloted. CONCLUSION: The experience of the complex training intervention to improve maternal and perinatal health care in the Central Asian Republics is encouraging, but roll-out will be challenging. The quality of care and the attitudes of healthcare providers will have to be monitored continuously.

Bowser D, Hill K. Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth, Report of a Landscape Analysis.  USAID; 2010 Sep 20.
Ref ID: 56
Notes: This USAID landscape analysis report is a review of the evidence on the topic of disrespect and abuse in facility-based childbirth. The primary purpose of the report is to review the evidence in published and gray literature with regard to the definition, scope, contributors, and impact of disrespect and abuse in childbirth. This document reviews reports of disrespect and abuse in facility-based childbirth across a range of birth care settings in low, middle and high income countries. The report intentionally focuses on care provided at the time of birth given the intense vulnerability of women during childbirth. The report cites potential contributors of abuse as normalization of disrespect during childbirth, lack of community engagement and oversight, financial barriers, and lack of autonomy and empowerment.

Bradley S, McAuliffe E. Mid-Level Providers in Emergency Obstetric and Newborn Health Care: Factors Affecting their Performance and Retention Within the Malawian Health System. Human Resources for Health 2009;7:14.
Ref ID: 405
Abstract: BACKGROUND: Malawi has a chronic shortage of human resources for health. This has a significant impact on maternal health, with mortality rates amongst the highest in the world. Mid-level cadres of health workers provide the bulk of emergency obstetric and neonatal care. In this context these cadres are defined as those who undertake roles and tasks that are more usually the province of internationally recognised cadres, such as doctors and nurses. While there have been several studies addressing retention factors for doctors and registered nurses, data and studies addressing the perceptions of these mid-level cadres on the factors that influence their performance and retention within health care systems are scarce. METHODS: This exploratory qualitative study took place in four rural mission hospitals in Malawi. The study population was mid-level providers of emergency obstetric and neonatal care. Focus group discussions took place with nursing and medical cadres. Semi-structured interviews with key human resources, training and administrative personnel were used to provide context and background. Data were analysed using a framework analysis. RESULTS: Participants confirmed the difficulties of their working conditions and the clear commitment they have to serving the rural Malawian population. Although insufficient financial remuneration had a negative impact on retention and performance, the main factors identified were limited opportunities for career development and further education (particularly for clinical officers) and inadequate or non-existent human resources management systems. The lack of performance-related rewards and recognition were perceived to be particularly demotivating. CONCLUSION: Mid-level cadres are being used to stem Africa's brain drain. It is in the interests of both the government and mission organizations to protect their investment in these workers. For optimal performance and quality of care they need to be supported and properly motivated. A structured system of continuing professional development and functioning human resources management would show commitment to these cadres and support them as professionals. Action needs to be taken to prevent staff members from leaving the health sector for less stressful, more financially rewarding alternatives.

Bruce K. Economic Analysis of the Indonesian Village Midwife Program Case Studies from West and East Java.  2002.
Ref ID: 416
Notes: This document presents an Executive Summary written by Kerry Bruce, MPH for PATH, based on the findings from the paper, Pembiayaan Program Bidan di Desa: Kabupaten Cianjur, Kediri dan Blita, written for PATH by Mardiati Nadjib, Purnawan Junadi, Prastuti Soewondo et.al. from the Centre for Health Research at the University of Indonesia in 2002.  The purpose of this study was to inform central and district level decision makers in ASUH program areas on: the cost of the village midwife program to date, a five year projection of expenses and the possible consequences of a decision to continue or discontinue the program. The research looked at the situation in three districts on Java (Cianjur in West Java, Kediri and Blitar in East Java). This research was a cross-sectional study using both quantitative and qualitative methods. Recommendations include continued subsidization of the village midwife program, potential subsidies for drugs and medicines, that financing of subsidies should be clearly delineated between central and district governments, and that deciding on the standard of education of the midwives should occur prior to deciding whether the program should be continued.

Bruce K. Reducing Early Neonatal Mortality on Java, Indonesia: Increasing Homevisits During the First Week of Life.  2004 Apr.
Ref ID: 418
Notes: This paper examines the use of the homevisit in four districts on Java as a method to reduce early neonatal mortality. The paper outlines the goals and aims of the intervention, examines the methods and design of the intervention, looks at who it targets, the results to date, how the intervention might be generalized for wider implementation and the implications of these findings for the program. On Java in Indonesia, where resources are limited and the IMR is still relatively high compared with developed countries, providing a homevisit to a postpartum woman within seven days of the birth is one strategy that is used to reduce early neonatal mortality. The strategy has strengths in that it can identify problems for neonates early and initiates the process of Hepatitis B immunization which can reduce rates of chronic Hepatitis B infection. The strategy of providing homevisits also has weaknesses in that its impact is difficult to measure and the capacity of the Indonesian neonatal medical facilities to deal with problems has not been evaluated or addressed as part of the intervention. Economic, social and logistic barriers to care identified as a result of a homevisit have also not been rigorously evaluated and addressed.

LOI No 049-2005/ AN: Portant Santé de la Reproduction,  Burkina Faso, (2005).
Ref ID: 59
Notes: This document presents Burkina Faso's law for good reproductive health. It outlines all aspects relating to good health such as physical mental and social, and addresses the health of women, men, children and adolescents, and neonates.

LOI No 030-2008/ AN: Portant Lutte Contre Le VIH/SIDA et Protection des Droits des Personnes Vivant Avec le HIV/SIDA. JO No26 du 26 juin 2008,  Burkina Faso, (2008).
Ref ID: 60
Notes: This document outlines Burkina Faso's HIV/AIDS law for the protection and rights of people living with HIV/AIDS. The document defines HIV/AIDS and measures of protection, in particular towards health services, vulnerable people, and their families and community.

Butts-Garnett G. Midwifery Assessment in Guyana.  2010.
Ref ID: 383
Notes: This document is an assessment to determine the baseline number of midwife graduates, their deployment to different levels of health facilities, geographical distribution and national needs in these areas. The report cites 494 midwives working in Guyana with 334 post basic and 157 trained at direct-entry level. The assessment revealed that while Single Trained midwives are trained specifically for community level facilities such as health centres and health posts, they are assigned at all levels of hospital, including the national referral and teaching hospital. Many post basic trained midwives also work at supervisory level and in administration, but do not necessarily work in maternal and reproductive health as some may be assigned to surgical and medical nursing wards/clinics. The report finds that the number of midwives working in the system is inadequate and poor distribution continues to make the situation worse.

Calderón L. Una Estrategia Efectiva para la Reducción de la Mortalidad Materna: La Atención Calificada del Parto con Enfoque Intercultural.  Bolivia, UNFPA.
Notes: This is a strategy document written by Lilian Calderon, maternal health division, UNFPA Bolivia. This document outlines Bolivia's strategy to reduce maternal mortality with specific attention to skilled care during childbirth through an intercultural approach. This documents highlights the main cause of maternal mortality as being when there is no access to skilled care. The majority of deaths occur among indigenous people, particularly in rural areas. In this context, all pregnancies should be considered as at risk. In consideration of the multi-cultural make up of Bolivia, skilled personnel are required who will promote and practice culturally sensitive health services.

Canadian International Development Agency, Ministry of Health and Social Welfare United Republic of Tanzania. Proposal for a Tanzania Health Workforce Initiative (Draft 3).  2009 Jan 8.
Ref ID: 227
Notes: This draft document is a joint CIDA and MOH Tanzania proposal for a health workforce initiative. The initiative proposed in this document is based on a series of detailed discussions that have taken place across a wide variety of human resources for health (HRH) stakeholders, including government, donor partners and non-state actors. Following from these discussions, the Health Workforce Initiative has been designed to twin the Government of Tanzania's key priorities of HRH and public-private partnerships (PPP). It will, on the one hand, support eligible private sector training institutions (including Tutor Training Institutions), to enable them to scale up the production of mid-level health workers and trainers, and on the other hand, support eligible research institutions in undertaking priority HRH operations research and studies, with a view to informing evidence-based planning and decision making in HRH. The implementation mechanism adopted for this initiative is largely a responsive one. The sub-projects to be supported under this initiative will be based on proposals submitted by partner institutions in line with tender calls.

Center for Reproductive Rights. Surviving Pregnancy and Childbirth: An International Human Right - Briefing Paper.  2005 Jan.
Ref ID: 423
Notes: This document is a briefing paper by the Center for Reproductive Rights. This briefing paper discusses the international legal standards for the rights to life, health, non-discrimination and reproductive self-determination and identifies governments' corresponding duties to ensure women's enjoyment of those rights. It provides global illustrations of the toll that inadequate health-care delivery, pervasive discrimination and denials of reproductive decision-making take on women's lives and health, and discusses the gap between the international communities staked commitments to promoting maternal survival and its actions to that end thus far.

Center for Reproductive Rights, Federation of Women Lawyers-Kenya (FIDA). Failure to Deliver: Violations of Women's Human Rights in Kenyan Health Facilities.  2007.
Ref ID: 419
Notes: This document is a report jointly produced by the Center for Reproductive Rights and the Federation of Women Lawyers -Kenya. The main objective of this report is to highlight the existing flaws in reproductive health care in Kenya. This report covers two decades of women's experiences, with the most recent delivery experiences occurring in the past six months. Women were asked about their experiences with contraception, pregnancy, and delivery throughout their lives in order to understand the long-term repercussions of mistreatment in the health care context. This report does not encompass all reproductive health services, but focuses primarily on women's experiences with family planning, pregnancy, and childbirth. The report identified difficulties in access to family planning services and information, cases of abuse and neglect during delivery, structural barriers to quality maternal health care, and discrimination in the health care system.

Center for Reproductive Rights, Women Advocates Research and Documentation Centre. Broken Promises: Human Rights, Accountability, and Maternal Death in Nigeria. 2008.
Ref ID: 422
Notes: This report is a joint publication of the Center for Reproductive Rights (CRR) and the Women Advocates Research and Documentation Centre (WARDC). This report is based on desk and field research conducted between October 2007 and May 2008. The desk research involved a literature review of research publications such as books, journals, newspaper articles, and documentary analysis, as well as a synthesis of policies, legislation, and national demographic and health surveys published by the federal and state governments of Nigeria. In addition, it included reviews of civil society and non-governmental organisation surveys and publications on health and reproductive health care. This report focuses specifically on the Nigerian government's responsibility for the dire state of maternal health in the country. While the Nigerian government has repeatedly identified maternal mortality and morbidity as a pressing problem and developed laws and policies in response, these actions have not translated into a significant improvement in maternal health throughout the country. A number of factors inhibit the provision and availability of maternal health care in the country, including: the inadequacy or lack of implementation of laws and policies, the prevalence of systemic corruption, weak infrastructure, ineffective health services, and the lack of access to skilled health-care providers. The separation of responsibilities for the provision of health care among the country's three tiers of government both contributes to and exacerbates the harmful impact of these various factors.

Center for Reproductive Rights. Maternal Mortality in India: Using International and Constitutional Law to Promote Accountability and Change.  2008.
Ref ID: 414
Notes: This report focuses primarily on maternal mortality as a human rights concern. This report is intended to serve as a resource for those interested in using international and constitutional legal norms and mechanisms to establish government accountability for maternal deaths and pregnancy-related morbidity through public interest litigation and human rights advocacy. A human right to survive pregnancy implies the need for constitutional guarantees of access to pre- and postnatal health care and emergency obstetric care for all pregnant women, as well as the need for legal protection against discrimination that puts women's physical integrity and reproductive health in jeopardy. By highlighting stories of women who have died giving birth, this report illustrates the connections between their experiences and state action or inaction. Information from studies undertaken by local non-governmental organizations (NGOs) has been used to draw attention to important trends and challenges in implementing maternal health policies. Some of these studies contain data that may be used as a basis for public interest litigation. Finally, this report showcases a few important legal initiatives being undertaken in parts of India that seek accountability for maternal deaths and morbidity in order to inspire further action.

Chopra M, Munro S, Lavis JN, Vist G, Bennett S. Effects of Policy Options for Human Resources for Health: An Analysis of Systematic Reviews. Lancet 2008 Feb 23;371(9613):668-74.
Ref ID: 4

Clapham S, Pokharel D, Bird C, Basnett I. Addressing the Attitudes of Service Providers: Increasing Access to Professional Midwifery Care in Nepal. Tropical Doctor 2008;38(4):197-201.
Ref ID: 394

Commission on Information and Accountability for Women's and Children's Health: Working Group on Accountability for Resources. Co-Chairs Summary Statement: H.E. Mr Jakaya Mirisho Kikwete, President, United Republic of Tanzania & Prime Minister Stephen Harper, Canada.  2011.
Ref ID: 236
Notes: See 238 and 239 for additional reports on this meeting. This document presents a summary statement by the co-chairs on the Commission on Information and Accountability for Women's and Children's Health. The Commission on Information and Accountability for Women's and Children's Health, called at the request of the UN Secretary-General, met in Geneva on January 26, 2011, to take the next step in this unparalleled opportunity to make a difference in the lives of women and children. Co-chaired by President Jakaya Kikwete of United Republic of Tanzania and Prime Minister Stephen Harper of Canada, the Commission agreed to establish a framework to monitor global commitments for maternal, newborn and child health and ensure committed resources save as many lives as possible. The meeting discussed issues relating to improving accountability for results and resources.

Commission on Information and Accountability for Women's and Children's Health: Working Group on Accountability for Resources. Discussion Paper, 18 January, 2011. 2011 Jan 18.
Ref ID: 239
Notes: This document presents a discussion of the meeting to be held on 26 Jan 2011. See R236 and R238 for notes on this 26 Jan 2011 Meeting. The objective of the Commission is to lead a process to propose a framework for global reporting, oversight and accountability on women's and children's health. Such a framework will help countries monitor where resources go and how they are spent, providing the evidence needed to show which programmes are the most effective to save the lives of women and children. The Commission will be supported by two technical working groups that respectively focus on accountability for results and accountability for resources. Taking into account what is currently being done in the area of tracking resources, the 'Working Group on Accountability for Resources' will propose indicators to measure and report on funding from both external and domestic sources, propose institutional arrangements at country and global levels, and identify best practices and methods for assuring the quality of and usability of tracking financial resources, including opportunities for innovation in information technology.

Cow S, Marcus J, Adams C. Midwife-Led Units in Community Settings, Cape Peninsula South Africa.  6-6-2010.
Notes: This is a PowerPoint presentation about community midwifery in South Africa. It provides a general background of the situation and outlines specific challenges to being a midwife in this context. It also presents an outline of midwifery training programmes and clinical status leading to professional practice. Authors of this document are from University of cape Town and Mowbray Maternity Hospital, South Africa.

Crisp N, Gawanas B, Sharp I. Training the Health Workforce: Scaling Up, Saving Lives. Lancet 2008 Feb 23;371(9613):689-91.
Ref ID: 364
Notes: This document is a Lancet article about the importance of scaling up the health workforce. The article provides an overview of the World Health Assembly's call to all member states to contribute to a rapid scale up to the production of health workers and discusses the context in which the Task Force for Scaling Up Education and Training for Health Workers was established. The Task Force identified several common critical success factors which need to be in place for scale-up programmes, such as political engagement, collaboration around a country-led plan, substantial financial investment, commitment to short and long-term health workforce planning, and commitment to producing appropriately trained health workers, expansion of pre-service education and training programmes, good information systems with monitoring and assessment, effective management and leadership, and labour market capacity and policy to absorb and sustain an increase in health workers.

Currie S, Azfar P, Fowler RC. A Bold New Beginning for Midwifery in Afghanistan. Midwifery 2007 Sep;23(3):226-34.
Ref ID: 23
Notes: This article discusses maternal mortality in Afghanistan, particularly in regards to the post-conflict situation. Given the high rates of maternal mortality, the authors identify that rapid mobilization of female healthcare providors, especially in rural areas is essential to improving these statistics. The article recommends an overall strengthening of midwives and the midwifery profession in Afghanistan. Challenges that still need to be overcome are identified as improving the services provided by midwives who were already in practice at the beginning of the reconstruction and whose earlier training was interrupted, not standardized, or otherwise inadequate according to new standards; Afghan midwives need to be more respectful towards clients; and gender barriers need to be addressed.

Daniels K, Lewin S, Policy Group. The Growth of a Culture of Evidence-Based Obstetrics in South Africa: A Qualitative Case Study. Reproductive Health 2011 Mar 28;8(1):5.
Ref ID: 365

Dawson A. Towards a Comprehensive Approach to Enhancing the Performance of Health Workers in Maternal, Neonatal and Reproductive Health at Community Level: Learning from Experiences in the Asia and Pacific Regions. University of New South Wales, Sydney: Human Resources for Health Knowledge Hub; 2010.
Ref ID: 406
Notes: This discussion paper presents a comprehensive approach to the assessment of individual health worker, team and HRH management performance in the context of health system strengthening and the achievement of Millennium Development Goal 5 (MDG 5). The paper focuses on health workers who deliver maternal, newborn and reproductive health care to households or provide outreach services from specific points in a community. Human resources in this context include nursing and midwifery professionals, community health workers, and traditional or cultural practitioners. These cadres do not only provide care at critical locations that vulnerable populations need to access, but they can also facilitate community empowerment which is central to primary health care. This paper considers HRH performance improvement in relation to health system strengthening and MDG 5 through a multidimensional perspective where HRH and service delivery is also linked to information systems, the supply of medical products, vaccines and technologies, financing, leadership and governance.

De Brouwere V, Dieng T, Diadhiou M, Witter S, Denerville E. Task Shifting for Emergency Obstetric Surgery in District Hospitals in Senegal. Reproductive Health Matters 2009 May;17(33):32-44.

de Haan O. Bridging the Gap; An Effective Approach to Strengthen the Health System from Two Entries Through Empowering Pregnant Women and Their Families and Health Providers Simultaneously. 
Notes: This is a 3 page briefing on a project implemented in central Asia to make high-quality care available to rural women in Tajikistan and Kyrgizstan. The approach of the project was to reduce maternal and newborn mortality by addressing families directly and educating them through Parents Schools and simultaneously train providers in client-centred services. Findings from the project state that the client education program as offered by the Parents School turns out to be highly effective: knowledge on physiology, danger signs and birth preparedness increased significantly among women and their families and reduced fear and anxiety for the delivery. Providers treat women with more respect, clients are supported to deliver under their own conditions (free positions as alternatives for the Rachmanovsky chair, partner participation) and they are enabled to make an informed choice on family planning after delivery.

de Haan O. From Patient to Client. Patient Education and Counseling 2010 Dec;81(3):442-7.
Ref ID: 279

de Haan O, Askerov A, Chirkina G, Popovitskaya T, Tohirov R, Sharifova D, et al. Preparedness for Birth in Rural Kyrgyzstan and Tajikistan. Follow-up KAP Study Among Women, Households and Health Professionals.  2010.
Ref ID: 277
Notes: NSPOH, AP3, TFPA. This report, funded by the Dutch Ministry of Foreign Affairs is a part of a larger safe motherhood project aimed to promote sexual and reproductive health and rights in rural areas in Central Asia. This report describes the differences in knowledge, attitudes and practices of various target groups before and after the main project interventions in Kyrgyzstan and Tajikistan. The overall objective of the project was to reduce maternal and infant mortality through making high quality maternal care available to vulnerable rural women. The approach of the project was to reduce maternal and newborn mortality by addressing families directly and educating them through Parents Schools and simultaneously train providers in client-centred services. The case study presented in this report explores the key determinants of motivation and decision-making under both providers and users of health facilities. The study reports that provider-client communication is essential to improving the quality of perinatal health services and that the attitude of providers is the discriminating factor between formal acceptance of changes and the motivation to change practices at the work floor.

Department of Health Services Nepal. Health Facility Mapping Survey 2009/2010: An Initiative to Institutionalize Health-GIS in Nepal.  2010 Mar.
Ref ID: 88
Notes: Project supported by WHO, KOFIH, and SAIPAL. This survey is intended to initiate a foundation for health-GIS in Nepal as a way to improve health system management by modeling environmental and spatial factors relating to service availability and health workforce. The survey found high variation in health facility population ratio, doctor and nurse population, and bed population. This implies an unequal distribution of health facilities with respect to population density.

Desk Review of Midwifery Resources. 
Notes: This KT document is a table presenting an annotated review of various works identifying midwifery resources. Resource persons contacted: Vincent Fauveau, UNFPA; Della Sherratt, WHO; Ms Margareta Larsson, WHO; Petra Ten Hoop Bender, WHO; Kathy Herschderfer, ICM; Bryan Thomas, FIGO. Organizational websites consulted: ACNM, FCI, FIGO, ICM, UNICEF, USAID, WHO, World Bank. Such resources include health systems factors, quality of care, delivery of care, coordination of care, community level factors, health seeking behaviour, PPH management, etc.Source not provided.

Devane D, Brennan M, Begley C, Clarke M, Walsh D, Sandall J, et al. A Systematic Review, Meta-Analysis, Meta-Synthesis and Economic Analysis of Midwife-led Models of Care. London: Royal College of Midwives; 2010 Nov.
Ref ID: 259
Notes: See R260 for final report. This document presents findings from a literature based review of midwife-led care. The report presents a systematic review and meta-analysis of randomized trials of midwife-led models of care compared with other models of care for childbearing women; meta-synthesis of qualitative research on midwife-led care; and an assessment of the cost-effectiveness of midwife-led care in the UK. Results of this analysis indicate that financial savings are possible by shifting to midwife-led care for maternities that meet the specified eligibility criteria. Expanding midwife-led maternity services for eliglible maternities may offer a means of reducing costs compared to the current leading model of care.

Devane D, Brennan M, Begley C, Clarke M, Walsh D, Sandall J, et al. A Systematic Review, Meta-Analysis, Meta-Synthesis and Economic Analysis of Midwife-led Models of Care. London: Royal College of Midwives; 2010 Dec.
Ref ID: 260
Notes: Final Report of R259. This document presents findings from a literature based review of midwife-led care. The report presents a systematic review and meta-analysis of randomized trials of midwife-led models of care compared with other models of care for childbearing women; meta-synthesis of qualitative research on midwife-led care; and an assessment of the cost-effectiveness of midwife-led care in the UK. Results of this analysis indicate that financial savings are possible by shifting to midwife-led care for maternities that meet the specified eligibility criteria. Expanding midwife-led maternity services for eligible maternities may offer a means of reducing costs compared to the current leading model of care.

DFID. Burden, Determinants and Functioning Health Systems.  2010 Oct 15. Report No.: RMNH Evidence Series (No. 2).
Ref ID: 69
Notes: RMNH Evidence Series unpublished draft. This is the second in a series of 11 evidence reviews relating to reproductive, maternal and newborn health in low-income countries with the aim to appraise and synthesize relevant knowledge relating to policy and programme interventions. This second paper in the series provides the background overview of the magnitude of the burden of unintended pregnancy and poor maternal and newborn health, the distal determinants and wider health systems context. Avoidance of unintended pregnancy and safe childbirth are thus the two main intermediate outcomes impacting upon the health and survival of women of reproductive age and of newborns that are considered in this evidence series.

DFID. Evidence on Interventions to Reduce Unintended Pregnancies.  2010 Dec 10. Report No.: RMNH Evidence Series (No. 3).
Ref ID: 70
Notes: RMNH Evidence Series unpublished draft. This is the third in a series of 11 evidence reviews relating to reproductive, maternal and newborn health in low-income countries with the aim to appraise and synthesize relevant knowledge relating to policy and programme interventions. This third paper in the series stresses the unmet need for contraception as a key contributor to unwanted pregnancies, stating lack of knowledge, difficult access to supplies and services, financial costs, fear of side effects and opposition from spouses, other family members and often the wider socio-cultural environment as reasons for this unmet need.

DFID. A New Strategic Vision for Girls and Women: Stopping Poverty Before it Starts. 2011.
Ref ID: 299
Notes: This document is a DFID brief presenting its strategic vision for the empowerment of girls and women in the developing world. The vision aims to give girls greater choice and control over decisions that affect the cycle of poverty between one generation and the next. The vision specifies four action points necessary to achieve this goal: delay first pregnancy and support safe childbirth, get economic assets directly to girls and women, get girls through secondary school, and prevent violence against girls and women. The brief outlines these four action points and sets out goals for each. DFID's country offices will report results against a range of indicators in individual operational plans and associated results frameworks (selected to reflect country level priorities).

Diaz Ortíz D. Puerto Rico (Midwifery and Nursing Education). 
Notes: This is a document written by Debbie Díaz Ortiz from the Latin American & Caribbean Network for Humane Childbirth. It is a summary of midwifery and nursing education. This documents highlights the differences between both and stresses that nursing can learn from midwifery style, didactic and practice together. This document recommends that countries should be very aware of the differences, necessities and realities before extrapolating any educational program. Full source not provided.

Dieleman M, van Vilsteren M, Herschderfer K, Gerretsen B. A Tool for Planning and Management of HRH for Maternal and New Born Health. Commissioner WHO-MPS, editor. Draft HRH and MNH Tool 22/01/2011.  18-11-2010. Amsterdam, Royal Tropical Institute, KIT Policy and Practice.
Notes: This is a comprehensive tool developed by the WHO-MPS department and the Royal Tropical Institute for HRH in maternal and newborn health (MNH) with the aim to assist policy makers and planners at country level in planning and managing health care workers for MNH-service provision. This tool is designed as a checklist to assess policies and plans for HRH for MNH at country level and to identify actions for improvement. This tool is not intended as an assessment tool but summarizes key questions on aspects crucial to HR planning and management with the aim to facilitate discussions and negotiations between MNH and HRH planning staff.

Dogba M, Fournier P. Human Resources and the Quality of Emergency Obstetric Care in Developing Countries: A Systematic Review of the Literature. Human Resources for Health 2009;7(1):7.
Ref ID: 24

Dovlo D. Wastage in the Health Workforce: Some Perspectives from African Countries. Human Resources for Health 2005 Aug 10;3:6.
Ref ID: 25

Dumont A, de Bernis L, Bouillin D, Gueye A, Dompnier JP, Bouvier-Colle MH. Morbidité Maternelle et Qualification du Personnel de Santé : Comparaison de Deux Populations Différentes au Sénégal. Journal de Gynécologie, Obstétrique et Biologie de la Reproduction 2002;31:70-9.
Ref ID: 382
Notes: This document is a journal article comparing maternal mortality and the qualifications of health personnel in two populations of Senegal (St-Louis and Kaolack). The objectives of the study conducted was to compare and contrast the situation of these two populations in relation to the offering of health services, and construct health indicators which could be adapted on the basis of the comparisons made. The study aimed to determine the extent to which maternal health outcomes are dependent on the level of qualifications of the nursing and medical staff. Results found that maternal mortality was higher in the Kaolack area where women gave birth mainly in district health care centers most often attended by traditional birth attendants, than in St-Louis where women giving birth in health facilities were principally referred to the regional hospital and were generally assisted by midwives.

Dumont A, Tourigny C, Fournier P. Improving Obstetric Care in Low-Resource Settings: Implementation of Facility-Based Maternal Death Reviews in Five Pilot Hospitals in Senegal. Human Resources for Health 2009;7:61.
Ref ID: 397

Dussault G, Fronteira I, Prytherch H, Dal Poz MR, Ngoma D, Lunguzi J, et al. Scaling up the Stock of Health Workers: A Review for the International Centre for Human Resources in Nursing.  2009.
Ref ID: 373
Notes: This document is a review developed for the International Centre for Human Resources in Nursing. It is one in a series of documents that aims to explore nursing human resource issues and offer policy solutions. This paper synthesises some of the published and grey literature on the process of scaling up the health workforce, with a particular focus on increasing the number of trained providers of health services. Findings from the literature search reflect a lack of material on the process of scaling up the workforce. This paper focuses on augmenting the stock of workers, which is just one of the many dimensions of scaling up health services. The results indicate that the costs of the process of scaling up go beyond direct expenditure, such as additional costs incurred by workers delivering more services.

East Central and Southern African College of Nursing. Nursing and Midwifery Professional Regulatory Framework. Arusha, Tanzania: Commonwealth Regional Health Community Secretariat; 2001.
Ref ID: 132
Notes: This project was produced by ECSACON and Intrah (University of North Carolina, Chapel Hill) for the PRIME II Project and with support from USAID. This document presents a regulatory framework which indicate the acceptable minimum parameters for professional practice, core competencies, core content and standards of education for nurses and midwives. This is important for the monitoring and evaluation of the quality of nursing and midwifery care. The document is intended for educators, practitioners, students, policy makers and researches.

El-Khoury M, Gandaho T, Arur A, Keita B, Nichols L. Improving Access to Life-Saving Maternal Health Services: The Effects of Removing User Fees for Caesareans in Mali. Bethesda, MD: Abt Associates Inc.; 2011 Apr.
Ref ID: 420
Notes: This document was produced for review by USAID as part of the Health Systems 20/20 Cooperative Agreement, a project that supports countries to address health systems barriers to the use of life-saving priority health services. Health Systems 20/20 works to strengthen health systems through integrated approaches to improving financing, governance,  and operations, and building sustainable capacity of local institutions. The objectives of this particular study were to: a. assess the effects of removing caesarean user fees in the public sector in Mali on access to caesareans, especially among women of low socioeconomic status (SES); b. understand how the policy is being implemented at the facility level; and c. identify key remaining barriers to accessing caesareans in order to inform appropriate future interventions or programmatic changes to reduce maternal mortality in Mali. Findings from the study include that service providers, communities, and local political actors support the free policy. Since the launch of the free caesarean initiative, institutional delivery and c-section rates in Mali have increased and post caesarean maternal and neonatal deaths declined in most regions. However, the free policy seems to be disproportionally benefiting the wealthier groups and although information about the policy is becoming increasingly well known, information about the specific components of the policy remains fragmented.

Eltigani Elfadil Mahmoud L. Turning a Corner on the Road to Maternal Health: A New Vision for Midwifery in Sudan. Federal Ministry of Health Republic of Sudan, editor. 
Notes: This document is a PowerPoint presentation by the National Reproductive Health Director, Federal Ministry of Health, Sudan. It presents an overview of the situation in Sudan relating to maternal and neonatal health, and discusses challenges which need to be addressed such as: village midwives versus SBAs, poor conditions of schools, donor dependence of schools, and no standardization of curricula. The author presents a framework for scaling up midwifery which includes issues relating to supervision, training and education, funding, monitoring and evalution, and access and equity.

Essendi H, Mills S, Fotso JC. Barriers to Formal Emergency Obstetric Care Services' Utilization. Journal of Urban Health 2010.
Ref ID: 252
Notes: This report is a document produced by Bolivia's Ministry of Health and Sport and is supported by PAHO and WHO Bolivia. This document presents a national strategic plan to improve health of Bolivia's people, in particular perinatal, maternal and neonatal health. This report highlights barriers caused by exclusionary factors and considers options which allow health to be seen as holistic and culturally sensitive. The plan outlines a systematic approach towards guiding interventions relating to improving information networks, referral systems and the categorization of health facilities. This policy document complements the national sexual and reproductive health plan, the plan to prevent uterine cancer, and the national plan for adolescents.

Estado Plurinacional de Bolivia Ministerio de Salud y Deportes. Proyecto de Ley de Systema Único de Salud - 21 de septiembre de 2010. La Paz, Bolivia; 2011 Jan.
Ref ID: 181
Notes: This document outlines the universal health system law of Bolivia. This law is intended to guarantee the rights to universal health care to all inhabitants within Bolivia. This includes universal coverage for all services and that such services are provided in an equitable manner. This law is complementary to the implementation of the Politica de Salud Familiar Comunitaria Intercultural (policy for intercultural community family health) which prioritizes health promotion and prevention of illnesses related to the social determinents of health. This document written on the premise that health is a universal human right and that interaction between sectors, social and community participation, equity and quality of care are among  the key principals in achieving this.

Evans CL, Maine D, McCloskey L, Feeley FG, Sanghvi H. Where There is No Obstetrician - Increasing Capacity for Emergency Obstetric Care in Rural India: An Evaluation of a Pilot Program to Train General Doctors. International Journal Of Gynecology And Obstetrics 2009 Dec;107(3):277-82.
Ref ID: 26

Evans G, Rehnström U. Assessment of the Community Midwifery Programme in Southern Sudan.  2010 Feb.
Ref ID: 153
Notes: This report is produced jointly by the Ministry of Health-Government of Southern Sudan (MOH-GOSS) and Liverpool Associates in Tropical Health (LATH). This document is an assessment of the Community Midwifery training programme introduced by MOH-GOSS in 2006. The programme is intended to make skilled maternity care accessible, acceptable, affordable, sustainable and cost-effective. The assessment reviews the capacity of midwifery training institutions and the current knowledge, skills, confidence and practices of community midwives. The findings state that the curriculum was felt to be adequate, provided it was fully implemented and the students received ample practice in deliveries but that there is considerable variance in the quality of clinical tutoring, standards and quality of care are lacking and also a variance in the performance and clinical capacities of community midwife graduates.

Evans G, Lema ME. Road Map for Community Midwifery in Southern Sudan.  2010 Jun.
Ref ID: 154
Notes: This report is produced jointly by the Ministry of Health - Government of Southern Sudan (MOH-GOSS) and the Liverpool Associates in Tropical Health. This report follows the Community Midwifery programme recommendation to propose a road map with short and longer term actions to improve access of mothers to skilled attendance during labour and delivery. This road map presents recommendations that focus on improving the quality of community midwives by regulating training and practice, providing internships and linking recent graduates to available jobs, improving the availability of community midwives by addressing pay and classification issues, increasing demand for midwifery services by educating communities, and preparing highly educated and skilled nursing and midwifery human resources for the increasingly complex future of health care of Southern Sudan.

Family Care International. Saving Women's Lives: The Skilled Care Initiative.  2000.
Ref ID: 304
Notes: This document is a two page brief providing an overview of Family Care International's Skilled Care Initiative. The initiative, launched in 2000, is a multi-faceted, five-year project to increase the number of women who receive skilled care before, during, and after childbirth. The project is being implemented in four rural, underserved districts in Burkina Faso, Kenya, and Tanzania. It also includes advocacy and information-sharing in the Latin America and Caribbean (LAC) region, and with global partners. The initiative focuses specifically on "skilled care" as a strategy for reducing maternal mortality and morbidity. The initiative emphasizes the critical importance of the environment where the provider works, such as the need for supportive policies, equipment, efficient communication systems and infrastructure. The project works in collaboration with government agencies and aims to offer project activities that are sustainable and replicable.

Fauveau V, Donnay F. Can the Process Indicators for Emergency Obstetric Care Assess the Progress of Maternal Mortality Reduction Programs? An Examination of UNFPA Projects 2000-2004. International Journal Of Gynecology And Obstetrics 2006 Jun;93(3):308-16.
Ref ID: 426

Fauveau V. Program Note: Using UN Process Indicators to Assess Needs in Emergency Obstetric Services: Gabon, Guinea-Bissau, and The Gambia. International Journal Of Gynecology And Obstetrics 2007 Mar;96(3):233-40.
Ref ID: 425

Fauveau V, Sherratt DR, de BL. Human Resources for Maternal Health: Multi-Purpose or Specialists? Human Resources for Health 2008;6:21.
Ref ID: 27

Federal Ministry of Health Ethiopia, UNICEF, UNFPA, WHO, AMDD. National Baseline Assessment for Emergency Obstetric and Newborn Care.  2008.
Ref ID: 303
Notes: See R185 for alternate version. This document is a national baseline EmONC assessment for Ethiopia, conducted in collaboration with the Federal Ministry of Health, WHO, UNFPA, UNICEF, and AMDD. The 2008 assessment presents information on the availability, use and quality of EmONC services in the country. In Ethiopia, only 6% of women that experience major obstetric complications receive life-saving care. The assessment also indicates a significant resource gap to scaling up quality maternal and newborn services. The government is working to reduce rates of maternal mortality through grassroots social mobilization and accelerating the expansion of infrastructure, equipment, supplies and the referral system.

Federal Ministry of Health Ethiopia, UNICEF, UNFPA, WHO, AMDD. National Baseline Assessment for Emergency Obstetric and Newborn Care.  2008.
Ref ID: 185
Notes: This is an assessment report by Ethiopia's Ministry of Health with contribution from UNICEF, UNFPA, WHO, and AMDD. The assessment establishes for the first time the national baseline information on the availability, use and quality of emergency obstetric and newborn care (EmONC) services in Ethiopia. The survey conducted in 2008 was a large emergency obstetric and newborn care facility-based survey that canvassed all hospitals and health centers in the government and non-governmental sectors. The purpose of this was to inform Health Sector Development Programm (HSDP) -IV and provide evidence for guiding policy and planning to strengthen the health system using emergency obstetric and new care as a point of entry. The key baseline indicators established through the EmONC assessment include: whether the number of fully functioning EmONC services is sufficient for the entire population of the country; if distribution of facilities is equitable; if pregnant women access these facilities for delivery; if women with major obstetric complications access these facilities; if enough critical services are provided; availability of newborn care; and adequate quality of care.

Federal Ministry of Health Republic of Sudan, UNFPA. Reproductive Health Services Map in Sudan.  2005 Jul.
Ref ID: 103
Notes: This is a joint UNFPA, Sudan Ministry of Health document mapping reproductive health services throughout the country. This document details the organizational structure at state and locality levels, maternal and neonatal health services at rural hospitals, and maternal and neonatal health services at villages. The document does not list conclusions or recommendations.

Federal Ministry of Health Republic of Sudan. The National Strategy for Reproductive Health 2006 - 2010.  2006 Aug.
Ref ID: 102
Notes: This is a strategy document aimed to improve the state of reproductive health in Sudan. The overall objective of the strategy for RH in Sudan is to accelerate progress towards meeting the nationally set and internationally agreed RH targets (esp. MDGs) and ultimately to attain highest achievable standard of RH for all population. This document defines key important issues for effective implementation of the National RH Strategy: sustainable financing mechanism, human resources development, quality in service provision, utilization of the services, improving information system, mobilizing political will, creating supportive and legislative and regulatory mechanisms, and stregthening evaluation and accountability.

Federal Ministry of Health Republic of Sudan, Central Bureau of Statistics. The Sudan Household Health Survey (SHHS).  2007 Apr.
Ref ID: 105
Notes: DRAFT. This is an unfinished draft of the survey which has been conducted as part of the effort to assess the situation of children and women and to monitor progress towards selected MDG indicators. Survey tools are based on the models and standards developed by the global MICS project, and PAPFAM designed to collect information on the situation of children and women in countries around the world. It collects data relating to health and MDG indicators. Results are presented in table format.

Federal Ministry of Health Republic of Sudan. National Strategy Document for Scaling-up Midwifery in the Republic of Sudan.  2010.
Ref ID: 100
Notes: This is a strategy document calling for the need to scale-up midwifery practices. This document is presented in response to Sudan's high maternal mortality rate which is off track to meeting MDG 5. The ministry of health recognizes the importance of midwifery care the most appropriate and cost-effective health care professional who can provide care in normal pregnancy and childbirth, including risk assessment and recognition of complications. This document sets out various recommendations such as the importance of evidence based advocacy efforts, expanding midwifery coverage and prioritizing underserved communities, and liasing between donors, NGOs and Sudan's National Technical Midwifery Committee.

Federal Ministry of Health Republic of Sudan. Road Map for Reducing Maternal and Newborn Mortality in Sudan (2010 - 2015). Khartoum; 2010 Dec.
Ref ID: 101
Notes: This roadmap is developed in order to move towards the MDG goals and to accelerate the reduction of maternal and newborn mortality. The objectives of this roadmap are to improve policy, utilization and quality of MNH services, ensure access to care, strengthen the capacity of health systems for the planning and management, monitoring and evaluation of MNH programmes, increase the availability and usage of youth friendly reproductive health and HIV prevention services, and to strengthen the capacities of individuals, families and communities for health promotion.

Federal Ministry of Health Republic of Sudan. National Reproductive Health Policy. 2010.
Ref ID: 104
Notes: This document outlines Sudan's reproductive health policy. Reproductive and sexual health is a high priority for the government. This document is produced with the aim of improving the health status of the population and to reduce rates of maternal mortality and reaching the MDG 5 goal. This document draws from existing national policies and strategies and national and international commitments. The policy calls for comprehensive reproductive health services, integration of RH services with mainstream primary health care, health workforce development for reproductive health services, equitable financing of reproductive health services, RH technology, and governance and monitoring of reproductive health.

Fond de Solidarité Prioritaire (FSP) pour la Mère et l'Enfant. Reduction de la Mortalite Maternelle et Infantile et Formation des Formateurs. Sage-Femmes aux Avants-Postes? Rencontres de Libreville (Gabon) 19-25 novembre 2010, Congrès de la SAGO, Assises de la FASFACO, Hôtel Laico. 
Notes: This report presents findings from a meeting in November 2010 in Gabon addressing maternal and neonatal mortality. The FSP mother-infant programme is a partnership between francophone universities and various institutions working to improve maternal and neonatal health in participating African countries as well as some southeast Asian countries. A key focus of this partnership is to reinforce professional practice and improve HRH issues. This document highlights the importance of compent midwives and the need to strengthen health personnel and a variety of other issues such as access and quality of care.

Frenk J, Chen L, Bhutta ZA, Cohen J, Crisp N, Evans T, et al. Health Professionals for a New Century: Transforming Education to Strengthen Health Systems in an Interdependent World. Lancet 2010 Dec 4;376(9756):1923-58.
Ref ID: 28
Notes: This article provides an analysis of education for health professionals and provides a brief history of reforms to strengthen professional education. The authors identify that professional education has not kept pace with challenges specific to the 21st century. The problems are stated as systemic, where there is a mismatch of competencies in patient and population needs, poor teamwork, persistent gender stratification of professional status, narrow technical focus without broader contextual understanding, episodic encounters rather than continuous care, predominant hospital orientation at the expense of primary care, quantitative and qualitative imbalances in the professional labour market, and weak leadership to improve health-system performance. The authors recommend that all stakeholders should partake in a rethinking of major reforms given these challenges and that professional educators are key players since change occurs through their leadership and ownership.

Fullerton JT, Johnson PG, Thompson JB, Vivio D. Quality Considerations in Midwifery Pre-service Education: Exemplars from Africa. Midwifery 2010 Dec 1.
Ref ID: 261

Gabrysch S, Cousens S, Cox J, Campbell OM. The Influence of Distance and Level of Care on Delivery Place in Rural Zambia: A Study of Linked National Data in a Geographic Information System. PLoS Medicine 2011;8(1):e1000394.
Ref ID: 262

Gabrysch S, Zanger P, Seneviratne HR, Mbewe R, Campbell OM. Tracking Progress Towards Safe Motherhood: Meeting the Benchmark yet Missing the goal? An Appeal for Better Use of Health-System Output Indicators with Evidence from Zambia and Sri Lanka. Tropical Medicine and International Health 2011 Feb 14.
Ref ID: 369

Ghérissi A. Programme d'Études de Sage Femme à Djibouti.  2006 May.
Ref ID: 327
Notes: This document provides an overview of the midwifery profession in Djibouti. The report is a WHO document and outlines midwifery education programmes in the country. The report provides a definition for midwifery practice and what it means to be a midwife in Djibouti. It covers the general competencies necessary to practice, the philosophical foundation of midwifery curriculums and the role of the midwife in the community. Regarding programmes of study, it outlines the structure of curriculums, organization, and teaching and evaluation methods.

Ghérissi A. Developing, Organising and Implementing Midwifery in the Arab Region: Outlines for a Consensual Midwifery National/Regional Strategy -UNFPA Regional Maternal Health Strategy Workshop. Cairo, 11-15 April 2010.  2010.
Ref ID: 393
Notes: This document is a series of slides put together for the UNFPA Regional Maternal Health Strategy Workshop in Cairo in 2010. The presentation discusses midwifery in the Arab region and why it is important to professionalize and strengthen midwifery in practice. The representation further offers recommendations on how best to proceed in practice such as human resources planning and deployment, a specific competency-based basic education programme, in-service education, and regulation.

Ghérissi A. Yemen - Health and Population Project (HPP) Acceleration of MDGs 5 and 4 - Preparation Phase Development of a National Midwifery Strategy in Yemen. MoPHP Funded by the World Bank Midwifery Training Program (2010-2015): Draft Mission Report for 20 Days International Consultancy (July-August 2010).  2010 Aug.
Ref ID: 358
Notes: This document is a draft mission report for an international consultancy held in 2010. This document presents a progress report on the Health and Population Project in Yemen. The project, funded by World Bank is to develop a consensual comprehensive National Midwifery Strategy in Yemen for 2010-2015 that should be articulated and integrated in the National Reproductive Health Strategy in the process of being developed for the same period. The report cites the need for the midwifery education programme in Yemen to be reviewed and updated according to a paradigmatic approach that integrates educational, sociocultural and disciplinary paradigms. This report provides an overview of this approach placed in the context of current midwifery training strategies.

Global Health Workforce Alliance. Reviewing Progress, Renewing Commitments - The First Progress Report on the Kampala Declaration and Agenda for Global Action in Priority Countries.  2010.
Ref ID: 134
Notes: DRAFT. This paper was commissioned by the Global Health Workforce Alliance (GHWA), as part of its mandate to implement solutions to the health workforce crisis, and with the specific objective of reviewing progress in the implementation of the Kampala Declaration and Agenda for Global Action. This document presents an agenda for priority an investment in and improvement of human resources for health, particularly in countries facing critical health workforce challenges. This report identifies bottlenecks in human resources which it states as often being the weakest link of health systems. This document outlines key areas of HRH challenges such as: leadership, evidence, education, retention, migration, and investment.

Global Health Workforce Alliance. Embargoed Country Briefs - Embargoed unitl 27 January 2011.  2010 Dec.
Ref ID: 133
Notes: This document presents one-page briefs regarding HRH for priority embargoed countries. It lists general country description data, HRH statistics and scores for individual AGA progress indicators.

Global Health Workforce Alliance. GWHA Technical Brief (Final) "Reviewing Progress, Renewing Commitments - Progress Report  on the Kampala Declaration and Agenda for Global Action in Priority Countries".  2010 Dec 24.
Ref ID: 163
Notes: The is a GWHA technical brief to monitor progress against the Agenda for Global Action which followed the Global Forum on Human Resources for Health, held in Kampala, Uganda in 2008. This document presents the progress of this declaration. Key messages include: though progress has been achieved in addressing the global health workforce crisis, some areas still require increased attention; all countries should have national health workforce plans that are realistically costed, comprehensive, gender balanced; implementation of these plans should occur in concert with all main sectors involved; gaps in health workforce information need to be filled; and investment to address health workforce needs to occur from both development partners and national governments and should address long-term predictable funding aligned to national plans and country needs.

Gordon SJ. Final Report - Consultancy for the Conduct of an Assessment to Determine the Baseline Number of Midwife Graduates, Their Deployment to Different Levels of Health Facilities, Geographical Distribution and National Needs in These Areas.  2009.
Ref ID: 138
Notes: This Consultancy was done as a part of the support provided to the Guyana Nurses Association by the UNFPA Caribbean Sub-Regional Office/ Guyana Work plan to determine the baseline number of midwife graduates, their deployment to different levels of health facilities, geographical distribution and national needs in these areas. This document reports that the importance of the role of the midwife in Guyana's achieving MDG 5 requires adequate numbers of midwife, an organised programme of continuing education and supervision and support of midwives, especially those at the periphery.

Resolution No. 348 On Approval of the Strategic Plan for Reproductive Health of the Republic of Tajikistan by 2014,  Government of the Republic of Tajikistan, (2004).
Ref ID: 214
Notes: This document outlines Tajikistan's policy for the improvement of reproductive health. The Government of the Republic of Tajikistan's concern about the persistent consequences of gender disparity, particularly their influence on women's health, and of socio-economic inequality in countries which limit women's opportunities for achievement of health, has provided the basis for the development of the current Strategic Plan on Reproductive Health of the Republic of Tajikistan, which is specific for the country. Through implementation of this plan, the government expects to raise awareness toward the right for independent and informed choice, decrease mortality rates (maternal, infant, perinatal, neonatal), decrease the absolute number of abortions, increase the use of modern contraceptive methods among married couples, increase use of antenatal care services, and increase the percentage of deliveries assisted by trained medical staff.

Graner S, Mogren I, Duong lQ, Krantz G, Klingberg-Allvin M. Maternal Health Care Professionals' Perspectives on the Provision and Use of Antenatal and Delivery Care: A Qualitative Descriptive Study in Rural Vietnam. BMC Public Health 2010;10:608.
Ref ID: 193

Gross JM, Rogers MF, Teplinskiy I, Oywer E, Wambua D, Kamenju A, et al. The Impact of Out-Migration on the Nursing Workforce in Kenya.  2010.
Ref ID: 194
Notes: This is a study examining the impact of out-migration on Kenya's nursing workforce. This study analyzed nursing data from the Kenya Health Workforce Informatics System, collected by the Nursing Council of Kenya and the Department of Nursing in the Ministry of Medical Services. The study design comprised an analysis of trends in Kenya's nursing workforce from 1999-2007. Findings identified high nurse migration and a potential reduction in the ability to maintain Kenya's nursing workforce through training. The study concludes that this represents a substantial economic loss to the country.

Grupo das Mulheres Parlamentares de Timor Leste (GMPTL). Report on the National Conference on Reproductive Health, Family Planning and Sex Education.  2010.
Ref ID: 268
Notes: This document presents the proceedings of East Timor's National Conference on reproductive health. The report presents East Timor's declaration for affirmative action to reduce maternal and child death, birth rate and teenage pregnancy and affirms the right of every Timorese to access sexual, maternal and reproductive health information and services that are affordable, good quality, culturally sensitive and gender responsive. Problems identified during consultations prior to the conference were lack of services, health professionals, transport and infrastructure, as well as lack of education and information on reproductive health.

Gupta N. Human Resources for Maternal, Newborn and Child Health: From Measurement and Planning to Performance for Improved Health Outcomes.   2010.
Notes: Submitted for publication consideration in The Lancet - 25 June 2010. This paper is based on a study which reviewed the situation of human resources for health in 68 low and middle income countries. Data was collected and analysed cross-nationally on HRH availability, distribution, roles and functions from new existing sources, and information from country reviews of HRH interventions that have positively impacted oh health services delivery and population health outcomes. The findings indicate the 68 countries demonstrate availability of doctors, nurses and midwives which is positively correlated with coverage of skilled birth attendance. Most (78%) of the target countries face acute shortages of highly skilled health personnel, but large variations persist within and across countries in workforce distribution, skills mix and skills utilization. Too few countries appropriately plan for, authorize and support nurses, midwives and community health workers to deliver essential maternal, newborn and child health-care interventions that could save lives.

Guyana Country Summary.  2011.
Ref ID: 139
Notes: This document presents a general overview of Guyana. It details estimates of demographics relating to MDG 5: demographics, education, midwifery workforce and policies and challenges. Source not provided.

Haiti. Nurse Midwives - Key Players in Maternal Mortality Reduction Efforts in Haiti. 2009.
Ref ID: 384
Notes: This document provides a brief summary of the Maternity of Petite Rivière de l'Artibonite, a maternity centre in Haiti that offers a range of services including antenatal consultations, partum and postpartum care, family planning, and attention to the prevention of mother to child HIV transmission. These services are ensured by nurse midwives as part of compulsory social service, and by students of the National School of Nurse Midwives (ENISF), during their internships, supervised by seniors. Source not provided but appears to be written for UNFPA/Haiti.

Haiti. Rapport Enquête SONU.  2009.
Ref ID: 311
Notes: This document presents an analysis of the availability, use, and quality of emergency obstetric care in Haiti. The specific objectives of this analysis include an evaluation of the availability of establishments that are equipped for EmONC care, the availability and types of medical schools, specifically midwifery and nursing, training programmes available, the number of actual health personnel working, and human resource policies. Results of the analysis are presented in table form.

Haji M, Durairaj V, Zurn P, Stormont L, Mapunda M. Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce Through Decentralized Health Financing Systems. Bulletin of the World Health Organization 2010 May;88(5):397-9.
Ref ID: 21
Notes: This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector, better use of existing financial resources, and creation of financial incentives for health workers. The paper also considers the conditions under which decentralized health financing systems can lead to improved health workforce retention using examples from several countries including Brazil, China, Costa Rica, Guyana, India, Kenya, Pakistan, the Philippines, Romania, Rwanda, Thailand, Uganda, Tanzania, and Zambia. The document concludes that it is evident that providing the ministry of health with autonomy, by delinking the health workforce from the civil workforce and providing strategic performance incentives, are means by which health workers can be successfully recruited and retained. The authors also note that such policies only work if health system objectives are aligned with appropriate institutional and incentive structures.

Harmonization for Health in Africa. Investing in Health for Africa - The African Investment Case.  2010 Dec.
Ref ID: 195
Notes: FINAL. This document presents reasons for investing in African Health Systems. This report produced by HHA is intended for African leaders and partners, Ministries of Health and Finance, and other key stakeholders to accelerate development and growth. This report states that careful and systematic priority-setting processes that consider factors such as demographic trends, the burden of diseases, and how health services are financed, are needed to ensure that health system investments are deployed where they are most needed and will return the most value for money in terms of improving health outcomes. Policies to strengthen health systems should be developed in partnership with key stakeholders New and existing resources should be invested in both the public and private sector, considering their respective comparative advantages and enabling them to serve as platforms for sustainable health improvements. Investment in the governance and stewardship functions of the government is also needed to translate policies into action on the ground and promote accountability in the health system.

Harvey SA, Ayabaca P, Bucagu M, Djibrina S, Edson WN, Gbangbade S, et al. Skilled Birth Attendant Competence: An Initial Assessment in Four Countries, and Implications for the Safe Motherhood Movement. International Journal Of Gynecology And Obstetrics 2004 Nov;87(2):203-10.
Ref ID: 29

Harvey SA, Blandon YC, McCaw-Binns A, Sandino I, Urbina L, Rodriguez C, et al. Are Skilled Birth Attendants Really Skilled? A Measurement Method, Some Disturbing Results and a Potential Way Forward. Bulletin of the World Health Organization 2007 Oct;85(10):783-90.
Ref ID: 16

Hassan-Bitar S, Narrainen S. 'Shedding light' on the Challenges Faced by Palestinian Maternal Health-Care Providers. Midwifery 2009;27(2):154-9.
Ref ID: 396

Hull T, Rusman R, Hayes A. Village Midwives and the Improvement of Maternal and Infant Health in NTT and NTB.  1998 Dec 4.
Ref ID: 433
Notes: This document is a report prepared for the Australian Agency for International Development (AusAid). It is a report of a study undertaken to examine concerns regarding the recruitment, training, placement, management and career prospects of young term-contract nurse-midwives in villages of East and West Nusatenggara in Indonesia. Findings from the study indicate that the problems of the village midwife system are serious, however they are recognized as such by collaborating agencies. The village midwife scheme (Bidan di Desa) introduced by Indonesian government in 1989 is cited by the authors as flawed, where one of the greatest weaknesses of the system was the pressure to reach overly optimistic recruitment targets. Other problems reported include issues regarding to the design and implementation of the program, personal security of the midwives, integration in the local community, the level of demand of their services, their relationships with other health personnel and local officials, and the length of time they stay in their respective villages.

Hussein J, Phoya A, Tornui JA, Okiwelu T. Midwifery Practice in Ghana and Malawi: Influences of the Health System. In: Reid L.Churchill Livingstone, editor. Freedom to Practise: An International Exploration of Midwifery Practice.London: Elsevier; 2007. p. 75-99.
Ref ID: 401
Notes: This document is a book chapter about midwifery practice and the health system. This chapter discusses the health system's influence on midwifery practice and how this is an essential part of how midwives define their role and practice. Health system in this chapter refers to the wider context or environment in which midwives practise including the systems which train, govern, and regulate midwifery practice, provide essential supplies and equipment, set up referral mechanisms and organize private and public care provision. This chapter discusses how factors of the health system can both help and hinder the practice of midwives, with specific reference to Ghana and Malawi.

Hutchinson C, Lange I, Kanhonou L, Filippi V, Borchert M. Exploring the Sustainability of Obstetric Near-miss Case Reviews: A Qualitative Study in the South of Benin. Midwifery 2010;26(5):537-43.
Ref ID: 378

Ijadunola KT, Ijadunola MY, Esimai OA, Abiona TC. New Paradigm Old Thinking: The case for Emergency Obstetric Care in the Prevention of Maternal Mortality in Nigeria. BMC Womens Health 2010;10:6.
Ref ID: 308

Indian Nursing Council Act, 1947, ACT NO. 48 of 1947, India Nursing Council, (1947).
Ref ID: 336
Notes: This document is a copy of Act number 48 of 1947, and act to constitute an India Nursing Council. The objective is stated as: "Act to constitute an Indian Nursing Council.. WHERE AS it is expedient to constitute an Indian Nursing Council in order to establish a uniform standard of training for nurses, midwives and health visitors". At time of enactment this act extends to the whole of India except the state of Jammu and Kashmir. The document defines the composition and constitution of the council and requirements for standardizing training for nurses, midwives and health visitors.

India Nursing Council. Statistics: Distribution of Nursing Educational Institutions Recognized by the Indian Nursing Council and Number of Registered Nurses in India.  2010.
Notes: This document is a table depicting the distribution of nursing educational institutions recognized by the Indian Nursing Council and the number of registered nurses working in India. The table provides data on numbers divided by state and level of qualification.

Indonesia. Neither Dukun nor Doctor: The Concept of Bidan Desa as a Means to Reduce Maternal and Infant Mortality. 
Notes: This document is the English language version of a paper titled: Tinjauan Tentang Program Bidan di Desa di Kawasan Timur Indonesia. The paper presents an overview of a village midwifery scheme introduced by the Indonesian government in 1989. The basic concept of the village midwife program was that a trained nurse with an additional year of training in midwifery skills could significantly improve the quality and quality of antenatal, obstetric, post-natal and contraceptive services in a village. The government then recruited large numbers of these nurses, trained them through special crash programs, and hired them on limited term appointments. The authors indicate that this strategy resulted in most of the candidates being young, unmarried and lacking in relevant work experience. This paper offers critiques of the program citing problems at the policy design level where most of the problems relate to the policy decisions leading the program into a target oriented emergency effort which in turn compromised professional and administrative standards in the name of quick coverage and inexpensive implementation. Full source not provided.

Indonesia. Referral Mechanism. 
Notes: This document is a chart of the referral mechanism in Indonesia.

Indonesia. Administrative Structure of Health Organization. 
Notes: This document is a chart of the administrative structure of Health organization in Indonesia.

Indonesia. The Health Referral System in Indonesia.  2005.
Ref ID: 162
Notes: The principal aims of the investigation were to review and document the existing public health referral systems and attendant health service delivery mechanisms focusing on: a) medical and laboratory services; and, b) selected programme operations, against the background of the current decentralization process. This has involved an examination of public health referral systems in various districts in Indonesia in order to ascertain their effectiveness. The following activities were undertaken: Categorizing of services that are provided by health facilities at all levels primary, secondary and tertiary (village, district, province, centre and teaching/specialized) taking into consideration what is practiced, Examining the referral services between hospitals and their linkages with other hospitals both horizontally and vertically, and Reviewing the current health service referral system and critically assess the strengths and weaknesses of the system. This report recognizes that unless and until there is an effective third party purchasing arrangement (health insurance) that covers more of the population than at present health professionals will have little or no incentive to change their current 'for profit' practices with regard to appropriate and more equitable referral practices. Author not provided.

Institut de Perfectionnement du Personnel de Santé (IPPS) République de Guinée. Projet Création de la Filière Sage Femme.  2010 Jun.
Ref ID: 187
Notes: This document presents a general overview of the situation in Guinea such as socio-economic demographics, cultural make-up, and health indicators. This report is issued by the Institute for the Improvement of Health Personnel which appears to be a subdivision of the Ministry of Health Guinea. The report outlines a project dedicated to the development of practical competencies of midwives and to increasing the availability of midwifery services so as to reduce maternal mortality. It presents an analysis of human resources for health and finds that there is a shortage of qualified midwives. This report specifies areas to be acted such as: recruitment, education, curriculum, and student fees.

Institut national de la statistique et de la démographie. Burkina Faso Annuaire Statistique Edition 2008.  2009 Apr.
Ref ID: 58
Notes: This document produced by the National Institute of Statistics and Demography Burkina Faso presents the 2008 annual report of statistics. This 2008 edition is the third in a series beginning in 2006 and presents a general synthesis of the social and economic state of Burkina Faso over a period of 10 years. Statistics mentioned include geography, demography, economy, finance and commerce, and external affairs.

Institut National des Statistiques Ministère des Finances et de la Planification Economique, Ministère de la Santé Rwanda. République du Rwanda: Enquête sur la prestation des services de soins de santé 2007 Prestations des Soins Obstétricaux et Néonatals d'Urgence (SONU).  2008 Nov.
Ref ID: 319
Notes: This document presents the results of the 2007 health service performance survey conducted in Rwanda, with specific emphasis on emergency obstetric care. This is the second survey of its kind conducted in Rwanda. This survey provides detailed findings relating to the quality, availability and use of maternal health services in the country, including available facilities, medications and equipment as well as issues pertaining to skilled personnel.

International Confederation of Midwives. Essential Competencies for Basic Midwifery Practice 2002.  2002.
Ref ID: 72
Notes: This ICM document presents guidelines written for generic worldwide use by midwives and midwifery associations responsible for the education and practice of midwifery in their country or region and for those interested in developing midwifery education, and information for those in government and other policy arenas who need to understand who a midwife is, what a midwife does, and how the midwife learned to be a midwife. It outlines key midwifery concepts and provides a framework for decision-making in midwifery care.

International Confederation of Midwives, International Federation of Gynaecology and Obstetrics. Prevention and Treatment of Post-partum Haemorrhage - New Advances for Low Resource Settings (Joint Statement).  2006.
Ref ID: 11
Notes: This is a joint ICM and FIGO statement that reflects the current (2006) state of the art and science of prevention and treatment of post-partum haemorrhage (PPH) in low resource settings. This report recognizes PPH as a leading cause of maternal deaths in settings (both hospital and community) where there are no birth attendants or where birth attendants lack the necessary skills or equipment to prevent and manage PPH and shock. This report is a call to action that endorses the provision of skilled birth attendants and improved obstetric services as central to efforts to reduce maternal and neonatal mortality.

International Confederation of Midwives. The Member Association Capacity Assessment Tool. 2010 Jun 6.
Ref ID: 75
Notes: The MACAT is a tool designed to identify areas of strength and weakness of midwife associations in low income countries and to determine the impact of capacity development activities over time. This tool was initially developed by ICM in 2003, follwoed by a subsequent review in 2005. This document is a summary of a third review and offers potential recommendations. The document finds that the MACAT is a useful tool for initiating the cycle for organisational capacity development, by identifying needs and using those to develop interventions, and measuring impact at the end of the cycle.

International Confederation of Midwives. Essential Competencies for Basic Midwifery Practice.  2010.
Ref ID: 404
Notes: This document is a paper discussing ICM's essential competencies for basic midwifery practice. It is a living document where the competency statements undergo continual evaluation and amendment as the evidence concerning health care and health practices emerges and evolves. In this document the term "competencies" is used to refer to both the broad statement heading each section, as well as the knowledge, skills and behaviours required of the midwife for safe practice in any setting. They answer the questions "What is a midwife expected to know?" and "What does a midwife do?" The competencies are evidence-based. This document outlines the scope of midwifery practice and provides a list of seven basic competencies including additional abilities.

International Confederation of Midwives. ICM Global Standards for Midwifery Education 2010 - Guidelines Survey Document.  2010 Apr.
Ref ID: 196
Notes: This document is a survey of standards and guidelines for midwifery education. The survey makes the assumption that the standards will be adopted though edited as needed. The survey asks about opinions of proposed guidelines for each standard and leaves room for additional comments. It covers topics relating to organization and administration, financial and public policy support for the education programme, budgets that meet programme needs, self-governance of faculties, management experience, and midwifery competence among others.

International Confederation of Midwives. Essential Competencies for Basic Midwifery Practice 2010.  2011.
Ref ID: 430
Notes: This document presents the most recent version of ICMs essential competencies for basic midwifery practice. Throughout this document the term "competencies" is used to refer to both the broad statement heading each section, as well as the knowledge, skills and behaviours required of the midwife for safe practice in any setting. They answer the questions "What is a midwife expected to know?" and "What does a midwife do?" The competencies are evidence-based. The competencies are written in recognition that midwives receive their knowledge and skills through several different educational pathways. They can be used by midwives, midwifery associations, and regulatory bodies responsible for the education and practice of midwifery in their country or region. The essential competencies are guidelines for the mandatory content of midwifery pre-service education curricula, and information for governments and other policy bodies that need to understand the contribution that midwives can make to the health care system. The Essential Competencies for Basic Midwifery Practice is complemented by ICM standards and guidelines related to midwifery education, regulation and clinical practice (Ref IDs 427, 428, 429)

International Confederation of Midwives. Global Standards for Midwifery Education (2010). 2011.
Ref ID: 427
Notes: This document presents the most recent version of the ICM Global Standards for Education. This report is one of the essential pillars of ICM's efforts to strengthen midwifery worldwide by preparing fully qualified midwives to provide high quality, evidence-based health services for women, newborns, and childbearing families. ICM's pillars include updated core competencies for basic midwifery practise, midwifery education, midwifery regulation and strong midwifery associations. The midwifery education standards were developed globally using a modified Delphi survey process during 2009-2010 and represent the minimum expected for a quality midwifery programme, with emphasis on competency-based education rather than academic degrees. ICM developed the Global standards for midwifery education to assist primarily three groups of users: 1) countries who do not yet have basic midwifery education but are wanting to establish such programmes to meet country needs for qualified health personnel, 2) countries with basic midwifery education programmes that vary in content and quality who wish to improve and/or standardise the quality of their midwifery programme(s), and 3) countries with existing standards for midwifery education who may wish to compare the quality of their programme to these minimum standards. ICM expects that those countries whose current standards exceed these minimum standards will continue to offer the higher level of preparation for midwives in their region. The stated standards as listed are: I. Organisation and Administration II. Midwifery Faculty III. Student Body IV. Curriculum V. Resources Facilities and Services and VI. Assessment Strategies. The education standards were developed in tandem with the update of the Essential competencies for basic midwifery practice (2010) (See Ref ID 430) as these competencies define the core content of any midwifery education programme. This document was also produced together with an updated version of Global Standards for Midwifery Regulation (Ref ID 429). Additionally see Ref ID 428 for companion guidelines to this document.

International Confederation of Midwives. Global Standards for Midwifery Regulation (2011). 2011.
Ref ID: 429
Notes: The International Confederation of Midwives (ICM) has developed the ICM Global Standards for Midwifery Regulation (2011) in response to requests from midwives, midwifery associations, governments, UN Agencies and other stakeholders. The goal of these standards is to promote regulatory mechanisms that protect the public (women and families) by ensuring that safe and competent midwives provide high standards of midwifery care to every woman and baby. The aim of regulation is to support midwives to work autonomously within their full scope of practice. By raising the status of midwives through regulation the standard of maternity care and the health of mothers and babies will be improved. These standards were developed during 2010 in tandem with the development of global standards for midwifery education (see Ref ID 427) and the revision of the ICM essential competencies for basic midwifery practice (Ref ID 430). Together, the ICM essential competencies and the global standards for regulation and education provide a professional framework that can be used by midwifery associations, midwifery regulators, midwifery educators and governments to strengthen the midwifery profession and raise the standard of midwifery practice in their jurisdiction.

International Confederation of Midwives. Global Standards for Midwifery Education 2010 - Companion Guidelines.  2011.
Ref ID: 428
Notes: This document presents the Companion Guidelines for ICMs most recent version of the Global Standards for Midwifery Education 2010 (see Ref ID 427). These guidelines were developed to address the following questions: "What is needed to implement each standard (suggested guidelines)?" and "How does one determine whether the standard has been met (evidence needed)?" A glossary of key terms used throughout the Standards is offered to assist in understanding. These Companion guidelines are intended to offer guidance on the ICM Global standards for midwifery education 2010. The document lists information in two columns. The first column offers suggestions on how to meet each standard and may include examples to illustrate what is meant. These examples are NOT all inclusive and midwifery educators will have others. The second column highlights the type of evidence, with some examples, that a programme might use to determine when and whether they have met the standard. Much of the evidence is in the form of written documents, letters of support, and faculty meeting minutes.

International Confederation of Midwives and United Nations Population Fund. Investir dans les sages-femmes et autres professionnels compétents dans la pratique de sage-femme pour sauver la vie des mères et des nouveau-nés et améliorer leur santé. 2006.
Ref ID: 438

International Council of Nurses. Nature and Scope of Nurse-Midwives - Position Statement. Geneva; 2007.
Ref ID: 197
Notes: This document is a position statement regarding midwifery practice. The document outlines ICN's committedness to the MDGs and acknowledges that midwifery practice is organized differently in different countries. In this context, ICN encourages nurse-midwives to work with national nurse associations at country level as appropriate. ICN holds that nurses and midwives share common goals but nurse-midwives have particular expertise in and concern for the care of women during pregnancy, delivery and the post-partum period in the care of the neonate. Nurses and nurse-midwives should be prepared in programmes of sufficient length and academic and clinical content to facilitate safe and autonomous practice.

International Council of Nurses. The Role and Identity of the Regulator: An International Comparative Study. Geneva; 2009.
Ref ID: 198
Notes: This paper reports on the project, The role and identity of the regulator: An international comparative study, undertaken by the International Council of Nurses (ICN) and funded by the National Council of State Boards of Nursing, Centre for Regulatory Excellence. This report addresses nursing regulation, professional practice and socio-economic welfare issues. This study is conducted in response to ICN's identification of the need to compare and contrast the powers of regulators in a systematic way in order to facilitate dialogue between jurisdictions in managing the risk associated with increasing nurse migration. The movement of nurses between jurisdictions can pose an increased risk to patients. In order to mitigate this risk, regulators need processes in place which can be enhanced through an understanding of the regulatory framework used in an applicant's country of origin.

International Federation of Gynaecology and Obstetrics, International Confederation of Midwives. Maternity Care in the World.  1976.
Ref ID: 371
Notes: This document is the second edition of a report of a joint ICM/FIGO study group. It presents a synthesis of maternity care in the world. It includes information on maternity care and family planning services in 210 countries and the expanded role of the professional midwife as a teacher and family counsellors. This is a study of the training and practice of midwives and maternity nurses in each continent. The aim of this project was to continue the improvement of maternal and child care, and the quality of maternal and child life through the inclusion of family planning among services provided by midwives. This report describes the situation in each country and suggests practical improvements both for the short-term and the long-term. This document is a partial copy of the entire report (up to page 151).

International Labour Organization, World Health Organization. Joint ILO/WHO Guidelines on Health Services and HIV/AIDS. Geneva: World Health Organization; 2005.
Ref ID: 340
Notes: This document is a joint ILO/WHO statement presenting the guidelines for health services and HIV/AIDS following the Tripartite Meeting of Experts. The purpose of the guidelines is to promote the sound management of HIV/AIDS in health services, including the prevention of occupational exposure. The guidelines are intended for all groups and bodies who partake in activities relevant to the delivery of health care and are designed to be used as a basis for practical policy and technical reference. The guidelines cover legislation, policy development, labour relations, occupational safety and health and other technical subjects.

Islam M. Priority Action HR (4): Strengthening Human Resources for MNCH.  2010.
Notes: This is a powerpoint presentation from WHO reporting on the progress of human resources for MNCH. It details Priority Action 4 which is a review of country reports, literature review and the adaptation of the HR assessment tool or framework. Activity 4.1 is to ensure that MNCH aspects of human resources are adequately included in national health plans and human resource plans. The report finds that maternal health is an important componant of national strategies and plans andthat human resources for MNH is listed as a key intervention. Lacking are specific strategies/statements to improve maternal health through HR, specifc figures for HR for MNH, or specific estimated needs of HR.

Iyengar K, Iyengar SD. Emergency Obstetric Care and Referral: Experience of Two Midwife-Led Health Centres in Rural Rajasthan, India. Reproductive Health Matters 2009 May;17(33):9-20.
Ref ID: 31

Jacobs AM. Renforcement des Capacités du Programme de la Santé Maternelle et Néonatale. Ressources Humaines des Infirmières Sages Femmes et Autres.  2010 Feb.
Ref ID: 318
Notes: IMA/UNFPA-Haiti. This document presents an overview of the available human resources relating to midwives and nurses in Haiti. The report outlines issues relating to the existing competencies of midwives, retention and problems with out-migration, training programmes, and monitoring and evaluation. The report emphasizes strengthening midwifery education programmes and establishing direct-entry programmes for midwifery students.

Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of Planned Home Birth with Registered Midwife Versus Planned Hospital Birth with Midwife or Physician. Canadian Medical Association Journal 2009 Sep 15;181(6-7):377-83.
Ref ID: 400

Jhpiego, UNICEF. Emergency Obstetric and Neonatal Care (EmONC) Needs Assessment.  2010 Oct.
Ref ID: 302
Notes: This document is an emergency obstetric care needs assessment for Afghanistan. Produced with support from UNICEF, the Ministry of Public Health and Jhpiego launched a large-scale, facility-based EmONC needs assessment that encompassed first-level referral hospitals and health facilities throughout Afghanistan. The purpose of the assessment was to identify needs and gaps to inform program efforts for increasing the quality, coverage and utilization of EmONC services. Findings related to human resources indicate: 80% of facilities had the staff needed to offer all seven BEmONC signal functions, but only 67% had the staff needed to offer all nine CEmONC functions. Only 54% of hospitals and an obstetrician/gynecologist (OB/GYN) and 58% had a pediatrician on staff. There was a lack of providers in hospitals who could provide blood transfusions for mothers and newborns (72%). Midwives showed extensive use of partograph management (89%). Based on the 78 facilities that were assessed, 11,096 skilled birth attendants (SBA) would be needed to fill the gap to meet the recommended target of 1 SBA per 100 births for these facilities.

Jokhio AH, Winter HR, Cheng KK. An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan. New England Journal of Medicine 2005 May 19;352(20):2091-9.
Ref ID: 32

Kenya. Community Midwifery Implementation Guidelines in Kenya.  2006 Apr.
Ref ID: 254
Notes: This document presents guidelines for midwifery implementation in Kenya. This document highlights the importance of skilled care at birth in particular community based interventions as essential to achieving MDGs 4 and 5. This document gives a general overview of maternal care in Kenya and what it means to be a midwife (concepts, practice etc). The document outlines strategies to increase skilled attendance in the community as well as the process for introducing community midwifery and criteria for selection. Challenges documented include linkages with formal health system, communication and transport for referral, source of initial supplies, drugs and equipment, and financial, policy and sustainability factors. Source not provided.

Kenya. Kenya Nursing and Midwifery Strategy.  2007.
Ref ID: 314
Notes: This document is letter providing the author's personal suggestions regarding strategic plans to improve maternal and child mortality in Kenya, particularly through strengthening the midwifery workforce. The author provides quotes from the original document and responds to each in turn. The original document highlights the need for an improved nursing strategy in order to aid in reversing the current health related mortality trends. The author recommends that the vision should perhaps be broken up into smaller steps such as differentiating more between midwifery and nursing. Midwives in Kenya are currently only qualified as such after training as nurses. The author recommends that this "one package" is a very big expectation and could potentially negatively impact retention rates. Source not provided.

Kenya. Proposed Resolution on Strenthening Nursing and Midwifery for the 128th Executive Board and the Sixty-Fourth World Health Assembly.  2011 Jan 13.
Ref ID: 329
Notes: Edited draft. This report is a proposed resolution for strengthening nursing and midwifery for Kenya. The resolution is proposed by Kenya and co-sponsored by Burundi. The report lists a series of recommendations for the Sixty-fourth World Health Assembly which include recognizing the need to build sustainable national health systems and to strengthen national capacities and to improve the availability of basic health services.The report outlines requests to the Director General such as continued investment and appointment of qualified nurses and midwives to headquarters and regional and country posts, technical support for the development and implementations of policies, strategies and programmes on interprofessional education and collaborative practice, and to continue to promote cooperation between agencies and organizations concerned with the development of nursing and midwifery. Source not provided.

Kenya Health Workforce Project. Kenya's Health Workforce Training Capacity: A Situation Analysis.  2010.
Ref ID: 200
Notes: The purpose of this report is to provide CDC-Kenya and other US government agencies with information regarding the current supply of healthcare workers in Kenya and the current capacity for training new workers.  This report is being provided by the Kenya Health Workforce Information System (KHWIS) project funded by CDC/PEPFAR and administered by the Nell Hodgson Woodruff School of Nursing, Emory University, in collaboration with the Ministry of Medical Services (MoMS) and Kenya's health professional regulatory bodies. This report presents an analysis of interventions to scale-up Keny's health workforce and seeks to provide a situation assessment of Kenya's current health workforce training capacity to inform evidence-based workforce planning and scale-up initiatives.

Kenya Health Workforce Project. Kenya's Health Workforce Informatics System (KHWIS). 2010.
Ref ID: 201
Notes: This document outlines the Kenya Health Workforce Informatics System, the longest running and most comprehensive human resources information system in sub-Saharan Africa. The system computerizes and streamlines an existing MOH documentation and reporting process for health care workers and produces accurate and timely workforce information for decision-makers. Components of the system include a national database of qualified health workers including nurses, physicians, laboratory professionals and clinical officers, as well as data on their current deployment status.

Kenya National Bureau of Statistics (KNBS), ICF Macro. Kenya Demographic and Health Survey 2008-2009. Calverton, Maryland: KNBS and ICF Macro; 2010.
Ref ID: 313
Notes: This document is the 2008-2009 DHS for Kenya. This report summarises the findings of the 2008-09 Kenya Demographic and Health Survey (KDHS) carried out by the Kenya National Bureau of Statistics (KNBS) in partnership with the National AIDS Control Council (NACC), the National AIDS/STD Control Programme (NASCOP), the Ministry of Health and Sanitation, the Kenya Medical Research Institute (KEMRI), and the National Coordinating Agency for Population and Development (NCAPD). ICF Macro provided technical assistance for the survey through the USAID-funded MEASURE DHS programme, which is designed to assist developing countries to collect data on fertility, family planning, and maternal and child health. The survey provides data on general demography as well as detailed information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood and maternal mortality, maternal and child health, and awareness and behavior regarding HIV/AIDS.

Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, et al. Going to Scale with Professional Skilled Care. Lancet 2006 Oct 14;368(9544):1377-86.
Ref ID: 255
Notes: Maternal Survival 3. This article is part of the Maternal Survival Series and discusses issues associated with scaling up midwifery workforce. The authors discuss the necessity for addressing political constraints to emphasise the speed and visibility of results.

Kone KG. Analyse de la Situation des Services de Soins, du Personnel Infirmier et du Personnel Obstétrical dans le Système de Santé au Sénégal par Rapport aux Dispositions de la Convention n° 149 et de la Recommandation n° 157 de l'OIT. International Labour Organization; 2009 Nov.
Ref ID: 348
Notes: This document is an ILO report describing the situation of health services and nursing and obstetric personnel working in Senegal in the context of ILO Convention 149 and ILO Recommendation 157. Findings from the study indicate that there is no specific health policy for nurses in Senegal.

Kongnyuy EJ, Hofman J, Mlava G, Mhango C, van den Broek N. Availability, Utilisation and Quality of Basic and Comprehensive Emergency Obstetric Care Services in Malawi. Maternal and Child Health Journal 2009 Sep;13(5):687-94.
Ref ID: 7

Kruk ME, Paczkowski M, Mbaruku G, de Pinho H, and Galea S. Women's Preferences for Place of Delivery in Rural Tanzania: A Population-Based Discrete Choice Experiment. American Journal of Public Health, September 2009, Vol 99, No. 9: 1666-1672.

Ref ID: 435

Lao. Revised Curriculum for Community Midwifery (part 2 - text).  2010.
Ref ID: 342
Notes: This document is a copy of the second section of the revised curriculum for community midwifery in Lao. This section outlines the details of the curriculum, specifically covering subjects available, the orientation programme, learning objectives and the incorporation of specific contents from Year 1 Technical (Direct Entry) CMW Programme into the orientation programme. This document outlines classes and number of credits granted for each, instruction methods and evaluation procedures. Refer to R341 for the first part of this document.

Lao. Curriculum for Post-basic Community Midwifery (Part 1 - text).  2010.
Ref ID: 341
Notes: This document is a copy of the first section of the revised curriculum for community midwifery in Lao. The purpose of the curriculum is to develop existing and low-grade staff at the 1st level of health care into professional mid-level community midwife with the appropriate knowledge and capacity to deliver quality maternal, newborn and child health and in keeping with national standards and protocols. The curriculum builds on that developed and presented for approval in 2009 by the Faculty of Nursing University of Health Sciences, then called the College of Health Technology (CHT).  The curriculum developed by CHT was a 2 -year (11/12+2) curriculum for Technician Diploma majoring in Community Midwife. The curriculum presented in this document corresponds to year II of this 2-year curriculum for Technician Diploma majoring in Community Midwife. This section of the document goes up to page 20. For the remainder of the document including subject outlines, refer to R342.

Larrinaga M. Addressing Maternal Health in H'Mong Communities in Viet Nam. UNFPA News: Feature Story . 18-8-2009. 5-2-2011.
Notes: This is a UNFPA feature news story on maternal health in Vietnam. The story presents an overview of birth and midwifery practice and awareness campaigns to reduce rates of maternal mortality. Efforts to ensure skilled birth attendance have contributed to reduction in MMR and the country is on track to meeting MDG 5.

Larrinaga M. Recruiting Ethnic Minority Midwives to Meet Mother' Needs in Remote Areas of Viet Nam. UNFPA News: Feature Story . 28-2-2010. 5-2-2011.
Notes: This is a UNFPA feature news story about ethnic minority midwives in Vietnam. Ethnic minorities in remote areas in Vietnam face particular challenges in regards to maternal health care and tend to face high levels of maternal mortality. The story highlights the importance of cultural sensitivity and recruiting locally to address these issues. In light of this, the UNFPA has implemented an 18 month training programme for the recruitment and training of local women to become midwives. This story discusses this programme.

Lassi ZS, Haider BA, Bhutta ZA. Community-Based Intervention Packages for Reducing Maternal and Neonatal Morbidity and Mortality and Improving Neonatal Outcomes. Cochrane Database of Systematic Reviews 2010 Mar;11:CD007754.
Ref ID: 14

Lori JR, Starke AE. A Critical Analysis of Maternal Morbidity and Mortality in Liberia, West Africa. Midwifery 2011 Jan 11.
Ref ID: 431

Lunan B, Clements Z, Mahony S, Hope-Jones D. Maternal Health in Malawi: Challenges and Successes.  2010 Dec.
Ref ID: 192
Notes: This document is a draft report produced by the Scotland Malawi Partnership (SMP), released in Dec 2010 for external consultation among key Scottish and Malawian stakeholders. The SMP provides a forum for the sharing of ideas and information for those organizations and individuals in Scotland who are engaged in efforts to alleviate poverty in Malawi. This draft document is the result of a 2010 study focused on maternal health. This study involved ascertaining the work being carried out by SMP affiliated groups, how it was done, and barriers being faced. The aim of this is to enhance partnership and to reduce duplication to promote and share positive practice. The major issues raised in this document are lack of resources and healthcare systems, limited access to services, the role of skilled attendants at birth and and gender equality.

Lynch B, de Bernis L. Document de Réflexion - Formation et Régulation des Sages-femmes en Haïti.  2010 Mar.
Ref ID: 334
Notes: This document is a reflection on the formation and regulation of midwives in Haiti. This document was developed under the order of the director of the Haitian Ministry of Health, Department of Family Health unit, as a result of a meeting between representatives from UNFPA (Luc de Bernis) and ICM (Bridget Lynch). The document presents an overview of challenges met in strengthening the health workforce, mainly formation, regulation and association. Recommendations include presenting diplomas to eligible students whose studies were affected by the 2010 earthquake, reforming the curriculum, including adding direct-entry programmes, ensuring practical experience is gained for a minimum of 3 years through employment in the public sector, and creating advanced practice opportunities for midwives who have completed their training and practical experience.

Maclean GD, Forss K. An Evaluation of the Africa Midwives Research Network. Midwifery 2010 Dec;26(6):e1-e8.
Ref ID: 18

Mahmood Q. Ethiopia Country Profile: Midwifery Workforce.  2008.
Ref ID: 366
Notes: This document is a country profile for Ethiopia's midwifery workforce. It is presented in table form and provides data for the name of cadre, length of pre-service training, time spent on midwifery during pre-service, age of entry into pre-service, number of years schooling required for entry, whether home births are conducted and allowed, whether births are conducted in a community facility or hospital, and if there is a formal programme in place for career advancement.

Maldonado Canedo AM. Propuesta de Perfil Profesional de la Licenciada en Enfermería Obstetriz Basado en Competencias. La Paz: Colegio de Enfermeras de Bolivia; UNFPA; 2008 Dec.
Ref ID: 180
Notes: This document outlines the proposal for the professional profile of certified obstetric nurses based on competencies. It defines obstetric nurses as individuals who have completed the proper requirements for professional licensure such as a nationally accredited education that comprises an integrated multi-disciplinary knowledge base of science, technology, human rights, ethics and morality with respect to health and quality of life mothers and neonates. The professional profile based on competencies is constituted by key objectives of belonging to the nursing profession (reasons why), general competencies (grouping of essential functions) and specific competencies (actions and behaviours that the obstetric nurse should demonstrate).

Maldonado Canedo AM. Anteproyecto de Ley del Ejercicio Profesional de Enfermería (Tercer Borrador). La Paz: Colegio de Enfermeras de Bolivia; UNFPA; 2008 Dec.
Ref ID: 179
Notes: Draft 3. This document is a draft outlining the preliminary law regarding professional nursing practice in Bolivia. The objective of the law is to present norms, regulations and guidelines which guarantee the protection of professional nurses and nursing practice in all sectors. This law is to be applied to the national health system and was coordinated with respect to the fundamental principals and values of nursing practice in line with the Constitution and Universal Declaration of Human Rights. The document presents guidelines regarding male/female nurses, auxiliary nurses, obstetric nurses and outlines categories and concepts of nursing practice in general.

Manca R. Maternal and Neonatal Health Seeking Behaviour, Referral and Delivery Waiting House - Socio-Anthropological Research Report.  2005.
Ref ID: 150
Notes: This report is written for WHO. It provides an anthropological analysis of health seeking behaviour in non-Western countries, specifically Indonesia. This report highlights the importance of taking into consideration the cultural specificity of illness and illness cognition in each given region of the world. The report draws material from university student theses and attempts to synthesize the data. The author recommends that WHO and the Indonesian Department of Health work in cooperation with the Indonesian Department of Education in order to prepare effective reproductive health education programs to be included in school curricula.

Masterson A. Core and Developing Role of the Midwife: Literature Review.  2010 Jun 9.
Ref ID: 77
Notes: This is the report of a pragmatic and focussed literature review commissioned to inform the Midwifery 2020 work on the core and developing role of the midwife. It is part of the information and evidence base for the Midwifery 2020 programme report. The review summarized the literature of the 4 countries of the UK and identified relevant examples from international literature. The report states that midwives should be the first point of contact and the lead professional and coordinator of care. Maximization of the potential of the midwifery profession will allow for greater involvement with the public and policy makers.

Masud Ahmed S, Awlad Hossain M, Mushtaque RajaChowdhury A, Uddin Bhuiya A. The Health Workforce Crisis in Bangladesh: Shortage, Inappropriate Skill-Mix and Inequitable Distribution. Human Resources for Health 2011 Jan 22;9(3).
Ref ID: 158
Abstract: Background Bangladesh is identified as one of the countries with severe health worker shortages. However, there is a lack of comprehensive data on human resources for health (HRH) in the formal and informal sectors in Bangladesh. This data is essential for developing an HRH policy and plan to meet the changing health needs of the population. This paper attempts to fill in this knowledge gap by using data from a nationally representative sample survey conducted in 2007. Methods The study population in this survey comprised all types of currently active health care providers (HCPs) in the formal and informal sectors. The survey used 60 unions/wards from both rural and urban areas (with a comparable average population of approximately 25 000) which were proportionally allocated based on a 'Probability Proportion to Size' sampling technique for the six divisions and distribution areas. A simple free listing was done to make an inventory of the practicing HCPs in each of the sampled areas and cross-checking with community was done for confirmation and to avoid duplication. This exercise yielded the required list of different HCPs by union/ward. Results HCP density was measured per 10 000 population. There were approximately five physicians and two nurses per 10 000, the ratio of nurse to physician being only 0.4.Substantial variation among different divisions was found, with gross imbalance in distribution favouring the urban areas. There were around 12 unqualified village doctors and 11 salespeople at drug retail outlets per 10 000, the latter being uniformly spread across the country. Also, there were twice as many community health workers (CHWs) from the non-governmental sector than the government sector and an overwhelming number of traditional birth attendants. The village doctors (predominantly males) and the CHWs (predominantly females) were mainly concentrated in the rural areas, while the paraprofessionals were concentrated in the urban areas. Other data revealed the number of faith/traditional healers, homeopaths (qualified and non-qualified) and basic care providers. Conclusions Bangladesh is suffering from a severe HRH crisis-in terms of a shortage of qualified providers, an inappropriate skills-mix and inequity in distribution-which requires immediate attention from policy makers.

Mavalankar D, Vora K, Prakasamma M. Achieving Millennium Development Goal 5: Is India serious? Bulletin of the World Health Organization 2008 Apr;86(4):243-243A.
Ref ID: 434
Notes: This document is one page editorial regarding the high rate of maternal mortality in India in the context of meeting MDG 5 - which is currently off target. Despite rapid economic growth in India, there are still extremely high rates. The authors believe the key reasons for this are political, administrative and managerial rather than a lack of technical knowledge. The authors assert that there is a lack of focus and limited management capacity on emergency obstetric care. Other problems include the absence of a specific midwifery cadre, lack of management capacity in the health system, and an absence of comprehensive maternal health services.

Mbaruku G, Bergstrom S. Reducing Maternal Mortality in Kigoma, Tanzania. Health Policy and Planning 1995 Mar;10(1):71-8.
Ref ID: 403

Medical Research Council of South Africa. Intrapartum Care in South Africa - Review and Guidelines.  MRC; 2005.
Ref ID: 212
Notes: This report is the result of a meeting held by MRC Maternal and Infant Health Care Strategies Research Unit involving both health workers and administrators from the provincial Departments of Health. The aim of the meeting was to review the current relevant research on intrapartum care and define what is known, what knowledge is lacking and how labour should be managed in maternity units in South Africa. This report presents the review of the past and current status of intrapartum care in South Africa, a review of the normal labour in African women and how it differs from other races, a comprehensive intrapartum care guideline which contains the motivation for each step and a review of the current strategies being used to improve intrapartum care. Some proposed strategies for improving the quality of intrapartum care include comprehensive training, auditing of units on day to day management of labour, and identifying individuals who would be especially adept at driving implementation.

Merlin. All Mothers Matter - Investing in Health Workers to Save Lives in Fragile States. United Kingdom; 2009.
Ref ID: 142
Notes: This report explores the links between high maternal mortality rates and the health worker crisis in fragile states. The report highlights the cost of lost productivity, linking maternal health with economic growth. It makes innovative recommendations for doubling the health workforce and delivering the required number of midwives to ensure MDG 5 is reached. The report finds that above all, increased political will from international and national actors, together with effective distribution of more and predictable resources have shown the biggest impact on improving maternal health.

Midwifery Society of Nepal. International Day of the Midwife' - 5th May 2010 and Midwifery Care: "The World Needs Midwives Now More Than Ever!". 2010.
Notes: This is a document put out to for the International Day of Midwives and is written to bring awareness of the importance of midwifery. Maternal, perinatal and neonatal rates are high in Nepal. This document details the need for greater institutional deliveries and greater use of skilled birth attendants and states that professional midwives are a crucial human resource for safe motherhood.

Ministerio de Salud Nicaragua. Ley de Regulación de la Profesión de Enfermería. 
Notes: This document presents the law for the regulation of professional nursing in Nicaragua. The law refers to male and femal nurses and auxiliary nurses with varying levels of diploma/certification. It defines key principals, roles and responsibilities of nursing and the nursing profession.

Ministère de la Santé Burkina Faso. Plan d'Accélération de Réduction de la Mortalité Maternelle et Néonatale au Burkina Faso (Feuille de Route).  2006 Oct. Report No.: Draft Version: Octobre 2006.
Ref ID: 61
Notes: Draft Version: October 2006, Draft outline set out by the Burkina Faso Ministry of Health, division of family health, to accelerate the reduction of maternal and neonatal mortality in accordance with the Millennium Development Goals. This document is intended as a guide for governments in the development of a national plan to achieve the MDGs. It calls for the partnering of all actors in the health systems, financial, and technical to work together over the next ten years.

Ministère de la Santé Burkina Faso. Rapport d'Analyse Situationelle de la Profession Sage Femme et Maïeuticien d'Etat au Burkina Faso en 2009.  2009 Aug.
Ref ID: 63
Notes: Burkina Faso Ministry of Health document together with support from UNFPA and the International Confederation of Midwives. This is a situational analysis of the current state of the midwifery profession looking at 3 key domains, education, regulation and associations. The report highlights the need for competent health personnel and improvements in the curriculum.

Ministère de la Santé Burkina Faso, UNFPA, International Confederation of Midwives. Rapport d'Analyse Situationnelle de la Profession Sage Femme et Maïeuticien d'État au Burkina Faso en 2009.  2009.
Ref ID: 412
Notes: Same as R063 but with additional note: Ce rapport ignore complètement les deux catégories associées d'Accoucheuse Brevetée et d'Accoucheuse Auxiliaire, pourtant très sollicitées pour les accouchements en particulier en milieu rural  (voir Charlemagne Ouedraogo). Burkina Faso Ministry of Health document together with support from UNFPA and the International Confederation of Midwives. This is a situational analysis of the current state of the midwifery profession looking at 3 key domains, education, regulation and associations. The report highlights the need for competent health personnel and improvements in the curriculum.

Ministère de la Santé Burkina Faso. Politique et Normes en Matiere de Santé de la Reproduction.  2010 May.
Ref ID: 62
Notes: Burkina Faso Ministry of Health document together with support from WHO, UNFPA, and UNICEF; outlining the policies, norms and protocols relating to reproductive health. This document presents an overview of the state of reproductive health in Burkina Faso and outlines government measures produced in response to the worldwide need to improve maternal mortality such as policies relating to reproductive health in general as well as norms and protocols in regards to reproductive health services.

Ministère de la Santé Burkina Faso. Annuaire Statistique 2009. Burkina Faso; 2010 May.
Ref ID: 57
Notes: This document produced by MOH Burkina Faso presents the 2009 annual report of health related statistics. In recognition of the importance of tracking changes in demography and epidemiology toward strengthening health systems, this document presents an important source of capital for the planning and implementation of health policies. This document reports on 63 health districts, 13 health regions and 12 regional and national hospitals throughout Burkina Faso.

Ministère de la Santé de la Solidarité et de la Promotion du Genre - Union de Comores. Plan Stratégique de Développement des Ressources Humaines pour la Santé.  2010 Jan 25.
Ref ID: 130
Notes: This document outlines the Comoros Ministry of Health strategic plan for the development of human resources for help. The objective of this plan is to promote an enhanced quality and quantity of human resources in the Comoros. This report details current weaknesses in this sector such as insufficient salaries, a lack of employment descriptions, poor working conditions, a lack of effective evaluating mechanisms, and a general feeling of demotivation among health personnel. This report states that there needs to be a national policy regarding staff motivation.

Ministère de la Santé Djibouti, UNFPA. Plan de Travail Annuel 2009 pour l'Accélération de la Réduction de la Mortalité Maternelle (Fonds Thématique pour la Santé maternelle).  2009 May 25.
Ref ID: 301
Notes: This document is a work plan proposal for the 2009 UNFPA/Djibouti Ministry of Health project to accelerate the reduction of maternal mortality in Djibouti. This is a 5 year project to take place between 2009 and 2013 which aims to improve the availability and quality of reproductive health care services, in particular making family planning and emergency obstetric care accessible to underserved populations. Improving human resources is included in the strategy. The document includes a table of expected results, outputs and indicators, planned activities, timeframe and planned budget.

Ministère de la Santé et de l'Hygiene Publiqe Côte d'Ivoire, International Conferdation of Midwives, UNFPA. Rapport d'Analyse Situationnelle des Institutes de Formations et la Pratique des Sages Femmes en Côte D'Ivoire.  2009 Jul.
Ref ID: 131
Notes: This document presents an evaluation of the state of midwifery in the Ivory Coast. The intent of this document is to provided an account which highlights the importance of midwives and promotes the development of the profession. Areas of concern outlined in the document are finance and budgeting, training and education, and improve working condtions and incentive structures.

Ministère de la Santé et de la Prévention République du Sénégal, Agence Nationale de la Statistique et de la Démographie. Comptes Nationaux de la Santé 2005.  2005.
Ref ID: 240
Notes: This is a MOH Senegal National Health Report for 2005. This document presents figures for reproductive health in the country, in particular in the context of expenditures and finance. This report addresses issues such as private and public finance in the health sector, and allocation of funds.

Ministère de la Santé et de la Prévention République du Sénégal, Service National de l'Information Sanitaire. Carte Sanitaire du Senegal.  2008.
Ref ID: 248
Notes: Final Version. This MOH Senegal document maps out health services and distributions. It provides figures relationg to human resources, demography, health districts, infrastructure, and an inventory of equipment.

Ministère de la Santé et de la Prévention République du Sénégal. Plan National de Developpement Sanitaire PNDS 2009-2018.  2009 Jan.
Ref ID: 242
Notes: Final version. This document outlines Senegal's National Health Development Plan. Covering the period 2009-2018, this plan is intended as a strategy document to reduce poverty and reach the MDGs. This plan calls for the working together of all health related sectors: health professionals, civil society, private, local and other development stakeholders. This strategy takes a multisectoral approach in order to strengthen Senegal's health system and improve access and quality of health care. Areas in need of strengthening include: health promotion, human resources development, information and referral systems, and health infrastructure.

Ministère de la Santé et de la Prévention République du Sénégal, Service National de l'Information Sanitaire. Annuaire Statistique 2009.  2009.
Ref ID: 241
Notes: This document in an annual statistical report produced by MOH Senegal and the National Health Information Services. This report presents figures relating to geography and demography, socio-economic context, health systems, health resources, human resources, distribution of health districts and epidemiology such as HIV/AIDS, morbidity and mortality, mental health and others.

Ministère de la Santé et de la Prévention République du Sénégal. Analyse: Arrêté Portant Validation des Programmes de Formation de la Sage-Femme d'Etat, de l'Infirmier d'Etat et de l'Assistant Infirmier.  2010 Aug 6. Report No.: 05045.
Ref ID: 245
Notes: This MOH Senegal document presents a short overview of laws relating to health worker training programmes in Senegal, specifically state midwives, state nurses, and assistant/auxiliary nurses. This policy document consists of three clauses. 1. state training programmes fall under the jurisdiction of the MOH,  2, private training programmes have to conform to these laws, and 3, each respective government officer (human resources, MOH) will be in charge of ensuring these laws are being conformed to.

Ministère de la Santé et de la Prévention République du Sénégal. Programme de Formation de l'Assistant Infirmier au Sénégal.  2010 Mar.
Ref ID: 243
Notes: This document presents the MOH Senegal Programme for Assistant (Auxiliary) Nurse Training. The document outlines the requirements for auxiliary nurse candidates and is intended to increase professional competencies so as to improve individual, family and community health. The document presents an outline of training modules and curriculum for assistant/auxiliary nurses in Senegal.

Ministère de la Santé et de la Prévention République du Sénégal. Programme de Formation de l'Infirmier au Sénégal.  2010 Mar.
Ref ID: 244
Notes: This document presents the national Nurse Training Programme as defined by MOH Senegal. The objectives of this are to produce competent and capable nurses to improve individual, family and community health. This document outlines the modules and curriculum of nurse training in Senegal.

Ministère de la Santé et de la Prévention République du Sénégal. Programme de Formation de la Sage-Femme au Sénégal.  2010 Mar.
Ref ID: 246
Notes: This document presents the national Midwife Training Programme as defined by MOH Senegal. The objectives of this are to produce competent and capable midwives to improve individual, family and community health. This document outlines the modules and curriculum of midwifery training in Senegal as well as the necessary qualifications to partake in these programmes.

Ministère de la Santé et du Planning Familial République de Madagascar, UNFPA, International Confederation of Midwives. La Profession de Sage-Femme à Madagascar: Revue Documentaire sur la Formation, la Réglementation, la Supervision et l'Association des Sages-Femmes en Exercice à Madagascar.  2009 Jul.
Ref ID: 388
Notes: This document provides a review of the formation, regulation, supervision and association of midwives working in Madagascar. This document is produced with support from the Madagascar Ministry of Public Health, UNFPA and ICM. This report offers a definition of the profession of midwifery and discusses challenges particular to the organization, formation and regulation of midwifery in Madagascar, such as insufficient numbers of working midwives.

Ministère de la Santé Publique de la Population et de la Lutte Contre le SIDA - République Centrafricaine, UNFPA. Évaluation de la Disponibilité, de l'Utilisation et de la Qualité des Soins Obstetricaux d'Urgence dans la Zone d'Intervention de L'UNFPA en République Centrafricaine.  2010 Aug.
Ref ID: 128
Notes: This document is a joint report by the CAR's Ministry of Public Health and UNFPA. The report presents an evaluation of the availability, utilization and quality of emergency obstetric services within the UNFPA intervention zone. The objective of this study is to present an evaluation that can later be used as a basis for the strengthening and reinforcement of interventions to reduce maternal mortality in the CAR.

Ministère de la Santé Publique et de la Lutte contre les Endémies Rèpublique du Niger. Programme National de Santé de la Reproduction 2005 - 2009.  2005 Jun 15.
Ref ID: 346
Notes: This document outlines Niger's National Reproductive Health Plan 2005-2009. This plan is a part of the National Plan for Health Development 2005-2009.  The reproductive health plan is the Niger's national policy. This document presents an overview of the situation in Niger, including demographics, maternal mortality figures, quality of reproductive health services, availability of EmONC, family planning, and HIV/AIDS, and outlines strategies to address these issues.

Ministère de la Santé Publique et de la Population République Centrafricaine. Politique Nationale de la Santé de la Reproduction.  2003 Oct.
Ref ID: 126
Notes: This document outlines CAR's national reproductive health policy. It presents an analysis of key issues relating to health in general and reports on the state of reproductive health. The document details the key priorities which need to be addressed. The objective to the compilation of this report is to present a policy which will be of benefit to the reduction of maternal and neonatal mortality.

Ministère de la Santé Publique et de la Population République Centrafricaine, World Health Organization Regional Office for Africa. Cartographie de l'Offre des Services de Santé - Rapport Final.  2006.
Ref ID: 127
Notes: This document presents a mapping of available health services in the CAR. This document details the state of health services at regional and district levels. The general objective of the mapping of health services is to reinforce information systems in the context of public health and to outline useful and modern methods for data collection and analysis.

Ministère de la Santé Publique Niger. Enquête SONU AU NIGER 2010 – EmONC Needs Assessment in NIGER 2010.  2010 Oct.
Ref ID: 395
Notes: This document is a report of an EmONC needs assessment conducted in Niger. This project was conducted with joint support from the Ministry of Health, UNFPA, UNICEF, the Common Fund (FC), the West African Organization for Health (OOAS) and AMDD. The report provides an overview of maternal and newborn health in Niger. Findings from the study indicate variations in numbers of births carried out by nurses or midwives per region.

Ministère de la Santé Publique République de Guinée. Plan National de Développement Sanitaire 2005 –2014.  2004 Aug.
Ref ID: 186
Notes: This plan outlines Guinea's national plan for the development of health and sanitation. This document is in response to prior Ministry of Health recommendations which call for the strengthening of the health system. There are two essential phases of this strategy plan: first, an analysis of the health sector, and second, the formation of strategic directions. This document looks at health systems through a social context and presents an evaluation in the context of finances, human resources, infrastructure and other health determinants.

Ministère de la Santé Publique République du Burundi. Politique National de la Santé de la Reproduction. Bujumbura; 2007 Sep.
Ref ID: 64
Notes: A document produced by the Ministry of Public Health in Burundi together with support from UNFPA, KFW Entwicklungsbank, WHO, and UNICEF. This document presents Burundi's national programme to improve sexual and reproductive health and highlights the importance of coordination between policy makers, health professionals, development partners and the general population.

Ministère de la Santé Publique République du Burundi. Politique de Developpement des Ressources Humaines Pour la Santé. Bujumbura; 2010 Jan.
Ref ID: 66
Notes: A document produced by the Ministry of Public Health in Burundi (final draft) calling for the development of improved human resources for health. This document outlines aims and objectives for improving the HRH crisis in Burundi and states that it recognises that poor HRH is a principal constraint to an effective health system. The document provides a brief background to the situation in Burundi and specifies areas for action as decentralization, finance, HR policies, and information system and structural reforms.

Ministère de la Santé Publique République du Niger. Document de Stratégie National de Survie de l'Enfant.  2008 Oct.
Ref ID: 347
Notes: This document is Niger's National Strategy for Child Survival. The strategy was developed as part of Niger's goal to meet MDGs 4 and 5. This document presents an overview of programmes designed to improve maternal and child health including: enhancing the availability and quality of health services, addressing issues of cost, reproductive health, continuing to promote decentralized health services, promoting community participation, increasing institutional capacities, adopting policies for human resources, and ensuring the availability of essential supplies, equipment and medicines.

Ministère de la Santé Publique République du Tchad. Rapport d'Élaboration d'un Projet de Renforcement des Capacités de la Pratique de Sage-Femme au Tchad.  2010 Jan.
Ref ID: 129
Notes: This report is intended as a first phase in the development of a national plan of action for midwifery in Chad. This report is focused on the premise that midwives are a valuable and essential human resource in a health systems approach to reaching MDG 4 and 5. It highlights the importance of capacity building and strengthening competencies of midwives and the midwifery profession. This report makes various recommendations relating to midwifery education and training, employment structures and laws, and strengthening regulation capacities.

Ministère de la Santé Publique Rèpublique du Niger. Plan de Développement de Ressources Humaines 2011 - 2020 en Santé.  2010 Nov.
Ref ID: 345
Notes: This document is Niger's national plan for the development of human resources for health 2011-2020 adopted by the Ministry of Health. The human resource plans forms an integral part of the broader national plan for health development 2011-2015 and shares the same objectives. Objectives specific to the human resources as outlined in this plan include providing an estimate of personnel, proposing measures to enhance incentives and benefits, and strengthen organizational capacities.

Ministère de la Santé Publique Rèpublique du Niger. Plan de Développement Sanitaire (PDS) 2011-2015.  2011 Jan 27.
Ref ID: 343
Notes: This document is the National Health Development Plan (PDS) for 2011 to 2015. This plan, adopted by the Niger Ministry of Public Health is the 3rd of its kind following the PDS 1994-2000 and 2005-2010. Strategies covered under this plan include extending health coverage, developing reproductive health services, strengthening human resources, ensuring the availability of essential medicines and treatments, reinforcing governance at all levels of the health system, developing mechanisms for financing the health sector, and the promotion of health related research.

Ministère de la Santé Republique de Madagascar. Santé de la Mère et de l'Enfant. 
Notes: This document, written by the Ministry of Public Health in Madagascar, provides an overview of the country's involvement in the global strategy to reduce maternal and newborn mortality. It provides a bulleted list of goals that are intended to meet the 2015 targets. This includes: ensuring the availability of emergency obstetric and neonatal care, caesarean sections and family planning; reducing maternal deaths by reinforcing activities such as applying a law where the minimum age of marriage is 18; ensuring the availability of skilled providers; and increasing the budget to address these challenges.

Ministère de la Santé Republique du Mali. Programme de Developpement Socio-Sanitaire 2005-2009.  2004 Dec.
Ref ID: 274
Notes: This document presents a report by the Ministry of Health in Mali. The PRODESS programme was developed to identify the relationships between public health and social issues such as poverty and poor health. The report discusses issues such as accessiblity and quality of services, the roles of the public and private sectors in the health system and financing.

Ministère de la Santé République de Madagascar. Revue Documentaire sur la Formation, la Réglementation, la Supervision et l'Association des Sages-Femmes en Exercice à Madagascar.  2009 Jul.
Ref ID: 76
Notes: This is a joint report issued by The Republic of Madagascar, UNFPA and International Confederation of Midwives. It documents the formation, regulation, and supervision of midwives and associations. This document presents as its objective an analysis of the actual situation of Madagascar's midwives in relation to programmes aimed at reducing maternal and neonatal mortality. It highlights the complexities of the development of human resources in developing countries and calls for a review into midwifery and nursing professions within a context of the specific cultural and socio-economic conditions in Madagascar.

Ministère de la Santé République du Benin. Évaluation des Besoins en Soins Obstetricaux et Neonatals d'Urgence au Benin - Rapport Préliminaire.  2010 Dec.
Ref ID: 120
Notes: This report was jointly issued by Benin's Ministry of Health, UNFPA, UNICEF, WHO and AMDD. This report presents an evaluation of the state of Benin's emergency obstetric and neonatal health needs and services in an effort to aid in the reduction of maternal and neonatal mortality. This study state's as its objective that it is intended as an entry point to guide policy related to MDG's 4 and 5. It calls for the strengthening of health systems, strengthening human resources and building personnel capacity.

Ministère de la Santé République du Gabon, UNFPA. Rapport Final de l'Enquête sur l'Évaluation des Besoins en Matière des Soins Obstétricaux et Néonataux d'Urgence (SONU) au Gabon.  2010 May 31.
Ref ID: 331
Notes: This document presents findings from a survey conducted by the Ministry of Health, Gabon and UNFPA on emergency obstetric and neonatal care services in Gabon. The survey was carried out with the objectives to determine the availability, quality and level of utilization of EmONC services, geographic distribution of facilities, availability of essential supplies and medicines, and the availability and level of training of health personnel. This survey was conducted with the aim to contribute to reinforcing the national health system in order to facilitate improved EmONC services. Findings of the study indicate considerable health workforce shortages, a lack of supplies and equipment, organizational challenges, and insufficient EmONC services.

Ministry of Finance Planning and Economic Development Republic of Uganda. Millennium Development Goals Report for Uganda 2010. Special Theme: Accelerating Progress Towards Improving Maternal Health.  2010 Sep.
Ref ID: 232
Notes: This Ministry of Finance Uganda document presents a report on the progress of the MDGs, specifically MDG 5. This MDG country report is the third in a series and is a product of a detailed consultative process involving different entities of government and the UN in Uganda. This progress report shows there has been progress toward many of the MDG targets, particularly in poverty, hunger and gender equality. Progress in health targets such as maternal and child mortality, access to reproductive health and incidence of malaria and other diseases have been slow. The analysis presented shows that even though some progress has been achieved, there is unevenness in how benefits are being shared. Four key interventions prioritized are: emergency obstetric care, skilled attendance at birth, family planning, and effective antenatal care.

Ministry of Health and Child Welfare Republic of Zimbabwe. The National Health Strategy for Zimbabwe (2009-2013) - Equity and Quality in Health: A People's Right. 
Notes: This strategy document follows Zimbabwe's National Health Strategy, 1997-2007: Working for Quality and Equity in Health. This document highlights poverty as a known negative determinant of health and prioritizes gender sensitive health strategies, educational opportunities particularly for women, and safe water supply and sanitation to influence the health and quality of life of communities. This document addresses determinants of health, specific diseases affecting Zimbabweans, health systems strengthening, and inclusive implementation.

Ministry of Health and Child Welfare Republic of Zimbabwe. The National Reproductive Health Policy. 
Notes: This document outlines Zimbabwe's national reproductive health policy. The objective of this policy is to provide comprehensive and good quality services which meet the needs of women, men and children and include reproductive health and safe motherhood interventions. The document presents this as the first integrated reproductive health approach to be formulated into policy and addresses gaps in the range of services available. The report provides a situation analysis such as economic challenges, available resources, and distribution of trained personnel and covers topics relating to reproductive health such as gender equality, STIs and HIV/AIDS, family planning, and cultural issues among others. The framework for implementation covers advocacy, health promotion, capacity building, monitoring and evaluation and quality healthcare delivery.

Ministry of Health and Child Welfare Zimbabwe. The Zimbabwe National Maternal and Neonatal Health Road Map 2007-2015.  2008 Nov.
Ref ID: 173
Notes: This document presents a roadmap for Zimbabwe's Ministry of Health and is supprted by UNFPA, UNICEF and WHO. In response to the high maternal and neonatal mortality rates in Africa, the African Union proposed an African Road Map aimed at providing guidance to governments in developing country-specific Road Maps to accelerate the attainment of the Millennium Development Goals related to maternal and newborn health.  The objectives of the Road Map are to provide skilled attendance during pregnancy, childbirth, and the postnatal period at all levels of the health care delivery system; and to strengthen the capacity of individuals, families, communities, civil society organizations and Governments to improve maternal and newborn health. Topics addressed include the maternal and neonatal mortality, policy, health system expenditure and financing, human resources for health and the relationship between the four pillars of safe motherhood and the 3 delays.

Ministry of Health and Population Government of Nepal. Strategic Plan for Human Resources for Health 2003 - 2017.  2003 Apr.
Ref ID: 95
Notes: This document specifies a strategic human resource plan of action for the health sector over the next fourteen years (2003-2017). It is based on a draft plan produced in the year 2000 and subsequently reviewed by the Ministry of Health. The plan has been updated to converge with the changing situation in Nepal and improved with the use of more accurate and more comprehensive information than was available during the preparation of the draft strategic plan. This document details the importance of HR planning as a subsidiary to health service planning as concerning the planning of resources to support health service development.

Ministry of Health and Population Government of Nepal. National Safe Motherhood and Newborn Health - Long Term Plan (2006 - 2017).  2006.
Ref ID: 92
Notes: This document is the second version of the National Safe Motherhood Long Term Plan 2002-2017 and was revised so as to ensure compliance with the MDGs and the Nepal Health Sector Programme - Implementation Plan 2004-2009. It is a guidelines document intended for policy makers, line ministries, external development partner, local NGOs and private health sector organisations. This revised plan takes into account increased emphasis on neonatal health, recognition of the importance of skilled birth attendance in reducing maternal and neonatal mortalities, health sector reform initiatives, legalization of abortion, mother to child transmission of HIV/AIDS and equity issues in safe motherhood services. It identifies 8 key outputs: equity and access, services, public private partnership, decentralization, human resource development, information management, physical assets and procurement, and finance.

Ministry of Health and Population Government of Nepal. National Policy on Skilled Birth Attendants (Supplementary to Safe Motherhood Policy 1994).  2006 Jul.
Ref ID: 94
Notes: This document outlines Nepal's SBA policy which is intended to improve maternal and neonatal health services at all levels of the health care delivery system and to ensure skilled care at every birth. The strategy calls for rapid expansion of accredited SBA training sites and capacity enhancement of trainers. It highlights the importance of service provision, strengthening training, professional accreditation and legal issues, and deployment and retention of SBA's.

Ministry of Health and Population Government of Nepal. National In-Service Training Strategy for Skilled Birth Attendants 2006 - 2012.  2007 Mar.
Ref ID: 89
Notes: This document outlines a training strategy to produce skilled birth attendants who are able to provide quality midwifery services and strengthen midwifery services in Nepal. It serves as an essential step to support the implementation of the National Policy for Skilled Birth Attendants. Key elements of the strategy are to provide sufficient SBAs to meet the MDG target, and to meet in-service training needs and the implementation of training.

Ministry of Health and Population Government of Nepal. Human Resource Strategy Options for Safe Delivery.  2009 Jan. Report No.: HSRSP Report No. 2.11-01-09.
Ref ID: 86
Notes: This report examines the current and future availability of skilled health workers for safe delivery services and the factors influencing their retention in government health facilities, particularly in rural areas. The report presents strategy options to address the main obstacles to adequate and appropriate staffing for safe delivery. The report details a shortage of trained staff and states that a root cause of the staffing problem is the government's inability to attract and retain sufficient numbers of trained staff in the publicly funded health system.

Ministry of Health and Population Government of Nepal. Post Training Follow-up for Skilled Birth Attendants: Review of Implementation Experiences.  2009 Sep.
Ref ID: 93
Notes: This is a document issued by Nepal following up on the National In-Service Training Strategy for Skilled Birth Attendants. This rationale for this document as stated is that in addition to strengthening SBA training, successful implementation of effective follow up within this major programme would help to establish systems for follow up in other programmes and generate trainer commitment to this practice. Some recommendations from the findings include    scaling up the strategy, orientation meetings for supervisors, clear objectives to follow up visits, equipped facilities for SBA services, skill retention strategies, and more support for rural/remote SBA's.

Ministry of Health and Population Government of Nepal. National List of Essential Medicines Nepal (Fourth Revision).  2009.
Ref ID: 85
Notes: This is a list put out by the Department of Drug Administration in Nepal and lists all essential medicines. The document defines essential medicines as those that satisfy the priority health needs of the population. The medicines selected are done so with due regard to disease prevalence, evidence on safety and efficacy, and comparative cost-effectiveness. The purpose of the list is to assure the availability of essential medicines within the context of functioning health systems.

Ministry of Health and Population Government of Nepal. Nepal Health Sector Programme Implementation Plan II (NHSP - IP 2) 2010 - 2015.  2010 Apr 7.
Ref ID: 90
Notes: This report details the Ministry of Nepal's plan to improve the health and nutritional status of the Nepali population and provide equal opportunity for all to receive quality health care services. The plan emphasizes services directed towards women, children, poor and excluded, and other at-risk populations. This will be done through behaviour change and communication interventions.

Ministry of Health and Social Welfare Tanzania. The Approved Organisation Structure of the Ministry of Health and Social Welfare.  13-1-2009.
Notes: This document is an organogram of the approved organizational structure of Tanzania's Ministry of Social Health and Welfare.

Ministry of Health and Social Welfare Tanzania Mainland, Ministry of Health and Social Welfare Zanzibar, World Health Organization. Tanzania Service Availability Mapping 2005-2006. Geneva: World Health Organization; 2007.
Ref ID: 221
Notes: This is a joint MOH Tanzania and WHO document mapping the services available in the country. This document presents the results of the 2005-2006 mapping survey (SAM). SAM is a rapid assessment tool that generates information on the availability of specific health services, health infrastructure and human resources for each district. The objectives of this survey are to provide planners and decision makers with information on the distribution of services, provide baseline monitoring information, and to assess whether the facility SAM can become a useful and feasible planning and monitoring tool at the district level. Services investigated include: laboratory services, blood transfusion services, medical equipment, injection and sterilization practices, HIV/AIDS, malaria, and safe motherhood.

Ministry of Health and Social Welfare United Republic of Tanzania. Primary Health Services Development Programme (PHSDP) 2007-2017.  2007 May.
Ref ID: 222
Notes: This document presents a situation analysis of the health sector in Tanzania. The health sector is understaffed and operating at less than the international standards. Despite the good network of primary health facilities, accessibility to health care is still inadequate due to many reasons. In some areas the accessibility to health facilities is more than 10 kilometers and where accessibility is less than 5 kilometers to health facilities the availability of health care is inequitable, with human resource operating at 32% of the required skilled workforce, insufficient medical equipment, and shortage of medicines, supplies and laboratory reagents. The PHSDP has been put in place to accelerate the provision of primary health care services. The main areas of focus are on strengthening health systems, rehabilitation, human resource development, the referral system, increase health sector financing and improve the provision of medicines, equipment and supplies.

Ministry of Health and Social Welfare United Republic of Tanzania. The National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania 2008-2015.  2008 Apr.
Ref ID: 224
Notes: This MOH Tanzania document presents a roadmap to reduce mortality relating to MDGs 4 and 5. The National Road Map Strategic Plan stipulates various strategies to guide all stakeholders for Maternal, Newborn and Child Health (MNCH), including the Government, development partners, non-governmental organizations, civil society organizations, private health sector, faith-based organizations and communities, in working together towards attainment of the Millennium Development Goals (MDGs) as well as other regional and national commitments and targets related to maternal, newborn and child health interventions. This document is intended as a guide to ensure improved coordination of interventions and delivery of services across the continuum of care as well as across operational levels of the system so that national level policy will reach community and regional levels. 

Ministry of Health and Social Welfare United Republic of Tanzania. Human Resource for Health Strategic Plan 2008-2013.  2008 Jan.
Ref ID: 223
Notes: This document presents MOH Tanzania's HRH strategic plan. This Human Resources for Health Strategic Plan has been developed with a view to creating an enabling environment to promote participation of key Human Resource for Health and Social Welfare stakeholders in addressing human resource crisis in the health sector. Specific focus is on planning and policy development capacity; leadership and stewardship; education, training and development; workforce management and utilization; partnership; research and development; and financing. Effective implementation of this plan, will lead to increased human resource capacity necessary for the achievement of quality health and social welfare services at all levels.

Ministry of Health and Social Welfare United Republic of Tanzania. Health Sector Strategic Plan III July 2009-June 2015, "Partnership for Delivering the MDGs".  2009.
Ref ID: 226
Notes: This document presented by MOH Tanzania is the third health sector strategic plan addressing the MDGs. This HSSP III is intended as a guiding reference document, for the preparation of the five-year Regional Strategic Plans, as well as, hospital and Council Health Strategic Plans. It will also guide the formulation of specific plans and programmes, including annual plans, at all levels. This document addresses issues of equity, gender, quality and governance and explains governance arrangements of the health sector such as the monitoring and evaluation of this strategic plan. Strategies covered include district health services, referral hospital services, central level support, HRH, health care financing, PPP, MNCH, prevention and control of diseases, and monitoring and evaluation.

Ministry of Health Bhutan. Bhutan Ministry of Health Organogram. 
Notes: This is an organogram of the structure of Bhutan's Ministry of Health.

Ministry of Health Government of Pakistan. National Health Policy 2001 The Way Forward: Agenda for Health Sector Reform.  2001 Dec.
Ref ID: 205
Notes: This document presents MOH Pakistan's 2001 policy for health sector reform. The document defines 10 specific areas as needing reforms:  the widespread prevalence of communicable diseases; inadequacies in primary/secondary health care services; remote professional and managerial deficiencies in district health system; greater gender equity in the health sector; nutrition gaps in the population; urbal bias in the health sector implementation modalities; introduction of regulation in the private medical sector; the creation of mass awareness in public health matters; effect improvements in the drug sector with a view to ensuring the availability, affordability and quality of drugs in the country; and capacity building for health policy monitoring in the ministry of health.

Ministry of Health Government of Pakistan. Pakistan: National Maternal and Child Health Policy and Strategic Framework (2005-2015).  2005 Apr.
Ref ID: 208
Notes: This is a draft document prepared for review by policymakers in health sector to provide a basis for further provincial consultations and development of National Maternal and Child Health Program. A comprehensive National MCH strategic framework has been developed by Ministry of Health in consultation with Departments of Health and other stakeholders with an objective to improve the accessibility of high quality and effective MCH services for all, particularly the poor and the disadvantaged. Public Health Forum held in Islamabad on April 1-2, 2005, in which this document was endorsed. Key areas of reform identified include: developing a unified policy on maternal and child health, implemented through an integrated national MCH program; training of LHVs and community skilled birth attendants to ensure that each birth is attended by skilled health personnel, ensuring comprehensive family planning services across all health care infrastructure; ensuring easy and organized access to high quality 24/7 basic and comprehensive EmONC for all; ensuring implementation of integrated management of childhood illness and child survival interventions through skill building of health care providers; expansion of Lady Health Workers; culturally appropriate interventions; and the development of social safety nets for the poor.

Ministry of Health Government of Pakistan, International Council of Nurses, International Confederation of Midwives, World Health Organization. Islamabad Declaration on Strengthening Nursing and Midwifery. 4-6 March 2007.  2007.
Ref ID: 97
Notes: This is a declaration made by the Federal Minister of Health for Pakistan in response to the World Health Assembly May 2006 Resolution WHA59.27 which reaffirmed the valuable role of nursing and midwifery professions to health systems and the health of the people they serve. The declaration is founded on the belief that effective nursing and midwifery services are critical to achieving the MDGs, to improving primary health care programmes and to the strengthening of health systems. This declaration calls for the scaling up of nursing and midwifery capacity, high level political leadership, a multi-sectoral approach, significant financial investment in education and employment expansion, and that each country must establish policies and practices to ensure self-sufficiency in workforce production.

Ministry of Health Government of Pakistan. National Health Policy 2009.  2009 Jul.
Ref ID: 206
Notes: Draft of MOH Pakistan's National Health Policy 2009. The vision of this policy is to improve the health and quality of life of all Pakistanis, particularly women and children, through access to essential health services. The goal of this policy as stated is to remove barriers to essential health services. The document outlines 6 key policy objectives to reach this goal: provide and deliver a basic package of quality Essential Health Care Services; develop and manage competent and committed health care providers; generate reliable health information to manage and evaluate health services; adopt appropriate health technology to deliver quality services; finance the costs of providing basic health care to all Pakistanis; and to reform the health administration to make it accountable to the public. This policy further states that it recognizes the varied needs of different provinces, therefore this policy is designed to contribute to advancing and strengthening the provincial health strategies.

Ministry of Health Government of Rwanda. Human Resources for Health Strategic Plan 2006-2010.  2006 Apr.
Ref ID: 151
Notes: This report documents the Health Sector Strategic Plan adopted by Rwanda. This plan identifies human resources as the major challenge if quality of care and the achievement of the MDGs are to be attained. This document introduces the plan, presents an overview of the health care system organization and structure, an analysis of the current health workforce and on training programs and training issues. This plan looks to improve policy, regulation and planning of HRH, improve management and performance, stabilize the labour market, create capacity such as strengthening education, training and research, and to monitor and evaluate progress.

Ministry of Health Government of Southern Sudan, UNFPA. Southern Sudan Maternal, Neonatal and Reproductive Health Strategy - Action Plan 2008-2011 (second draft and revision).  2007 Oct 18.
Ref ID: 156
Notes: DRAFT. This document is a draft and revision following recommendations made of key stakeholders and UNFPA organized workshop. It presents the Government of Southern Sudan's strategy to provide a comprehensive, integrated, equitable and sustainable maternal and reproductive health care (MRH) package. The goal of this strategy is to implement the recommendations of the MRH policy, including reducing maternal and neonatal mortality, increasing the availability and accessibility of resources, and ensuring adequately built, equipped and funded health facilities. The strategy outlines ten action plans in the arenas of: policy implementation, financing and advocacy of the strategy, human resource development, management of MNRH services, monitoring and evaluation of services, reproductive health commodities, access to facilities and health promotion, HIV/AIDS and STI programmes, and GBV and sexual and reproductive health rights programme and research.

Ministry of Health Indonesia, Provincial Government of West Nusa Tenggara, Provincial Government of East Nusa Tenggara. Measuring the Fulfilment of Human Rights in Maternal and Neonatal Health - Using WHO Tools.  2008.
Ref ID: 415
Notes: This document reports on 2 cities and 2 districts in West and East Nusa Tenggara, Indonesia. It is a report produced for the Ministry of Health and the provincial governments of each of these districts with support from the Indonesian German Development Cooperation Health Sector Support Team. This report summarizes the outcomes of exploratory research on human rights in maternal and neonatal health in two cities and two rural districts of Eastern Indonesia, and considers the research findings in the context of Indonesia's national human rights commitments. The research was conducted in 2007, following completion of a national level enquiry that was conducted from 2005 to 2006. The national enquiry was conducted in partnership between the Ministry of Health, WHO and various other stakeholders. The enquiry was part of a pilot to test the WHO Tool - Using human rights for maternal and neonatal health: a Tool for strengthening laws, policies and standards of care in three countries; Brazil, Mozambique and Indonesia. Priority health issues described in this report are: 1) Pregnancy, childbirth and the postpartum period: access to health services 2) Family planning: levels of knowledge about family planning methods; accessibility of family planning for unmarried people; husband authorization to seek services 3) Levels of birth registration 4) STIs and HIV/AIDS: knowledge, education and access to services for prevention and treatment 5) Violence against women 6) Unmet need for safe abortion services 7) Adolescent reproductive health: early marriage and pregnancy, and limited access to sexual and reproductive health education and services 8) This report also identifies vulnerable groups, as well as discrimination and equity issues, related to the fulfilment of human rights in maternal and neonatal health in the community.

Ministry of Health Kingdom of Cambodia. The MOH Health Workforce Development Plan 2006-2015 DRAFT.  2004 Nov.
Ref ID: 125
Notes: This is a draft document of Cambodia's Ministry of Health plan to produce a pool of health personnel from which health worker activity occurs in both the public and other sectors. The health workforce development plan presented in this document is based on a projection of the level of staffing of the health system in Cambodia for the period 2006-2015. This plan emphasizes workforce planning priorities to be recognized in the context of principal indicators of population health status, such as nutritional status, life expectancy, infant and under-five mortality, maternal mortality and morbidity rates for communicable diseases. This plan calls for the prioritization of adequate staffing, encouragement for service utilization and maximization of preventative activity.

Ministry of Health Kingdom of Cambodia. Cambodia EmONC Improvement Plan - For Implementation January 2010-December 2015. A Plan to Support and Increase the Availability and Utilisation of Quality Functional EmONC throughout Cambodia. 2009 Dec.
Ref ID: 124
Notes: This document outlines an improvement plan created following a national assessment of availability, quality and utilisation of emergency obstetric and newborn care in 2008 conducted by Cambodia's Ministry of Health to help understand why the country has one of the highest numbers of maternal and newborn deaths in the Southeast Asia region. The plan outlines 7 intended outputs: policy and minimum standards to support implementation of EmONC at all levels of care, improved availability and access eo EmONC, strengthened capacity to support the development of skilled care, increased utilisation of quality functional EmONC and services, functioning referral system, provincial EmONC plans developed and implemented by provincial health departments, and strengthened links to communities and increased utilisation of EmONC.

Ministry of Health Kingdom of Cambodia. National Emergency Obstetric and Newborn Care Assessment in Cambodia.  2009 May.
Ref ID: 122
Notes: This report is conducted by the National Institute of Public Health, Cambodia and supported by the National Maternal and Child Health Center and National Reproductive Health Program. This study is an assessment of the level of readiness of the Cambodia's health facilities to provide emergency obstetric care to mothers and newborns. The evidence of this report is intended as a baseline for future monitoring and evaluation and to assist policy makers and program managers to design effective strategies to reduce maternal and newborn mortality. The study finds that underreporting of maternal deaths is a common problem in Cambodia and that availability and utilization of EmONC facilities fall short. The study cites 'policy issues' and infrastructure as key barriers and calls for standards, guidelines and protocols to be put in place to address this.

Ministry of Health Kingdom of Cambodia. Fast Track Initiative - Road Map for Reducing Maternal and Newborn Mortality 2010-2015.  2010 May.
Ref ID: 123
Notes: This document outlines the initiatives and strategies that help reduce maternal and newborn mortality. This document describes components of the government's existing maternal and newborn health programs. The report highlights the strong association between family planning, skilled attendance at birth, access to safe abortions and rates of mortality. This road map is to be used in the context of the existing continuum of care encompassing reproductive, maternal, newborn and child health. The document calls for a scaling up and quality improvement of already existing initiatives. Critical areas of intervention identified include: emergency obstetric and newborn care, skilled birth attendance, family planning, safe abortion, behaviour change communication, removing financial barriers, and maternal death and surveillance response.

Ministry of Health Lao PDR, UNFPA. Assessment of Skilled Birth Attendance in Lao PDR. 2008 Mar.
Ref ID: 119
Notes: The purpose of this review is to answer the question: "What is the current capacity of Lao PDR to provide skilled birth attendance, also called skilled care, to its population?" Resulting from a workshop in July 2007 where national MCHexperts examined the situation on skilled care in Lao PDR, the Ministry of Health requested a comprehensive review of skilled birth attendance in the country. The document finds that the lack of adequate human resources is the primary gap found in the assessment of skilled birth attendance in Lao, PDR. Creating a new cadre of skilled birth attendant and the up-grading of existing MCH workforce to become skilled birth attendants, is the foremost need.  Nonetheless, making these urgent human resource improvements cannot occur in a vacuum.  There must be concurrent attention to all the other factors that establish the enabling environment. These are: political will to make change happen, the funding for it, functional facilities that provide the suitable level of EmONC, good education and training programs for skilled birth attendants/midwives, access, and a community ready to utilize and benefit from a good maternal child health delivery system.

Ministry of Health Nepal. Reproductive Health Clinical Protocol for Auxiliary Nurse Midwife.  1999.
Ref ID: 54
Notes: This document produced by MOH Nepal, Family Health Division outlines the clinical protocol for auxiliary nurse midwives. Produced in the context of recommendations from ICPD Cairo in 1994, the government of Nepal undertook and intensive process of consensus building to identify the basic minimum RH services. A national Reproductive Health Strategy was developed to provide an overall policy framework. These RH clinical protocols outline exactly what is expected from managers and service providers of government and non government organizations at each level of the national health care system.

Ministry of Health Republic of Kenya, Population Council. Community Midwifery Implementation Guidelines in Kenya - Taking Midwifery Services to the Community.  2007 Jan.
Ref ID: 253
Notes: This document is produced by the MOH Kenya Division of Reproductive Health and the Population Council. This document sets out the approach to be taken to sure that the Kenyan communities have the capacity and motivation to take up their essential role in health care delivery. This in turn enhances community access to health care and thus improves the productivity, reducing poverty, hunger and maternal and child mortality as well as improving education performance across all cycles of life. This can only be achieved through the establishment of sustainable Level One Services that aim at promoting dignified livelihoods throughout the country through decentralization of services and accountability. It is within this context that the community midwife is seen as an agent of change in the community and can contribute positively to the reduction of maternal and perinatal morbidity and mortality. The community midwife is in a position to provide health care services and assume the responsibilities of a professional health service provider  deep in the community that include; health promotion, disease and prevention and detection, care giving and compliance with treatment and advice, and claim the health rights of the community.

Ministry of Health Republic of Kenya, Population Council. Community Midwifery Implementation Guidelines in Kenya - Taking Midwifery Services to the Community.  2007.
Notes: Draft of R253.This is a draft written by the Division of Reproductive Health, Population Council for midwifery practice in Kenya. It presents guidelines for the promotion of community based healthcare principals. It stresses the importance of community involvement and population participation to reduce health inequities and highlights the role of the community midwife as an agent of change who can help promote community capacity.

Ministry of Health Republic of Uganda, World Health Organization. Service Availability Mapping (SAM). Geneva: World Health Organization; 2006.
Ref ID: 229
Notes: This is a joint MOH Uganda and Who document outlining the SAM project in Uganda conducted in 2004. The goal was to collect information on the availability and distribution of key health services by interviewing the district director of health services and his/her team in all 56 districts. SAM provided baseline monitoring information for the scale-up of key HIV/AIDS-related services such as antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT) of HIV, and counselling and HIV testing. The project mapped health service availability, health infrastructure, human resources, and social marketing programmes.

Ministry of Health The Government of the Republic of Zambia. National Training Operational Plan 2008: Field Assessments, Analysis and Scale-up Plans for Health Training Institutions.  2008.
Notes: This Operational Plan aims to summarize the current situation in health training institutions across the country and set plans for addressing current needs at individual schools. The document provides information for increasing capacity of each school in line with the national scale-up plan for health care workers in Zambia. The training institutions covered in this operational plan are Nursing and Midwifery Schools, Biomedical and Paramedical Colleges, and the University of Zambia School of Medicine. While staffing, infrastructure, and resources varied greatly between training institutes, common themes outlined in the document relating to challenges include: accommodation, faculty recruitment and retention, repairs to basic infrastructure, books, computers and teaching material shortages, and transportation to practice sites.

Mitchell K. EmOC Supply Side Capacity Assessments in Choma, Mongu and Serenje Districts, Zambia.  2010 Jul. Report No.: 399 (10C).
Ref ID: 267
Notes: The Mobilising Access to Maternal Health Services in Zambia (MAMaZ) programme is a three-year programme, funded by the UK Department for International Development (DFID) and implemented by Health Partners International (HPI), in conjunction with the Zambia Ministry of Health (MOH). The programme aims to identify and address community and household-level barriers that affect timely access to life-saving maternal and newborn health services. Although Choma, Mongu and Serenje districts are designated EmOC districts, a lot of effort is still required in order to ensure that obstetric clients in these districts will receive timely, life-saving obstetric services if they develop obstetric complications. All of the EmOC facilities assessed have significant gaps in staffing and staff capacity, as well as drugs, equipment and supplies for EmOC.  Addressing these gaps and establishing "EmOC referral zones" so that women seen at non-EmOC facilities have access to EmOC services, would improve the quality and availability of EmOC services and would complement the demand that will be created by the MAMaZ programme.

Mize L, Pambudi E, Koblinsky M, Stout S, Marzoeki P, Harimurti P, et al. "...and then she died" Indonesia Maternal Health Assessment.  2010 Feb.
Ref ID: 339
Notes: This is a report produced as part of the World Bank inputs to the Government of Indonesia Health Sector Review and Health System Performance Assessment and funded by DFID under the Health System Strengthening for Maternal Health Initiative. This report is aimed to contribute to strengthening the health workforce in Indonesia. The assessment finds that the approach to improve maternal health through emphasizing the use of a midwife for deliver and community based interventions has not had the expected impact. Evidence indicates that providing midwives alone is too narrow a strategy. Additional areas that need to be addressed include availability of services, standardizing quality of care, enhancing linkages between community facilities and village midwives and increase opportunities for the utilization of the national health insurance plan.

Moyo NT. The Member Association Capacity Assessment Tool (MACAT). 
Notes: This document is a PowerPoint presentation by the senior midwifery advisor at the International Confederation of Midwives. MACAT is a tool to used to initiate the organisational capacity development process in low income countries. This presentation covers the history and development of the MACAT and a basic introduction to the components of the tool.

Mullan F, Frehywot S. Non-Physician Clinicians in 47 Sub-Saharan African Countries. Lancet 2007;370(9605):2158-63.
Ref ID: 377

Nabudere H, Asiimwe D, Mijumbi R. Task Shifting to Optimise the Roles of Health Workers to Improve the Delivery of Maternal and Child Healthcare.  2010 Jun 22.
Ref ID: 83
Notes: This is a policy brief prepared by the Uganda country node of the Regional East African Community Health (REACH) Policy Initiative. This report is based largely on systematic reviews and details the state of health workforce shortages in Uganda, identifying task shifting as a potentioal conflict with current health professional regulations and licensure. This report is intended as a summary of the problem and potential options for solving this. It does not offer recommendations.

Nahar S, Banu M, Nasreen HE. Women-Focused Development Intervention Reduces Delays in Accessing Emergency Obstetric Care in Urban Slums in Bangladesh: A Cross-Sectional Study. BMC Pregnancy and Childbirth 2011 Jan 30;11(1):11.
Ref ID: 264

Namshum N. Recommendations of the Expert Advisory Group Meeting on the 14th Oct, 2004. 
Notes: This document presents recommendations following an expert advisory group meeting in India. The Expert Advisory Group Meeting held on 140.10.2004 as a follow up the meeting held on the 19th of July 2004 was to suggest recommendations on various issues which needed policy decisions related to the use of selected life saving drugs and interventions in obstetric emergencies by Staff Nurses LHVs and ANMs. The report provides a list in table form of potential drugs and interventions followed by recommendations for their administration. The procedures and drugs listed have been specifically recommended by WHO for use by skilled birth attendants for prevention of maternal deaths and that use of these drugs should be permitted to ANMs only after adequate training in the knowledge and use of each one.

National Aboriginal Health Organization. 2008. Celebrating Birth – Aboriginal Midwifery in Canada. Ottawa: National Aboriginal Health Organization.
Ref ID: 436

National Department of Health Papua New Guinea. Ministerial Taskforce on Maternal Health in Papua New Guinea.  2009 May.
Ref ID: 149
Notes: This is a report from the Ministry of Health, Papua New Guinea on the current situation of the impact maternal death has on the country. This report states that there is a crisis in maternal health in Papua New Guinea and presents 7 key recommendations to guide the response to this crisis and to build a stronger health system which that better meets the needs of our mothers. These recommendations are: securing investments between major government, private sector and development partners; ensuring universal free primary education for girls; recognising that MMR is the most sensitive indicator of quality and level of functioning of a health service and that a dysfunctional health system in PNG has been a major contribution to the high levels of maternal morbidity and mortality; strengthening the quality of voluntary family planning services, ensuring supervised delivery by a trained health care providor; ensuring that every woman has access to comprehensive obstetric care; and ensuring every woman has access to quality emergency obstetric care if required at first referral level.

New Zealand College of Midwives. Midwives Handbook for Practice. ISBN 978-0-473-12992-7.  2008. Christchurch.
Notes: This is the 4th edition of this handbook, original handbook published in 1993. This handbook is written for midwives, women and the general public to gain knowledge about midwifery. It is a document intended for professionals and the public to be able to measure midwifery practitioners and services and identifies actions which allow for effective practice. The guidelines are written in the context of women centered care and cultural sensitivity.

Niger. Déclaration pour Objet d'Exposer la Politique de Santé du Gouvernement de la République du Niger.  2002 May 7.
Ref ID: 344
Notes: This document is a declaration adopted by the Council of Ministers in May 2002 presenting an overview of health in Niger. The objective of the declaration is to define Niger's health policy as set in the context of developing the health system. The document outlines the policy and puts forth strategies to develop the health system such as strengthening human resources, extending basic health coverage, improving communication systems, and addressing challenges to quality of care.

Nizigama J, Batungwanayo C. Profil du Pays - Programme de Promotion des Sages-Femmes (Burundi). Bujumbura; 2008.
Ref ID: 65
Notes: This is a table put together by Dr. Nizigama from the Reproductive Health Programme at the UNFPA in collaboration with Dr. Batungwanayo from Burundi's Ministry of Public Health and the Struggle against HIV/AIDS, Faculty of Medicine, Bujumbura. It outlines categories of health personnel responsible for childbirth and obstetrics and their level of experience.

Norway. Proposed Resolution on Health Workforce Strengthening for the 128th Executive Board and the Sixty-Fourth World Health Assembly.  2011 Jan 11.
Ref ID: 330
Notes: This document presents Norway's proposal for health workforce strengthening. The recommendations made are directed to the Executive Board for the 64th World Health Assembly. The included recommendations cover issues such as addressing migration of health personnel, scaling up the health workforce, policies regarding the health workforce, and strengthening in-country capacity.

Nurse College of Bolivia, Autonomous University Juan Misael Saracho of Tarija, UNFPA. Pilot Project to the Institute for the Career in Midwifery within the University System of Bolivia.  2006.
Ref ID: 363
Notes: This document presents an overview of a pilot project conducted in Bolivia to implement midwifery into the Bolivian university system.  The program aims to offer university level training that is sensitive to the varied socio-cultural needs of the population. Specific objectives of the project were to design and implement a midwifery program within the faculty of health sciences of the universities of La Paz, Sucre, Tarija and Llallagua (Potosí), to propose a legal framework for a Bachelor's of Midwifery, and to educate teachers in midwifery with competencies in sexual and reproductive health within the intercultural, gender and human rights framework, both in practice and in training. The project was executed by a committee composed of members from the Ministry of Health and Sport, university authorities (national and international), the collaboration center as designated by PAHO/WHO to strengthen midwifery, the Nurse College of Bolivia and UNFPA.

Nyamtema AS, Urassa DP, Roosmalen JV. Maternal Health Interventions in Resource Limited Countries: A Systematic Review of Packages, Impacts and Factors for Change. BMC Pregnancy and Childbirth 2011 Apr 17;11(1):30.
Ref ID: 421

Odberg Pettersson K. Models of Maternal Health Care Services: A Global Overview. World Health Organization; 2007.
Ref ID: 374
Notes: This document is a report prepared for the World Health Organization, Making Pregnancy Safer department as one of four background papers for a technical consultation held in 2007. The paper reports on findings and gives recommendations for action based on a desk study related to: models of health care during pregnancy, childbirth, and the postpartum period; evidence of the models effectiveness; gaps in knowledge; and efforts to scale up skilled birth attendants in different regions of the world. Key findings indicate that there are extensive intra- and inter- regional differences in approach to the organization of maternal and neonatal health care and that midwife-led care for low-risk pregnancies is as safe and effective as that of physician-led care. The author states that models should be judged not only on MMRs but also on the content of the models, such as appropriateness, quality and evidence-based strategies applied within the models.

Oulton J, Hickey B. Review of the Nursing Crisis in Bangladesh, India, Nepal and Pakistan - Draft for Internal Review. Barcelona, Spain: Instituto de Cooperación Social, INTEGRARE; 2009 Feb.
Ref ID: 155
Notes: This document is a report produced by Integrare and commissioned by DFID, Regional Team for South Asia. This report outlines shared concerns relating to the nursing crisis in the four countries: quality assurance in education and practice; working conditions; faculty numbers and competence, teaching resources and student clinical experiences; and absenteeism, deployment policy, and planning skills. The document states that all four countries show weaknesses of varying degrees in planning, administration, education, practice, leadership, policy, and regulation.

Pakistan. Assessment of the Quality of Training of Community Midwives in Pakistan.  2010.
Notes: This document presents conclusions of a community midwife training programme in Pakistan. CMW training commenced in 2007/2008 in Pakistan and has made good progress in terms of numbers enrolled and trained. Results of theoretical knowledge testing of CMWs are encouraging and show commitment of CMW training schools and MNCH Programs, federal and provincial. However, poor aptitude in critical thinking and analytical skills and major weaknesses in management of maternal and neonatal complications especially their early identification and timely referral means that the majority of graduating CMWs lack competence to practice domiciliary midwifery independently. Broad limitations in all aspects of clinical learning opportunity, hospital as well as community, results from: shortfalls in enforcement of PC1 criteria; failure to translate PNC curriculum into an objective-based structured teaching training program; and lack of coordination among various stakeholders of the CMW training programme including; CMW school, training health institution, District Health system, LHW programme, community and CMWs families. Source not provided.

Pakistan Nursing Council (Community Midwifery Curriculum). List of Skills to be Imparted to a Midwife. 
Notes: This document as part of the Community Midwifery Curriculum lists skills needed to be a midwife. Skills listed include: antenatal care; normal deliveries; management of post-partum haemorrhage; immediate care of newborn and resuscitation; and postpartum care.

Pan American Health Organization, World Health Organization. Health Sector Analysis, Guyana.  2003 Feb.
Ref ID: 263
Notes: Unedited Draft Version. This document is a health sector analysis for Guyana. This analysis was conducted per request of the Ministry of Health of Guyana to provide input into the elaboration of the National Health Plan. It covers the political, social and economic contexts, human resources, health financing and spending, analysis of service delivery, essential public health functions and policy options and recommendations.

Parkhurst JO, Rahman SA. Non-Professional Health Practitioners and Referrals to Facilities: Lessons from Maternal Care in Bangladesh. Health Policy and Planning 2007 May;22(3):149-55.
Ref ID: 1
Notes: This article in Health Policy and Planning discusses issues relating to referral systems in Banladesh. The article states as key messages that a multitude of non-professional practitioners can play roles in decision making for maternal health care with the commonly used heading of 'traditional birth attendant' often too broad for programmatic use. Also, some non-professional practitioners may be useful to encourage referral of labouring women to professional facilities. The incentive structures to support or oppose referrals in specific contexts must therefore be addressed by planners wishing to engage with alternative providers to improve maternal care.

Pierre MR, Jacobs AM. Atelier de Réflexion - Autour de la Profession de Sage-femme en Haïti. 14 au 16 Décembre 2010. 
Notes: This document is a report on the proceedings of a workshop held at Club Indigo in Haiti. The focus of the workshop, backed by ICM and UNFPA was to discuss issues relating to the midwifery profession in Haiti. Midwives attending the workshop were able to discuss their experiences and reflect on challenges encountered. The overall aim of the workshop was to contribute to improving maternal and neonatal health, particularly in the context of MDGs 4 and 5 and focused specifically on the importance of the midwife to meeting these challenges.

Plan-Cadre des Nations Unies pour l'Assistance au Développement (UNDAF). Sénégal 2007-2011. Dakar: Système des Nations Unies au Sénégal; 2007.
Ref ID: 247
Notes: This document presents the United Nations Development Assistance Framework for Senegal. The UNDAF is a framework for the Senegal Country Team and describes priorities specific to the region. The initiatives outlined address poverty reduction, social services, and promotion of governance as three key areas.

Pradhan A, Barnett S. An Assessment of the Impact of the Aama Programme - Changes in the Utilisation of Emergency Obstetric Care (EOC) Services.  2010 Jun.
Ref ID: 144
Notes: This report is an assessment of the Aama programme on the utilisation of EOC services in Nepal. The Aama programme is a universal health care scheme designed to promote the usage of institutional care. It provides incentives to women in the form of cash payment at the time of discharge after delivery at a health institution, free delivery services at all public health facilities, and incentives to health workers. This assessment compares service utilisation data from Comprehensive Emergency Obstetric Care (CEOC) and Basic Emergency Obstetric Care (BEOC) facilities before and after the introduction of the Aama programme. The study finds that there was a substantial increase in the total number of deliveries at selected EOC facilities.

Projections for Midwife-Nurses.  2011.
Notes: This document shows 2 tables. Table 1:Projection of Midwife Supply 1999-2009. Table 2: Projection of Nurses Supply 1999-2009 (if current status of graduation and losses remain the same for the period). It reports numbers, average losses and supplies, and population growth rates in regards to nurses. Source not provided.

Rakhimova N. Information on Reproductive Health in Tajikistan.  2010 Jun 4.
Ref ID: 218
Notes: This document presents an analysis of obstacles and challenges to reproductive health in Tajikistan. Tajikistan has high levels of poverty and shows an increased gap between social and economic groups of the population. This document identifies the relationship between poverty, poor health and high rates of maternal mortality. This report suggests that family decision making plays an important role in addressing issues such as maternal mortality, where the head of household is often responsible for the decision to seek health services. Health reform models include re-structuring the system of health services delivery and quality development of primary health care based on concept of family practice; change of health financing and system of health providers' payment; public participation in decision of health questions; information management base. This document also identifies links with other sectors such as education, infrastructure, transportation, drinking water, and nutrition.

Ranjalahy Rasolofomanana J, Ralisimalala A. Evaluation des Besoins en Matière de soins Obstétricaux et Néo-natals d'Urgence à Madagascar.  2004.
Ref ID: 390
Notes: This document is a report of an EmONC needs assessment conducted in Madagascar. The objectives of the study were to determine the availability and quality of EmONC for mothers and newborns, to identify the means of increasing the utilization of services within the community, and to evaluate the costs associated with increasing or extending these services. Findings include unsatisfactory availability of EmONC equipment, uneven distribution of the availability of supplies in the country, and a shortage of skilled providers such as obstetricians, gynaecologists, or anaesthetists.

Ranson MK, Chopra M, Atkins S, Dal Poz MR, Bennett S. Priorities for Research Into Human Resources for Health in Low- and Middle-Income Countries. Bulletin of the World Health Organization 2010 Jun;88(6):435-43.
Ref ID: 39

Rao M, Rao KD, Kumar AS, Chatterjee M, Sundararaman T. Human Resources for Health in India. Lancet 2011 Jan 10.
Ref ID: 38

Renaudin P, Prual A, Vangeenderhuysen C, Ould AM, Ould M, V, Ould El JD. Ensuring Financial Access to Emergency Obstetric Care: Three Years of Experience with Obstetric Risk Insurance in Nouakchott, Mauritania. International Journal Of Gynecology And Obstetrics 2007 Nov;99(2):183-90.
Ref ID: 411

Renaudin P, Ould Abdelkader M, Ould Abdelaziz SM, Ould Mujtaba M, Ould Saleck M, Vangeenderhuysen C, et al. La Mutualisation du Risque Comme Solution à l'Accès aux Soins Obstétricaux d'Urgence. Expérience du Forfait Obstétrical en Mauritanie. Studies in Health Service Organization and Policy 2008;25:93-125.
Ref ID: 410
Notes: This document is a journal article discussing financial barriers to accessing emergency obstetric care in Mauritania, specifically in the context of risk pooling as a potential solution. Financial restrictions in accessing emergency obstetric care are a leading cause of high maternal mortality ratios in developing countries and particularly in Mauritania. Risk pooling allows all pregnant women to monitor their entire pregnancy for a much smaller sum.  In addition to facilitating access to care, this strategy aims improving the quality of emergency obstetric care and insurance better working conditions for providers.

Republic of the Gambia: National Planning Commission. Level of Achievement of the Millennium Development Goals (MDGs), MDG Status Report.  2009.
Ref ID: 306
Notes: This document presents the 2009 MDG status report for the Gambia. This is the fourth national report on the implementation status of the MDGs. This report is based on data from the 2003 Integrated Household Survey, the round three of the Multiple Indicator Cluster Survey (MICS III), 2005/2006, the 2003 census as well as sector specific data on education and health. The findings at national level state: Goal 2 (proportion of pupils starting grade 1 who reach last grade of primary) has been attained. On track to attaining net enrolment in primary education and literacy among 15-24 year olds, Goal 3 (gender parity in primary and lower basic has been attained and parity at senior secondary is within reach). Goal 4 (proportion of 1 year old children immunized against measles has been attained). Goal 6 (proportion of under-fives sleeping under ITNs is on track). The country is on course to meet both the Abuja and MDG targets of .80% of children sleeping under ITNs. Goal 7 (proportion of population using improved drinking water source has been attained). Goal 8 (partnership for development). Completion point under the enhanced HIPC Initiative has been reached and the country is eligible for debt relief under the HIPC to the tune of US$66.6 million and under MDRI to the tune of approximately US$373.5 million in nominal terms over the next 43 years (IMF Press Release No. 07/302, December 20, 2007. In addition, significant strides have been made in the fight against malaria prevention and control.

République Togolaise. Code de la Santé Publique de la République Togolaise. 
Notes: This is a government document of a Togolese law representing the national code for public health (number unspecified). The code defines rights relating to the promotion and protection of public health for the population. This includes protection for individuals, families and the collective against illness or ill health.

Riley PL, Vindigni SM, Arudo J, Waudo AN, Kamenju A, Ngoya J, et al. Developing a Nursing Database System in Kenya. Health Services Research 2007 Jun;42(3 Pt 2):1389-405.
Ref ID: 210

Ronsmans C, Scott S, Qomariyah SN, Achadi E, Braunholtz D, Marshall T, et al. Professional Assistance During Birth and Maternal Mortality in Two Indonesian Districts. Bulletin of the World Health Organization 2009;87(6):416-23.
Ref ID: 8

Royal College of Midwives. Position Statement No. 7: Birth Centres.  2004 May.
Ref ID: 258
Notes: This document provides RCM's position statement regarding birth centres. Pregnancy and birth are viewed as normal physiological processes in which medical intervention is inappropriate unless it is clinically indicated and evidence-based. Birth centres offer a cost effective, safe and satisfying alternative for women who experience normal pregnancy and birth. Birth centres are midwife led and offer midwifery care to predominantly low-risk women throughout the antenatal, intrapartum and postnatal periods.

Rööst M, Altamirano VC, Liljestrand J, Essén B. Priorities in Emergency Obstetric Care in Bolivia - Maternal Mortality and Near-Miss Morbidity in Metropolitan La Paz. BJOG 2009;116(9):1210-7.
Ref ID: 379

Rwanda. Map of Health Facilities. 
Notes: This is a map of health facilities in Rwanda. Types of facilities include health centers, dispensaries, district hospitals, military hospitals, national referral hospitals, prison dispensaries, and health posts. Source not provided.

Safe Motherhood Programme Nepal. Ensuring Adequate Human Resources for Safe Delivery Services - Factsheet. 
Notes: Produced with support from DFID and Options. This is a factsheet that details the need for skilled human resources and the need for a human resource strategy to establish a system for rational development, deployment and management of trained staff to support quality services at all levels of health faculty across the country. It presents various facts relating to the state of delivery care and services available and highlights the need for action.

Sandall J, Homer C, Sadler E, Rudisill C, Bourgeault I, Bewley S, et al. Staffing in Maternity Units: Getting the Right People in the Right Place at the Right Time. London: The King's Fund; 2011.
Ref ID: 320
Notes: This report was commissioned by The King's Fund to answer a fundamental question: Can the safety of maternity services be improved by more effectively deploying existing staffing resources? This report considers the available evidence about the relationship between staffing levels and deployment practices and safety of care for mothers and babies. It focuses specifically on the intrapartum period, which refers to labour and birth. In so doing, the report considers different staffing models and approaches. In recognition that current practice is likely to be more advanced than the published literature, a small number of case studies have been used to offer examples of innovative activities. Key findings indicate that evidence of the financial implications of different staffing models is limited, midwife-led models of care appear to offer potential for cost-saving, and although evidence regarding cost-effectiveness of task-shifting is limited, some models, such as the use of nurses in maternity services appear to offer cost savings.

Schaferhoff M, Schrade C, Yamey G. Financing Maternal and Child Health - What are the Limitations in Estimating Donor Flows and Resource Needs? PLoS Medicine 2010;7(7):e1000305.
Ref ID: 20
Notes: This article investigates how much donor assistance is currently available for maternal, newborn, and child health (MNCH) and how much additional financing will be needed. The authors examine the best estimates for current donor assistance to MNCH and of future funding that will be needed to reach MDGs 4 and 5. The study concludes that important strategic decisions must be made to accelerate this progress and reliable estimates on the currently available financial resources and the funding gap are a critical precondition for sound decision making and for directing investments. The study finds that the current level of aid devoted to MNCH is inadequate, providing only a fraction of the total resources required to achieve the health MDGs. Donors also are not living up to their promises where actual monies received is well below the originally pledged amounts.

Seboni NM. Proliferation of New Health Cadres: A Response to Acute Shortage of Nurses and Midwives by Sub-Saharan African Governments. International Journal of Nursing Studies 2009 Aug;46(8):1035-6.
Ref ID: 33
Notes: This article addresses the global shortage of health care workers, particularly the shortage of nurses and midwives in sub-Saharan Africa. The source of this problem is multifaceted but a major contributing factor is the widening economic gap between the developing and developed world which has led to limited resources in poverty in many developing countries. The article identifies the critical role nurses and midwives play in a country's health care system and cites migration to other African countries as a contributing factor to the problem. The motivation to migrate has been created by inadequate salaries, lack of incentives, lack of retention strategies, and the major impact of HIV/AIDS which has resulted in increasingly heavy workloads and long work shifts. The author concludes that training is important but can only be a temporary measure. There needs to be a participatory approach to healthcare and governments need to scale up the health workforce, in particular nurses and midwives.

Sexual and Reproductive Health Care: Core Competencies in Primary Care.  2010.
Notes: This document presents a comprehensive list of the attitudes and 13 competencies required for the effective provision of high-quality sexual and reproductive health (SRH) services by the SRH team at the primary health-care level. The documents are divided into four domains: attitudes for providing high quality SRH care, leadership and management, general sexual and reproductive health competencies for health providers, and specific clinical competencies. Competencies are listed in table form under these domains. Source not provided.

Shankar A, Sebayang S, Guarenti L, Utomo B, Islam M, Fauveau V, et al. The Village-Based Midwife Programme in Indonesia. Lancet 2008 Apr 12;371(9620):1226-9.
Ref ID: 34
Notes: This article describes the Village-Based Midwife Programme launched by the Government of Indonesia in 1989 in response to the high maternal mortality rate. The programme goal was to place a skilled birth attendant in every village to provide antenatal and perinatal care, family planning and other reproductive health services, and nutrition counselling. This article outlines lessons learned from the programme. Key points for the scaling up of skilled birth attendance include a health-systems approach that is both to-down (with clear policies, standards and training) and bottom-up (from communities for participation, demand, and accountability). Quality care for all births and affordable and accessible high quality emergency obstetric care is essential. Programmes should also aim to establish a platform that can readily adapt to advances in service standards and other community-based interventions and be context-specific.

Sharan M, Ahmed S, Malata A, Rogo K. Quality of Maternal Health System in Malawi - Are Health Systems Ready for MDG 5? 
Notes: This document presents findings from a study which examined the quality of health systems in Malawi, specifically relating to availability, accessibility, infrastructure, process of care and management. The report highlights gaps in the care seeking process as contributing to maternal mortality and morbidity. Such gaps are found at the community level where lack of recognition of danger signs and cultural and financial barriers cause delays in seeking care, as well as at the facility level where quality of services are important determinants of patient survival. The findings confirm the shortage of human resources for health and identify a critical gap in the health system as low quality of patient care and management of maternity services.

Sharan M, Ahmed S, Naimoli JF, Ghebrehiwet M, Rogo K. Health System Readiness to Meet Demand for Obstetric Care in Eritrea: Implications for Results-Based Financing (RBF).  The World Bank; 2010 Sep.
Ref ID: 272
Notes: This document presents an overview of the results-based financing strategy in Eritrea. RBF is an umbrella term encompassing both supply and demand side approaches for increasing the quantity and improving the quality of essential high impact health services through the provision of financial and/or in-kind incentives to a range of actors after measurable actions have been taken. Such schemes include performance based financing, performance based contracting, voucher schemes and conditional cash transfers. This document concludes that although financial incentives may improve utilization of health care, they may not impact health outcomes unless a minimum supply of effective health services is ensured. Where health systems are weak, strategies for demand creation are found to have the greatest impact on utilization of emergency obstetric care when accompanied by interventions to upgrade health facilities and improve quality of care.

Sharma B, Mavalankar D. Towards Midwifery for Maternal Care: A Road Map for India - Discussion Paper Prepared Based on Work Done by Consortium on Midwifery & EmOC.  2009 Sep 4.
Ref ID: 376
Notes: This document is a road map for midwifery prepared for the Centre for Management of Health Services, Indian Institute of Management, Ahmadabad. This paper suggests short and long-term actions to professionalize midwifery for community and institution based maternal and newborn care services. The short-term actions suggested are to increase the duration of in-service SBA training. Long-term actions suggested are to restart and upgrade the auxiliary nurse midwife course and make it into two streams: public health midwife and public health nurse with separate registrations. The paper also suggests the need to strengthen supervision of midwives and to improve the quality of midwifery pre-service education by creating dedicated midwifery teachers with joint posting in hospitals and schools and colleges so that they can practice and teach midwifery enriching both teaching and practice.

Sherratt DR, White P, Chhuong CK. Report of Comprehensive Midwifery Review (Cambodia). 2006 Sep.
Ref ID: 67
Notes: Report produced by the Ministry of Health, Kingdom of Cambodia. This report contains the results and recommendations from a comprehensive review of midwifery in Cambodia undertaken as an important component of the Mid-Term Review (MTR) of the Health Sector Strategic Plan, 2003-07 (HSP), and the Health Sector Support Project, 2003-07 (HSSP). Efforts to date appear to be having a positive impact. However, the results of this Comprehensive Midwifery Review do indicate that, to be able to move onto the next phase there is need for a change of focus. An emphasis that looks more towards quality of services, and focuses on ensuring that midwifery practitioners have minimum competencies. The document calls for a modification to the curriculum as well as highlights the need to establish a national, independent and a externally verifiable examination process.

Shiffman J, Ved RR. The State of Political Priority for Safe Motherhood in India. BJOG 2007 Jul;114(7):785-90.
Ref ID: 35

Sibley L, Sipe TA, Koblinsky M. Does Traditional Birth Attendant Training Improve Referral of Women with Obstetric Complications: A Review of the Evidence. Social Science & Medicine 2004 Oct;59(8):1757-68.
Ref ID: 36

Silva E, Batista R. Seguros de Salud y su Impacto en la Salud Materno Infantil de las Poblaciónes Indígenas y Rurales de Bolivia.  2009.
Ref ID: 381
Notes: This document is a series of slides providing an overview of maternal and newborn health policy in Bolivia. It outlines the context of the situation and provides data on maternal and newborn health indicators and the different types of health insurances available. Implications for policy indicate that any strategy to reduce maternal and neonatal deaths needs to be accompanied by reproductive health programs. The authors cite a need for policies and interventions to be developed in accordance with the differing needs of rural and indigenous populations.

Silva E, Batista R. Bolivian Maternal and Child Health Policies: Successes and Failures.  The Canadian Foundation for the Americas (FOCAL); 2010 May.
Ref ID: 380
Notes: This document is a report for the Canadian Foundation for the Americas (FOCAL), undertaken with financial support of the Government of Canada provided through the Canadian International Development Agency (CIDA). This report provides an overview of maternal and newborn health policy reform efforts undertaken in Bolivia and suggests that despite efforts such as the implementation of new health insurances, conditional cash transfers, and decentralization to give local governments more power to deliver more focused and effective policies, the results have fallen short. Improvements in access and supply of health services have been confined to urban and surrounding areas while rural and marginalized populations face growing levels of inequalities and inequities.

Skilled Birth Attendants 10 Years Later.  7-2-2009.
Notes: This document is a personal communication discussing the author's views on skilled birth attendance. The author states that the term "skilled birth attendant" has been problematic at many levels. Where the original intention of the Skilled Birth Attendant Initiative has been to allow governments to invest in an appropriate skill mix dependant on the needs of their country, instead it has led to the creation of a new cadre of workers where there are no established standards for training, regulation, practice or supervision. The goal to improve maternal health is to establish global standards for midwifery education and regulation and update global competencies. This task set out by ICM is stated to be carried out in the next two years.

Smith JM, Currie S, Azfar P, Rahmanzai AJ. Establishment of an Accreditation System for Midwifery Education in Afghanistan: Maintaining Quality During National Expansion. Public Health 2008 Jun;122(6):558-67.
Ref ID: 266

Soguel D. 'Gravity Birth' Pulls Women to Ecuador Hospital.  Women's eNews; 9 A.D. Feb.
Ref ID: 276
Notes: This is an article from "womensenews" about a hospital in Ecuador that runs a "vertical maternity ward". Given many women's preference for traditional childbirth methods common in Ecuador, the program was implemented as a way to promote and increase the occurrence of hospital delivery. The Ministry of Health has called for this strategy in 2008 in efforts to lower rates of maternal and neonatal mortality and to meet the MDG goals. So far the strategy has met with success and other hospitals in the country are following the example.

Spero JC, McQuide PA, Matte R. Tracking and Monitoring the Health Workforce: A New Human Resources Information System (HRIS) in Uganda. Human Resources for Health 2011 Feb 17;9(1):6.
Ref ID: 270

Streatfield PK, El Arifeen S. Bangladesh Maternal Mortality and Health Care Survey 2010 Summary of Key Findings and Implications.  2010.
Ref ID: 257
Notes: With contribution from USAID, Australian Government Aid Program, UNFPA, Measure Evaluation, ICDDR,B and NIPORT. This document presents findings from a 2010 survey to provide a maternal mortality estimate for the period 2008-2010. The objective of this survey was to determine whether MMR has significantly declined from 1998-2001 when the first national survey was conducted. Other stated objectives are to identify specific causes of maternal deaths, to assess the level of use of antenatal and postnatal care, to collect information on birth planning and to assess the experience of and care seeking for maternal complications and changes in care seeking pattern during 2005-2009. The findings suggest that MMR has declined and that Bangladesh appears to be on track to achieving MDG 5.

Šiupšinskas G. Training on Effective Perinatal Care for University Teachers (22-26 March 2010). Dushanbe, Tajikistan: UNFPA; 2010.
Ref ID: 215
Notes: This report summarizes the events of a WHO training package on effective perinatal care for university teachers. The author of this document was invited by UNFPA Tajikistan to direct and facilitate this training. The aim of the visit was to coordinate and supervise training for university teachers in obstetrics and neonatology in WHO Euro evidence-based package "Effective Perinatal Care", up to date clinical family-centered and efficient interventions aimed at reduction of maternal and perinatal morbidity and mortality and improvement of quality of perinatal care. Existing barriers and difficulties of implementation of evidence-based perinatal care were identified. The possible solutions were discussed. Based on the results of the course trainees drafted their own plans of action for implementation of proposed strategies. Presented plans revealed insufficient awareness of participants about real clinical problems existing in their institutions which is consequence of separation of teaching and clinical staff and their responsibilities in the maternities.

Tamang L. Project Development on Addressing shortage of Skilled Birth Attendants in Nepal Through Bachelor of  Midwifery Program.  2009.
Ref ID: 84
Notes: This document provides details of a programme to produce competent midwives in Nepal through a multidisciplinary healthcare team providing safe, sensitive, ethical care meeting the physical, psychological, spiritual, cultural and religious needs of women and their families, especially on the area of safe motherhood, reproductive health and child health services. It is a three year Bachelor programme to address the shortage of Skilled Birth Attendants. This program is governed under the Government of Nepal Public-Private Partnership Policy.

Tamang L. A Summary of Nurse-Midwife Education in Nepal.  2011.
Notes: This document is an email of a digest (source not provided) about nursing and midwifery Schools in Nepal. It provides a summary of the types of nursing and auxiliary nurse-midwife courses available. The author cites limited job opportunities due to a mismatch of supply versus demand in the context of available training courses. The author provides a general overview of the situation and states that there is still a vast amount of work which needs to be done to improve the quality of nursing education in Nepal.

Tanzania. Report on the Dissemination Workshop for Studies on Health Worker Retention in Tanzania.  2008.
Ref ID: 225
Notes: The workshop held on 19th June, 2008, was organized by the National Institute for Medical Research (NIMR) in collaboration with Capacity Project and Ministry of Health and Social Welfare (MOHSW). It was attended by participants from NIMR, MOHSW including the Director for human resources development, Dr Gilbert Mliga, Presidents Office Public Services Management, District Executive Directors of selected councils and donors (USAID, Irish Aid and WHO). The aim of the workshop was to disseminate results from human resources for health (HRH) studies done by NIMR, in collaboration with the Capacity Project and MOHSW, and seek participants' inputs to guide the MOHSW to formulate appropriate strategies to improve the retention of health workers.

Tanzania Nurses and Midwives Council. Number of Male and Female Nurses in Specified Region.  2010 May 10.
Ref ID: 324
Notes: This is a table that lists the numbers of nurses per region in Tanzania. It provides numbers on male and female nurses and whether they are enrolled or registered.

Temmar F. La Formation des Sages Femmes au Maroc Comme Ressource Déterminante dans la Réduction de la Mortalité et la Morbidité Maternelle et Périnatale. 
Notes: Produced by Division de la Formation, Ministère de la santé  Maroc, this document details the formation of the midwifery profession in Morocco and highlights the role of the midwife as a key determinant in the reduction of maternal and neonatal moratality. This document provides a description of the midwifery education reform which took place in 1994. The document details encouraging results of the state of Morocco's midwifery such as an increased number of operational training institutes and qualified midwives.

Temmar F. Midwifery Training in Morocco: A Crucial Resource for MNMMR. 
Notes: This document provides a short overview of the reform of midwifery training in Morocco. The MOH in Morocco underwent an in-depth reform of human resources, with particular emphasis on professionals concerned with maternal and neonatal mortality and morbidity reduction as well as reproductive health. The author cites encouraging results after 10 years of reform including: the implementation of more training institutes in all parts of the country, new posts created in peripheral facilities, improved pedagogic methods and revised curricula.

Temmar F. La Formation de la Sage-Femme au Maroc.  2005.
Ref ID: 81
Notes: Produced by Division de la Formation Ministère de la santé Maroc, this document presents a history of the development of the midwifery profession and training in Morocco before and after 1994 when an education reform took place and subsequently identifies challenges which need to be met. Maternal mortality is high in the country and there still seem to be shortages of professional recognition of midwifery practice. This document stresses the importance of midwifery training and a focus on women-centered care to make midwifery services more visible in the professional community.

ten Hoope-Bender P, Liljestrand J, MacDonagh S. Human Resources and Access to Maternal Health Care. International Journal Of Gynecology And Obstetrics 2006 Sep;94(3):226-33.
Ref ID: 40
Notes: Accession Number: 16904675. Language: English. Date Created: 20060904. Date Completed: 20070207. Update Code: 20101124. Publication Type: Journal Article. Journal ID: 0210174. Publication Model: Print-Electronic. Cited Medium: Print. NLM ISO Abbr: Int J Gynaecol Obstet Linking ISSN: 00207292. Subset: IM. Date of Electronic Publication: 2006 Aug 10

NSRKT 0906 389 Royal Decree Establishment of Cambodian Midwife Council,  The Royal Government of Cambodia, (2006).
Ref ID: 68
Notes: Informal translation of a royal decree establishing a midwife council. This document orders the establishment of a midwife committee with the purpose of gathering all qualified midwives who perform medical professional and para-clinic professional in the Kingdom of Cambodia. This does not include an already separate policy for traditional midwives. The document outlines the necessary moral, administrative, judicial, counseling, and mutual assistance functions.

Thompson JB. Midwifery Education: Building Global Consensus. The ICM Global Standards for Midwifery Education.  2010.
Notes: This is a PowerPoint presentation by the co-chair of the ICM Task Force on Standards. The presentation discusses the role of education in preparing fully qualified midwives to meet MDGs, the need for global midwifery standards (background review and challenges), the ICM collaborative process for reaching global consensus, draft ICM/WHO midwifery standards and reflections for the future. Lessons found include the need to provide support for the education of fully qualified midwives in resource poor nations, the need for agencies to work together to avoid 'quick fixes' as alternatives to midwife, and standards and guidelines need to be specific to country needs.

Timor-Leste. Links to Related Documents. 
Notes: This document provides a list of links to documents relating to health in East Timor. Links include: DHS 2009-10, Health Sector Strategic Plan 2008-12, Basic Services for Primary Health Care and Hospitals, Timor-Leste Health Seeking Behaviour, and the National Reproductive Health Strategy 2004-15.

Timor-Leste. Ministry of Health Projects Related to Maternal and Newborn Health. 
Notes: This is an excel spreadsheet listing projects relating to maternal and newborn health in East Timor. The table lists the name of the project, donor, implementing agency, expected outcomes and funding and financial data.

Togo. Togo Répartition de  la  Population et la Superficie par Région et par Préfecture en 2008. 
Notes: This document contains tables and graphs detailing the evolution of the population and distribution of Togo. Data is taken from the Direction Générale de la Statistique et de la Comptabilité Nationale. Source of document not provided.

Togo. Togo Répartition du Personnel de la Santé de Tous les Secteurs Selon les Catégories Professionnelles et les Région d'Occupation. 
Notes: This document presents a more detailed table of the distribution of health personnel in Togo. It lists personnel according to their professional category and region of occupation (general medicine, cardiology etc). Source not provided.

Togo. Togo Répartition des Ressources Humaines dans le Secteur de la Santé. 
Notes: This document presents a brief table of the distribution of human resources for health in Togo: doctors, nurses, and paramedical. Data from the table comes from Données du Ministère de la Santé (DAC/DARH). Source of this document not provided.

Togo. Togo Country Factsheets.  11.
Notes: These slides present a summary of Togo relating to midwifery and human resources for health. The first slide lists statistics: demographics, education, MDG 5 indicators, midwifery workforce, education, regulation and policies. The following slides detail a general overview of the country in the context of MDG 5 and women and newborn health. The document details the shortage of midwives in the country and states that there are significant variations in the distribution of midwives between urban and rural areas. This document highlights the need to review existing midwifery education modules, develop a monitoring and evaluation system, and organize continuing education schemes to reinforce midwife capacities and competencies. Source not provided.

Togo. Répartition du Personnel de la Santé de tous les Secteurs selon les Catégories Professionnelles et les Région d'Occupation.  2009.
Notes: This document is an excel spreadsheet listing the distribution of medical personnel in Togo according to professional category and region of employment.

Togo. Évolution de la Contraception de 1988 à 2006.  2011.
Notes: This document presents a table and a graph detailing the evolution and prevalence of contraceptive use in Togo from 1988 to 2006. The document shows modern contraceptive use has gone up since 1988 and traditional contraceptive methods have gone down. Source not provided.

Uganda. Uganda Facility Inventory.  2010.
Ref ID: 231
Notes: This document is a spreadsheet detailing facility inventory in various districts of Uganda. Source not provided.

Une Maternité pour les Hmongs MSF-F.  6-6-2010.
Notes: This is a two page document describing the development of a maternity clinic in the Hmong refugee camp of Petchabun in northern Thailand. It is written in interview style and asks the interviewee a series of questions relating to the opening of the maternity clinic. The clinic offers services that are culturally sensitive to Hmong traditions during childbirth, such as burial of the placenta. Source not provided.

UNFPA. 18-Month Training Programme for Ethnic Minority Women in Vietnam.  Good Practices from Asia and the Pacific - Country: Vietnam.
Notes: This document is a UNFPA country profile documenting the effectiveness of a training strategy for health care workers working in ethnic minority regions of Vietnam. The document highlights the high mortality ratios found in remote and mountainous ethnic minority areas are due to a shortage of skilled birth attendants, low capacity of healthcare workers in ethnic minority regions and cultural barriers limiting the access of ethnic minority women to reproductive health services. In this context, an ethnic minority midwifery (EMM) training programme has been implemented. This document is a brief progress review and states that the inclusion of the EMM strategy in the national Joint Annual Health Review 2010, developed by the MOH and the Health Partnership Group demonstrates positive outcomes.

UNFPA. Family Planning and Emergency Obstetric Care Facility Assessment in Seven Pacific Countries. November 2005 - June 2008. Federated States of Micronesia, Kiribati, Samoa, Solomon Islands, Tonga, Tuvalu, & Vanuatu. 
Notes: This is UNFPA report on the availability of family planning and emergency obstetric care in 7 Pacific countries. From the end of 2005 to the middle of 2008 the UNFPA Pacific Sub Regional Office conducted Family Planning (FP) and Emergency Obstetric Care (EmOC) Facility Surveys in seven Pacific countries - Federated States of Micronesia, Kiribati, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu. Of these countries all except the Federated States of Micronesia and Tonga are classified as a least developed country (LDC). This report provides a synopsis of the main findings from each of the surveys of the seven countries. The components of the survey include general FP and EmOC information, general facility data (number of beds, availability of blood products), equipment and supplies, personnel, service statistics and service volumes, support systems for EmOC, direct observation in delivery room, observation in labour and postpartum rooms, and observation of clinical records.

UNFPA, International Confederation of Midwives. Programme Investir dans les Sages-Femmes en Côte d'Ivoire: Experience en Matière de Renforcement des Compétences d'Environ 300 Sage Femmes en Instance d'Affectation. 
Notes: This document is a UNFPA/ICM factsheet discussing a programme for the reinforcement of midwifery competencies and the development of the midwifery profession in the Ivory Coast. The UNFPA/ICM programme created in 2009, aimed to identify the insufficiencies relating to midwife formation and the level of quality of training to become a midwife. Working with the MOH, the program oversaw the retraining of 290 new midwives.

UNFPA. The Maternal Health Thematic Fund. Preliminary EmONC Results from Data Analysis Workshop: Guyana. 
Notes: This document is a UNFPA report on the Maternal Health Thematic Fund (MHTF) in Guyana. This report provides an update to CORE team members on the main findings of the EmONC census of all maternity facilities in Guyana.  In addition to the main findings some background information is included on the indicators (Monitoring Obstetric Care Handbook) for ease of reference and assistance in interpreting the results. Based on country indicators, Guyana was selected in 2008 and began receiving support in 2009 from the MHTF for four areas of work: human resources for maternal health, emergency obstetric and newborn Care (EmONC), family planning, monitoring and evaluation. This document provides preliminary results from a data analysis workshop.

UNFPA, ICM, WHO, SIDA (Sweden), Immpact, & FCI. "Midwifery in the Community: Lessons Learned" - First International Forum on Midwifery in the Community 11-15 December 2006, Hammamet, Tunisia. 
Notes: This is a UNFPA-ICM Joint Initiative to support the call for a Decade of Action for Human Resources for
Health made at World Health Assembly 2006. This is a report based on the Forum which brought together experts from 22 low and middle-income countries in four regions of the world (Africa, Asia, Middle East and Latin America and the Caribbean) to consider how midwifery care in the community could be scaled-up. The objective of the forum was to collate knowledge and experience in developing policy and programme guidance for low-income countries wishing to strengthen their community midwifery workforce to save the lives of mothers and newborns. Six main themes were highlighted by the forum for the scaling-up of human resources for safe maternal and newborn care: getting on to the political radar screen, ensuring that the poor and hard to reach have midwifery care, education, supervision, enabling factors, and monitoring and evaluation.

UNFPA. No Woman Should Die Giving Life.  Facts and Figures 3.
Notes: This document is a UNFPA factsheet about skilled care during childbirth. This factsheet provides an overview of the importance of investing in human resources to reduce occurrences of maternal and newborn mortality, with particular emphasis on the role of midwives. The factsheet outlines the current state of skilled personnel worldwide and cites pertinent issues such as lack of trained personnel, inadequate training, brain drain, and cultural issues and lack of sensitivity which need to be addressed in order to improve health outcomes for mothers and newborns. In order to tackle these issues, the document cites a need for donor communities and countries to invest more in midwife training and retention, high-level political commitment, education, training, regulation, proper supervision, and labour protection, such as remuneration and incentives.

UNFPA. Expectation and Delivery: Investing in Midwives and Others with Midwifery Skills.  2006. UNFPA Maternal Mortality Update 2006.
Notes: This is the fourth issue of the Maternal Mortality Update which is published every two years by the Technical Support Division of UNFPA, prepared in collaboration with the International Confederation of Midwives. This document is intended to provide information about UNFPA institutional priorities and programmes relating to maternal mortality and morbidity reduction. This issue focuses on the key staff responsible for maternal health care: midwives and others with midwifery skills. It includes reports from all four of UNFPA's geographic divisions. The report stresses the importance of quality training and highlights the need for a comprehensive human resource policy which addresses overall numbers; recruitment, training, deployment and retention rather than just healthcare providors already in the system.    

UNFPA. Towards MDG 5: Scaling up the Capacity of Midwives to Reduce Maternal Mortality and Morbidity (Workshop Report). New York; 2006.
Ref ID: 109
Notes: This report documents the UNFPA workshop aimed to contribute to the scaling up of midwifery capacities and respond to the global focus  on human resources for health. The workshop included midwives from developing and industrialised countries, and midwifery advisors working at the international level. The discussions centered on the major barriers to the development of midwifery skills and proposed solutions. Recommendations included UNFPA taking a global role in saving women's lives, partnerships between UNFPA, ICM, FIGO and others to take a stand on the definition of a midwife,  referring to "Midwives and Others with Midwifery Skills (MOMS) rather than "skilled birth attendants", UNFPA establishing key messages for wide dissemination, UNFPA coordinating activities with all partners and taking a leadership role in the global health forum to demand attention given to women and the position of women health providers, promoting the need for woman-centered care, and formal communication to WHO to request the inclusion of nurses and midwives in all emergency assessments.

UNFPA. Grossesse, Accouchement, et Plus… : Investir dans les Sages-Femmes et Autres Personnels Compétents dans la Pratique de Sage-Femme.  2007 Apr.
Ref ID: 80
Notes: French draft of Ref ID 79. This is the fourth issue of the Maternal Mortality Update which is published every two years by the Technical Support Division of UNFPA, prepared in collaboration with the International Confederation of Midwives . This document is intended to provide information about UNFPA institutional priorities and programmes relating to maternal mortality and morbidity reduction. This issue focuses on the key staff responsible for maternal health care: midwives and others with midwifery skills. It includes reports from all four of UNFPA's geographic divisions. The report stresses the importance of quality training and highlights the need for a comprehensive human resource policy which addresses overall numbers; recruitment, training, deployment and retention rather than just healthcare providors already in the system.    

UNFPA. Midwifery Programme, Annual Report 2009 (Uganda). Uganda: UNFPA; 2009.
Ref ID: 230
Notes: This document is a UNFPA annual report for Uganda. This document presents a report on a year-long project to increase access to and utilization of quality maternal health services in order to reduce maternal mortality. The report finds that there is growing realization at the Ministry of Health and by professional bodies that the comprehensive nurse training has not been able to contribute much to the reduction of maternal mortality and therefore, there is an urgent need for reintroduction of vertical midwifery training in Public training schools. The curriculum for the Comprehensive Nurse programme also needs to be reviewed to make it suitable for training not only nurses, but midwives as well. Recommendations cited are to mobilize additional resources and prioritize implementation of the Midwifery Improvement Plan.

UNFPA. The State of Midwifery Training, Service and Practice in Uganda: Assessment Report.  2009 Jul 9.
Ref ID: 107
Notes: This needs assessment study is one of the key interventions of a project initiated by Uganda to scale-up midwifery capacities and building the profile of midwifery in the country. This project stems from a joint initiative launched by UNFPA and ICM aimed to build national capacity in low-resource countries to increase skilled attendance at all births . The study identifies gaps and needs in midwifery training, practice and regulation as bases for developing interventions to integrate the full continuum of maternal health care in the national health system. The study shows that there is a shortage of skilled midwives and poor employment opportunities and recommends that the government should set up a framework for employment to strengthen midwifery services nationwide.

UNFPA, UNICEF, World Health Organization, AMDD, MSIS. Évaluation des Besoins en Matière de Soins Obstétricaux et Néonatals d'Urgence à Madagascar.  2010 Mar.
Ref ID: 315
Notes: This document presents a report on emergency obstetric care in Madagascar. This report is an evaluation produced by UNFPA and the Madagascar Ministry of Publich Health, with collaboration from UNICEF, WHO, AMDD, and PACT MSIS. The aim of the evaluation is to determine the actual capacity of health facilities in regards to meeting the needs of pregnant women and newborns, such as the availability of EmONC facilities. The report identifies that a number of facilities providing EmONC do not meet preferred standards. Many lack proper infrastructure, materials, and knowledge of basic competencies. The report highlights the value of reinforcing community capacity and mobilization as a potential contribution to improving the situation.

UNFPA, Population Reference Bureau. Country Profiles for Population and Reproductive Health.  2010.
Ref ID: 108
Notes: This country profile document was produced in recognition of the 15th anniversary of Cairo's 1994 International Conference on Population and Development. This edition is an update of the 2005 volume. The report presents basic demographic trends, social and economic indicators, and statistics on maternal and child health, adolescent reproductive health, education, HIV/AIDS, gender equality, and reproductive health demand. All data were collected prior to 2009.

UNFPA. Towards MDG 5: Scaling Up the Capacity of Midwives: Workshop Report, New York, 21-23 March 2006.  2011.
Ref ID: 372
Notes: This document is a UNFPA report of a workshop held in New York in 2006 discussing the scaling up of midwives to reach MDG 5. The workshop aimed to identify new ways of working with and supporting midwifery in order to build countries' midwifery capacity. The sessions of the workshop were arranged for the most part on a regional basis, with the exception of one session where groups were convened around contextual situations, such as: very high maternal mortality and morbidity, poverty and low coverage by skilled birth attendant; high maternal mortality and morbidity in countries with transitional and mixed economy; and high maternal mortality and morbidity in conflict and complex situations. Some recommendations to UNFPA resulting from the workshop include UNFPA taking on a global role in saving women's lives, working with other major organizations to take a stand on the definition of a midwife where rather than "skilled birth attendants", UNFPA should always refer to Midwives or Others with Midwifery Skills (MOMS), and that UNFPA should promote the need for women-centred care, whether facility or community care.

UNICEF, Ministry of Health Djibouti. Évaluation des Besoins en Soins Obstétricaux et Néonataux d'Urgence en République de Djibouti.  2005 Nov.
Ref ID: 300
Notes: This document presents an evaluation of emergency obstetric and neonatal care needs in Djibouti. The report, produced by the Reproductive Health Team and UNICEF/Djibouti provides a general overview of maternal and neonatal mortality in Djibouti and presents an evaluation of emergency obstetric care needs in the context of the availability and quality of services within the health system. The document provides an overview of available human resources, in particular maternal and neonatal health workers.

UNICEF. Support to the Safe Motherhood Programme Maternal and Newborn Health Project - Needs Assessment of the Availability of Emergency Obstetric Services in Eight Districts.  2006.
Ref ID: 145
Notes: This document details a needs assessment survey which was conducted in eight districts in Nepal selected for implementation of the Maternal and Newborn Health Project. The objectives of this assessment are stated as to assess the status of MNH services and to compare the present status of EmOC services and assess changes in service delivery. The survey assesses infrastructure of health facilities, human resources, evidence based practices, and travel time and utilization of EmOC services. The document finds the human resource situation to be inadequate for MNH service provision and poor infrastructure of hospitals. Positive results showed that newborn care practices are being practiced reasonably well in health facilities but further strengthening is still needed.

UNICEF, UNFPA, World Bank, World Health Organization. UN Agencies Joint Statement on MDG 5.  World Health Organization; 2008 Sep 25.
Ref ID: 325
Notes: This document is a joint statement on behalf of UNICEF, UNFPA, World Bank, and WHO. The statement presents the above partners' consent to enhance support to the countries with the highest maternal mortality. Efforts will be made to strengthen health systems to achieve MDGs 4 and 5. This will be done through working with governments and civil society to strengthen national capacity. Efforts will include: conducting needs assessments and ensure health plans are MDG-driven and performance based, costing national plans, scale-up quality health services, address the need for skilled workers, financial barriers to access, tackle the root causes of maternal mortality, and strengthening monitoring and evaluation systems.

UNICEF. 2009 Coverage Evaluation Survey: All India Report.  2010.
Ref ID: 309
Notes: This document is a UNICEF report on the 2009 coverage evaluation survey conducted in India. At the request of Government of India, UNICEF planned and conducted a coverage evaluation survey in 2009 (CES 2009) to assess the impact of NRHM (National Rural Health Mission )strategies on coverage levels of maternal, newborn and child-health services including immunization among women and children. CES 2009 covered all the States and Union Territories of India. The NRHM was launched by the government in India in 2005 to improve health care for rural populations and included goals such as increasing contraceptive use by eligible couples, reducing unmet need for birth spacing, increase the use of skilled care during childbirth, improve postnatal and newborn care, better access to emergency obstetric services and care of sick children, and improved coverage for childhood immunization. This document presents the results in table form.

USAID. Achieving the MDGs. The Contribution of Family Planning: Democratic Republic of Congo.  Health Policy Initiative.
Notes: This document is a 2 page country brief for the Democratic Republic of Congo as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in the DRC. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of nearly 4 to 1.

USAID. The Emerging Midwifery Crisis in Ghana: Mapping of Midwives and Service Availability Highlights Gaps in Maternal Care.  2006 Jun.
Ref ID: 110
Notes: This document reports findings from a study of midwives in 10 districts of five regions in Ghana to examine specific sill sets, scopes of practice, and referral systems to identify gaps in access and service delivery, legal and operation barriers to practice, and geographical disparities in coverage. The report finds that midwives in Ghana share similar concerns and challenges as other critical healthcare providers despite differences in professional affiliation and training. Midwives require expanded pre- and in-service training opportunities and more resources to enhance the scope and quality of the services they are able to provide. The combination of an aging midwife population, inadequate salaries, and few incentives to remain in rural areas all pose challenges to reducing maternal and child mortality by supplying skilled providers who attend deliveries and provide services.

USAID. Tanzania: Population, Reproductive Health and Development.  2006 Dec.
Ref ID: 291
Notes: This document is a USAID funded report produced in collaboration with the Population Planning Section of the Tanzania Ministry of Planning, Economy and Empowerment. The report is designed as a guide to contribute to the design and implementation of strategies relating to population issues and their role in the social and economic development of the nation. It presents an overview of current population trends in Tanzania and how such trends might affect the long term development of the country. Given the rapid growth rate in the country, policy initiatives that take into account family planning and contraceptive security are noted as relevant factors for development initiatives and are discussed in this report.

USAID. Achieving the MDGs. The Contribution of Family Planning: India.  2009 Jul.
Ref ID: 292
Notes: This document is a 2 page country brief for India as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in India. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 13 to 1.

USAID. Achieving the MDGs. The Contribution of Family Planning: Nepal.  2009 Jul.
Ref ID: 293
Notes: This document is a 2 page country brief for Nepal as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Nepal. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 4 to 1.

USAID. Atteindre les OMDs. La Contribution de la Planification Familiale: Burkina Faso.  2009 Jul.
Ref ID: 275
Notes: This document is a 2 page country brief for Burkina Faso as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Burkina Faso. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 3 to 1.

USAID. Achieving the MDGs. The Contribution of Family Planning: Jordan.  2009 Jul.
Ref ID: 290
Notes: This document is a 2 page country brief for Jordan as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Jordan. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 17 to 1.

USAID. Achieving the MDGs. The Contribution of Family Planning: Malawi.  2009 Jul.
Ref ID: 289
Notes: This document is a 2 page country brief for Malawi as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Malawi. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 2 to 1.

USAID. Achieving the MDGs. The Contribution of Family Planning: Uganda.  2009 Jul.
Ref ID: 294
Notes: This document is a 2 page country brief for Uganda as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Uganda. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 2 to 1.

USAID. Achieving the MDGs. The Contribution of Family Planning: Bangladesh.  2009 Jul.
Ref ID: 287
Notes: This document is a 2 page country brief for Bangladesh as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Bangladesh. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 6 to 1.

USAID. Achieving the MDGs. The Contribution of Family Planning: Ethiopia.  2009 Jul.
Ref ID: 281
Notes: This document is a 2 page country brief for Ethiopia as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Ethiopia. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 2 to 1.

USAID. Achieving the MDGs. The Contribution of Family Planning: Kenya.  2009 Jul.
Ref ID: 282
Notes: This document is a 2 page country brief for Kenya as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Kenya. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 4 to 1.

USAID. Atteindre les OMDs. La Contribution de la Planification Familiale: Madagascar. 2009 Jul.
Ref ID: 283
Notes: This document is a 2 page country brief for Madagascar as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Madagascar. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 3 to 1.

USAID. Program Evaluation of the Pre-service Midwifery Education Program in Afghanistan. Final Phase One Report.  2009 Sep 16.
Ref ID: 111
Notes: This is a programmatic evaluation of midwifery education in Afghanistan to identify the strengths and weaknesses of these programs. The evaluation was funded by USAID and implemented by Health Services Support Project. Pre-service midwifery programs were assessed to describe needs (of Afghan women and their families for available and good quality maternal and newborn care), processes (such as student recruitment), outputs (to increase the number of graduate midwives in Afghanistan and time estimated to reach national coverage with current output of midwife graduates), outcomes (delivery of maternal health care and services, and impact (estimated maternal deaths averted by midwifery graduates. The report finds that women in the communities were satisfied with care received from midwives and viewed them as having a positive impact as role models.

USAID. The Health and Population Policy of Uttarakhand: A Review.  2009 Aug.
Ref ID: 296
Notes: This document presents a review of the health and population policy in Uttarakhand, India as part of the USAID Health Policy Initiative, Task Order 1. The policy is designed to improve the health status and quality of life of the population; alleviate inequalities in access to healthcare; address leading and emerging health concerns; and, eventually, stabilize growth of the population. As the first state in India to adopt an integrated health and population policy, this document reviews the policy six years after its implementation and is designed as an assessment of its progress and achievements, as well as identifying barriers. Recommendations from the assessment include: decentralized planning, integrated approaches between programmes and social development departments, clearer financial guidelines and systems, infrastructure development, human resource planning and development, and public private partnerships.

USAID. Achieving the MDGs. The Contribution of Family Planning: Bolivia.  2009 Jul.
Ref ID: 288
Notes: This document is a 2 page country brief for Bolivia as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Bolivia. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 8 to 1.

USAID. Atteindre les OMDs. La Contribution de la Planification Familiale: Mali.  2009 Jul.
Ref ID: 284
Notes: This document is a 2 page country brief for Mali as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Mali. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 3 to 1.

USAID. Achieving the MDGs. The Contribution of Family Planning: Niger.  2009 Jul.
Ref ID: 285
Notes: This document is a 2 page country brief for Niger as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Niger. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 3 to 1.

USAID. Atteindre les OMDs. La Contribution de la Planification Familiale: Sénégal. 2009 Jul.
Ref ID: 286
Notes: This document is a 2 page country brief for Senegal as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Senegal. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 6 to 1.

Viet Nam. Reaching Out to Minorities in Viet Nam with Midwives who Speak their Language. UNFPA News: Feature Story . 17-9-2010. 5-2-2011.
Notes: This is a UNFPA feature story midwives working with ethnic minorities in Vietnam. The story highlights the importance of culturally sensitive practice and the use of local langauges. This story reports on the experiences of trainees involved in the UNFPA 18 month MIdwife Training Programme for ethnic minority women.

Voetagbe G, Yellu N, Mills J, Mitchell E, Adu-Amankwah A, Jehu-Appiah K, et al. Midwifery Tutors' Capacity and Willingness to Teach Contraception, Post-Abortion Care, and Legal Pregnancy Termination in Ghana. Human Resources for Health 2010;8:2.
Ref ID: 413

Walker G. A Review of the Population and Reproductive Health Situation in the Republic of Tajikistan. Tajikistan: UNFPA; 2008 May.
Ref ID: 219
Notes: This document undertaken for UNFPA is a review of the state of reproductive health in Tajikistan. UNFPA programme guidelines identify the need to periodically undertake a review and analysis of the causes of a country's critical population, and reproductive health issues in order that they can be taken into account when the UNDAF is prepared. This review addresses safe motherhood, family planning and contraceptive security, STIs and HIV/AIDS, adolescent sexual and reproductive health, issues and underlying causes related to reproductive health, gender and disaster occurrence, preparedness and response.

Walker G. Evaluation of the Reproductive Health Component of the Second UNFPA Tajikistan Country Programme 2005-2009. Tajikistan: UNFPA; 2009 Jun.
Ref ID: 220
Notes: This UNFPA document is part of a mandatory periodical review of a country programme. This UNFPA Tajikistan Country Programme (2005-2009) is the Second UNFPA Country Programme for Tajikistan supported by UNFPA.  The goal of the Second UNFPA Country Programme is to "contribute to poverty reduction by focusing on reproductive health/family planning, population and development, and women's empowerment."  Achievements of the RH component of this country programme are most notably those with regard to efforts to improve the quality of maternity care, a functioning contraceptive management logistics information system, and increasing awareness among young people of RH issues including HIV/AIDS. Other activities contributing to improving quality of reproductive care include trainings in integrated comprehensive RH using evidence-based approaches and provision of essential equipment and screening tests necessary for effective care.

Walker J, Jokinen, M. Birth Centre Resource: A Practical Guide. United Kingdom: The Royal College of Midwives Trust; 2010 Nov.
Ref ID: 98
Notes: This is a follow-up document to RCM's 2009 'Standards for Birth Centres in England: A Standards Document'. This follow-up document is a practical guide aimed to aid those who are at any stage in the process of developing a birth centre. Birth centres are small facilities which provide maternity care for women who prefer a 'low tech', midwife led approach to birth. The document presents guidelines based around a social model of maternity care where women are able to make their own choices regarding pregnancy and birth. The standards are guided by the principles of prevention, sensitivity, safety and cost-effectiveness

Wall SN, Lee AC, Carlo W, Goldenberg R, Niermeyer S, Darmstadt GL, et al. Reducing Intrapartum-Related Neonatal Deaths in Low- and Middle-Income Countries - What Works? Seminars in Perinatology 2010 Dec;34(6):395-407.
Ref ID: 269

Wiknjosastro G, Basuki B, Danukusumo D. Several Contributing Factors Related to Maternal Near-Miss and Death at Selected Referral Hospitals in Jakarta and Tangerang. 2008 Mar.
Ref ID: 417
Notes: This document presents a report of a study funded by WHO. This study was conducted to identify the medical and non-medical causes of and circumstances surrounding maternal near miss deaths occurring at health facilities and to expand to personal, family or community that contributed to the maternal near-miss and death. Data was collected by special trained midwives from each participating hospitals. Near miss subject was interviewed on the second day after emergency situation was over, and for death cases data was collected from the husband and/or her closed relative. Additional data was also taken from hospital medical and registration records. Results of the study indicate that half of contributing factors of maternal deaths related to inappropriate care by the first providers (mainly midwives and some TBAs). Human resources, infrastructure, management as well as standard of emergency obstetric were noted inappropriate.

Wirth M. Professionals with Delivery Skills: Backbone of the Health System and Key to Reaching the Maternal Health Millennium Development Goal. Croatian Medical Journal 2008;49(3):318-33.
Ref ID: 424

Wiysonge CS, Chopra M. Do Nurse Practitioners Working in Primary Care Provide Equivalent Care to Doctors? - SUPPORT Summary of a Systematic Review.  2008 Aug.
Ref ID: 159
Notes: This document, backed by SUPPORT, The Cochrane Collaboration, Alliance and EVIPNet is a summary of a systematic review relating to nurse practitioners in primary care. It is intended for policy makers and other decision makers. Key messages of this summary state that low to moderate quality evidence indicates that patient health outcomes were similar for nurse practitioners and doctors, but that patient satisfaction and quality of care were better for nurse practitioners, and moderate quality evidence suggests that nurse practitioners had longer consultations and undertook more investigation than doctors. The studies included in this review were conducted in high-income countries and do not provide high quality evidence of the economic impacts of substituting nurse practitioners for doctors.

Wold JL, McQuide P, Golden C, Maslin A, Salmon M. Caring that Counts: Evidence Base for the Effectiveness of Nursing and Midwifery Interventions. A Paper Commissioned by the Commonwealth Steering Committee for Nursing and Midwifery. 
Notes: This document is a paper written for the Commonwealth Steering Committee for Nursing and midwifery. It presents an review of nurses and midwives in preventative and curative healthcare services that improve the health of the populations they serve. Based on both published and unpublished sources, this paper provides a review of 117 recent outcome studies and other literature in public health, home health, HIV-AIDS care; midwifery, primary care, acute care and tertiary care settings that support nursing and midwifery's contribution to improve access to cost effective, quality healthcare. In writing this manuscript, the authors view both nursing and midwifery as equally important professions within the health care system. Research is reported on each specialty area as it was found in that literature.

Women Deliver. Atelier sur la Réforme du Système Educationnel des Sages-femmes en Haïti. 
Notes: This document is a report on the proceedings of a workshop held by Women Deliver in Washington D.C. discussing the education system for midwives in Haiti. Participants of the workshop included professionals from UNFPA, the Haitian Ministry of Public Health, and midwives and other health professionals working in Haiti. The focus of the workshop was to discuss possibilities for reforming the current midwifery education system. The participants discussed the length of required education for midwives and agreed it was too long. Suggestions for reform included strengthening supervision capacity, introducing direct-entry programmes, strengthening regulation procedures, and developing policies specific to midwifery.

Women Deliver. Addressing Shortages of Skilled Attendants: Experience from Afghanistan (Expansion Mid Ed Afghanistan).  2011.
Ref ID: 42
Notes: This document presents an review of the shortage of skilled attendants in Afghanistan. In the last 5 years of reconstructing health care in Afghanistan, the MOPH, donors and international health organizations have faced many challenges in efforts to reduce Afghanistan's unacceptable maternal and newborn mortality statistics. Midwives must be available, allowed to do what they are trained to do, and have logistical and policy support. A comprehensive approach to increase the supply of professional skilled birthing care addressed: strengthening and expansion of midwifery education; initiatives to increase access to skilled care; creating a policy environment to ensure the pivotal role of midwives in provision of essential obstetric and newborn care; and supported the establishment of a professional association for midwives. The paper concludes that continuing mobilization of human resources and adopting a comprehensive health workforce planning approach as well as ongoing collaboration with the Government at central and provincial levels will contribute to continued improvements in maternity care in Afghanistan.

World Health Organization. Global Action for Skilled Attendants for Pregnant Women. 
Notes: This document outlines the WHO's proposed strategy to ensure the working together of countries and partners in order to meet the MDGs and reduce maternal and newborn mortality and morbidity. The document presents an overview of the WHO's call to action to increase skilled attendance for pregnant women. The proposed accountability framework focuses on human resources needed for safe motherhood including the systems required to support skilled birth attendants. The framework aims to assist key actors and national and international levels to identify and fulfill their key roles and responsibilities. This document outlines what WHO is currently doing to stimulate this action such as working with partners to coordinate efforts.

World Health Organization. Draft Framework for Assessing Situational Analysis and Identifying Needs to Strengthen Midwifery In-Country. 
Notes: This is a draft of a midwifery assessment tool. This document is in table form and presents a 0-3 scoring chart for rules/legislation of licensure, re-licensing procedures, curriculum, evidence/competency based standards established for midwifery practice, clinical areas and quality of service, norms for numbers of midwives needed, number of midwives in clinical post, sufficient midwife teachers in place, programme preparation for midwife teachers, quality teaching and learning resources available, job description for midwife, updating services in place, and provision for continued education.

World Health Organization. Strategic Directions for Strengthening Nursing and Midwifery Services. Geneva; 2002.
Ref ID: 170
Notes: This document outlines WHO's strategy to address the global nursing and midwifery imbalance. These Strategic Directions for Strengthening Nursing and Midwifery Services provides an evidence-based framework for action that will be undertaken by WHO and its partners to support countries dedicated to improving the quality of nursing and midwifery services. There are four essential elements (partnership, relevance, ownership and ethical action) necessary to strengthen nursing and midwifery services. Each of these elements needs to be based on the best available evidence and requires advocacy, capacity building, research and development, and monitoring and evaluation to ensure that the key result areas are translated into action and impact practice. This document calls for the need for collaborative action between governments, civil society, professional association, educational institutions, NGOs and international and bilatoral organizations.

World Health Organization, International Confederation of Midwives, International Federation of Gynaecology and Obstetrics. Making Pregnancy Safer: The Critical Role of the Skilled Attendant: A Joint Statement by WHO, ICM and FIGO. Geneva: World Health Organization; 2004.
Ref ID: 323
Notes: This document is a joint statement by WHO, ICM and FIGO. The statement presents an overview of skilled care and emphasizes the critical role of "skilled birth attendants" to reduce maternal and child morbidity and mortality. This statement is intended to urge governments, policy-makers, health care providers, donors and communities to increase access to childbearing bearing women and their families to a continuum of care.

World Health Organization. Policy Brief One - Integrating Maternal, Newborn and Child Health Programmes. Geneva; 2005.
Ref ID: 171
Notes: This is a WHO policy brief that focuses on exclusion as a key obstacle from good quality care. The document calls attention to the lack of measurable progress in maternal health and highlights the importance of newborn health as an important component of child health. The document identifies that most deaths could be avoided since life saving interventions are well known, but the main problem lies in choosing the right strategies for programmes to go to scale with and overcome the constraints that hamper the development of effective health systems. The document calls for programmatic solutions such as training for general practitioners or mid-level technicians, or delegating tasks to non-professionals or volunteers where appropriate.

World Health Organization. Taking Stock: Task Shifting to Tackle Health Worker Shortages. Health Systems and Services.  2006. Geneva.
Notes: This document follows the agreement of the June 2006 General Assembly High-Level Meeting on HIV/AIDS to work towards the goal of 'universal access to comprehensive prevention programmes, treatment, care and support' by 2010. This document addresses the serious health worker shortage as one of the main barriers to achieving this goal. This document states that there is a global shortfall and more than 4 million health workers are needed to meet this. WHO maintains that action on task shifting is imperative to help increase health workforce capacity. This document outlines WHO's action plan 'Treat, Train, Retain' which aims to identify and document the routine and best clinical practices and to understand existing regulatory frameworks that enable task shifting implementation.

World Health Organization, International Confederation of Midwives. Foundation Module: The Midwife in the Community - Education Materials for Teachers of Midwifery. Geneva: World Health Organization; 2006.
Ref ID: 399
Notes: This document is a reference guide providing education materials for teachers of midwifery. It is the second edition of the midwifery education modules produced with ICM for the Department of Making Pregnancy Safer, WHO. The midwifery modules have been developed by the World Health Organization (WHO) because of the need for education materials to facilitate the teaching of the midwifery skills required to respond to the major causes of maternal death. The modules, while primarily intended for in-service training programmes for midwives and nurse-midwives, can also be used in basic and post-basic midwifery programmes. In addition, the modules can be used to update the midwifery skills of other health care professionals.

World Health Organization. Consensus on Essential Competencies of Skilled Attendant in the African Region.  2006. Report No.: Report of Regional Consultation, Brazzaville, 27th of February-1st March.
Ref ID: 114
Notes: This document is a report following the Regional Consultation of Consensus on essential competencies of a skilled attedant in the African Region. The meeting was comprised of experts involved in the education, training and practice of midwives, nurses and doctors at country and regional level. The document emphasizes the need for adequate training of maternal and newborn health care providers to ensure the acquisition of the essential competencies for skilled care. The general objective of this meeting was to reach consensus on these essential competencies in Africa. This document emphasizes the importance of health education including counseling and that this should be included in maternal health services through pregnancy, childbirth and the postpartum period. This document recommends that only those health providers that have been trained to proficiency in midwifery skills and appropriate emergency obstetric and newborn care should be considered as skilled attendants and that all midwifery and medical training institutions should integrate emergency obstetric and newborn care into the pre-service training curricula.

World Health Organization. Consensus on Essential Competencies of Skilled Attendant in the African Region: Report of Regional Consultation Brazzaville, 27th February-1st March 2006.  2006.
Ref ID: 362
Notes: This document is a World Health Organization report for the Africa region. It is a report following a regional consultation which took place in Brazzaville in 2006 discussing essential competencies of skilled attendants for the region. This consultative meeting was attended by experts involved in the education, training and practice of midwives, nurses and doctors and country and regional level. The general objective of the meeting was to reach consensus on the essential competencies of skilled attendants. Specifically the meeting aimed to formulate recommendations for increasing coverage in quality and availability of skilled attendants. Key issues raised included an identified need for the definition of essential package of services provided at each level to guide definition of the different skills required to deliver the services, facilitative supervision and quality control systems should be put in place to ensure that quality of services are delivered within the competencies, as well as the post description of the health provider, and the delegation or transfer of tasks should be governed by clear guidelines and regulations defining who should delegate, what tasks to delegate and to whom to delegate.

World Health Organization. Models of Maternal Health Care Services.  2007.
Ref ID: 115
Notes: Report prepared by Dr. Karen Odberg Pettersson for Making Pregnancy Safer Department, WHO. This paper was commissioned by Making Pregnancy Safer (MPS) department as one of four background papers for a technical consultation to be held at the World Health Organisation (WHO) in October 2007. The consultation is related to ongoing discussions by United Nations Population Fund (UNFPA), International Federation of Midwives (ICM), WHO and partners on the possibility of scaling up midwifery, as one of the key solutions to reduce maternal and neonatal mortality. The actual paper reports on findings and gives recommendations for action based on a desk study related to: i) models of health care during pregnancy, childbirth and postpartum period, ii) evidence of the models effectiveness, iii) gaps in knowledge and iv) efforts to scale up skilled birth attendants in different regions of the world.

World Health Organization, Department of Reproductive Health and Research. Preventing Unsafe Abortion - Mid-Level Health-Care Providers are a Safe Alternative to Doctors for First-Trimester Abortions in Developing Countries. 2 p. Geneva: World Health Organization; 2008 Feb.
Ref ID: 19
Notes: This is a document produced by WHO and HRP -Special Programme of Research, Development and Research Training in Human Reproduction (UNDP, UNFPA, WHO, World Bank. This study is a comparative assessment of the safety of first-trimester abortion by type of providor in developing countries. The study was conducted to compare the safety of first-trimester abortion with manual vacuum aspiration performed by nurses, midwives, mid-level healthcare providers and doctors in South Africa and Viet Nam. This study finds that abortions performed by government trained and accredited nurses, midwives and midlevel healthcare providers in these countries were comparable in terms of safety and acceptability to those performed by doctors. The report concludes that countries seeking to expand safe abortion services can consider an approach similar to that taken by the results of this study.

World Health Organization, PEPFAR, UNAIDS. Task Shifting - Global Recommendations and Guidelines. Geneva; 2008.
Ref ID: 188
Notes: This report is produced in joint collaboration with WHO, PEPFAR, and UNAIDS and presents an approach that returns to the core principals of health services: accesible, equitable and of good quality. These recommendations and guidelines provide a framework that is informed by the ways in which access to health services can be extended to all people in a way that is effective and sustainable. This report proposes the adoption or expansion of a task shifting approach to help address the current shortages of health workers, in particular, countries that face a high HIV burden. Some recommendations outlined include: recommendations to adopt task shifting as a public health initiative,  recommendations to create an enabling regulatory environment for implemenation, recommendations to ensure quality of care, to ensure sustainability, and for the organization of clinical care services.

World Health Organization. Gender and Health Workforce Statistics. Geneva; 2008 Feb.
Ref ID: 176
Notes: This document presents a factsheet on the distribution of the health workforce in selcted countries. It is part of a series of factfiles on health workforce statistics produced by the Department of Human Resources for Health, WHO. This study focuses on gender equality in the labour force. The three main employment dimensions identified as a starting point to address these issues are occupation (segregation), working time and earnings. This data is useful to plan, monitor and evaluate successful gender-sensitive interventions in the work place, bringing to attention to the ways in which soical and behavioural differences between women and men may lead to inequalities in working conditions in the health sector and inequities between women and men's access to health care services and health outcomes.

World Health Organization. Report on the National Situational Analysis of Pre-Service Midwifery Training in Ethiopia. Addis Ababa; 2008 Jan.
Ref ID: 135
Notes: This is a national midwifery survey conducted as part of WHO's contribution to address gaps and issues identified during the subsequent review of Ethiopia's Health Sector Development Program initiated in 1997. The primary objective of this assessment is to appraise the status of infrastructural, human resources, programmatic and governance aspects of the pre-service midwifery training in the country. The survey finds that the number of midwifery training facilities has increased in the last decade but the number and capacity of midwifery training facilities is still very small compared to potential demand.

World Health Organization, Partnership for Maternal Newborn & Child Health. Investing in Maternal, Newborn and Child Health - The Case for Asia and the Pacific. p. Geneva: World Health Organization; 2009.
Ref ID: 17
Notes: 060a: WA 310 JA1

This document was prepared by the "Maternal, Newborn and Child Health Network for Asia and the Pacific". This report is a result of contributions from ADB, AUSAID, Bill and Melinda Gates Foundation, JICA, PMNCH, UNFPA, USAID, World Bank, and WHO. This report discusses the necessity to increase expenditure on maternal, newborn and child health and to make it more efficient, equitable, and sustainable. This report lists 6 main messages that are different from previous attempts as key factors in achieving these goals: attempts need to be grounded in the very latest and strongest evidence, 'best buys' need to be identified that take into account the local contexts (priorities and costs), money needs to be recognized as a powerful tool to change incentives and behaviour, need to work through health systems, integrates action to help both mothers and children, and they need to include the partnering of the analytical, technical and financial resources of governments and their development partners.

World Health Organization. Safer pregnancy in Tamil Nadu: From Vision to Reality. 86 p. New Delhi: WHO Regional Office for South-East Asia; 2009.
Ref ID: 37
Notes: 060a: WQ 240 2009SA
This document details Tamil Nadu's vision to significantly reduce the high rate of maternal death and pregnancy wastage. This is to be done through a comprehensive public health initiative that responds to women's needs from a right's-based approach. The document outlines a 3-fold path to achieve this. This is through prevention and termination of unwanted pregnancies, accessible, high-quality antenatal care and institutional delivery, with routine obstetric care and emergency obstetric first aid at the primary level, and accessible, high quality emergency obstetric care at the first referral level. Challenges identified in this document are the inability to ensure readily accessible emergency obstetric care as well as gender discrimination in health which results in poorer health outcomes for females.

World Health Organization, The Royal Tropical Institute. KIT - Draft HRH and Maternal Health Tool.  2009 Sep 13.
Ref ID: 116
Notes: This document is a draft of a report presenting the rational for the HRH and Maternal Health Tool. This is a new comprehensive tool developed by the WHO Making Pregnancy Safer Department and the Royal Tropical Institute designed as a checklist to assist policy makers and planners for maternal health at country level to improve HRH for maternal health. The document presents the methodology, the results and frameworks used to develop the tool and the checklist itself. The findings from the desk review and interviews show that maternal health care workers require a number of specific points of attention in addition to the generic checklist offered through the HRH action framework. These have been proposed under each of the 6 action fields: policy, education, in-service training, HRM systems, partnerships, leadership, and finance.

World Health Organization. Global Standards for the Initial Education of Professional Nurses and Midwives. Geneva; 2009.
Ref ID: 251
Notes: The global standards for initial nursing and midwifery education identify essential components of education. Implementation of the standards will facilitate progress towards the highest level of education attainable in a country or region, assure equitable and appropriate placement of nurses and midwives in health-care roles and, potentially, simplify recruitment practices throughout the world. The need for global standards has arisen for several reasons, the increasing complexities in health-care provision, the increasing number of health professionals at different levels, and the need to assure more equitable access to health care. The global standards for the initial education of professional nurses and midwives are intended to serve as a benchmark for moving education and learning systems forward to produce a common competency-based outcome in an age of increasing globalization. It is anticipated that the global standards will be used in the nursing and midwifery professions, as well as in other health-related professions and by policy-makers and decision makers in ministries of health and education, the public, education services, regulatory bodies and various other organizations.

World Health Organization. Monitoring Emergency Obstetric Care - A Handbook. Geneva: World Health Organization; 2009.
Ref ID: 402
Notes: This document, produced by WHO, UNFPA, UNICEF and AMDD is a handbook for emergency obstetric care services.  The purpose of this handbook is to act as a guide for practitioners working in maternal and newborn health. The handbook lists the different types of services available and provides a description and suggested use of each indicator. This handbook is based on the publication Guidelines for Monitoring the Availability and Use of Obstetric Services. The handbook provides a description of each indicator and how it is constructed and how it can be used; the minimum and/or maximum acceptable level (if appropriate); the background of the indicator; data collection and analysis; interpretation and presentation of the indicator; and suggestions for supplementary studies. There is a further section on interpretation of the full set of indicators.

World Health Organization. Sexual and Reproductive Care: A Comparison of Providers and Delivery Points Between AFRO and Other Regions.  2010.
Ref ID: 161
Notes: DRAFT. A global survey was undertaken in mid 2009 by the Department of Reproductive Health Research (RHR), World Health Organization (WHO) in Geneva, to identify what Sexual and Reproductive Health (SRH) provision is actually offered in Primary Health Care (PHC) and which health workers are providing this, in developing and a few developed. The purpose of the inter country survey was to gather information about SRH services provided in PHC mainly in developing countries; with an emphasis on the different ways SRH in PHC is organised; what SRH services are provided in each country, where it is delivered and by which providers. Results of this survey are especially relevant to AFRO.

World Health Organization. The Survey on the Role of Primary Care Providers in Sexual and Reproductive Health.  2010.
Ref ID: 160
Notes: FINAL. A global survey was undertaken in mid 2009 by the Department of Reproductive Health Research (RHR), World Health Organization (WHO) in Geneva, to identify what Sexual and Reproductive Health (SRH) provision is actually offered in Primary Health Care (PHC) and which health workers are providing this, in developing and a few developed. The purpose of the inter country survey was to gather information about SRH services provided in PHC mainly in developing countries; with an emphasis on the different ways SRH in PHC is organised; what SRH services are provided in each country, where it is delivered and by which providers.

World Health Organization. The Survey on the Role of Primary Care Providers in Sexual and Reproductive Health (Draft). Geneva; 2010.
Ref ID: 172
Notes: Draft of Ref ID 160. This document reports on a global survey undertaken in 2009 by the Department of Reproductive Health Research, WHO to identify what sexual and reproductive health provision is actually offered in primary health care and which health workers are providing this in developing and a few developed countries. This document discusses the development of the survey questionnaire, the pilot study, the sample of the main study and some results. Topics covered include birth registraiton, family planning, childbirth and immediate postpartum care, and overall activity of health workers and duration of training.

World Health Organization. Nursing & Midwifery Services - Strategic Directions 2011-2015. Geneva; 2010.
Ref ID: 204
Notes: This document presents the newly updated strategic directions for strengthening nursing and midwifery services. Complementing the 2002-2008 document, it seeks to provide policy-makers, practitioners and other stakeholders at every level with a flexible framewok for broad-based, collaborative action to enhance the capacity of nurses and midwives to contribute to universal coverage, people-centred health care, policies affecting practice and working conditions and the scaling up of national health systems to meet global goals and targets. This document provides directions in 5 key results areas: health system and service strengthening, policy and practice, education, training and career development, workforce management and partnership.

World Health Organization, UNAIDS, UNICEF. Toward Universal Access: Scaling Up Priority HIV/AIDS Interventions in the Health Sector: Progress Report 2010. Geneva: World Health Organization; 2010.
Ref ID: 356
Notes: This document, produced jointly by WHO, UNAIDS and UNICEF provides a progress report on efforts to scale up HIV/AIDS interventions in the health sector. This 2010 report presents evidence of progress in the global effort to fight HIV/AIDS but also indicates areas where significant work remains to be done. This document presents an overview of HIV programmes, key indicators of progress and challenges to be addressed. Areas of focus include expanding and optimizing the global HIV response, catalyzing the impact of HIV programmes on other health outcomes, strengthening health systems for a sustainable and comprehensive response, and tackling the structural determinants of responses.

World Health Organization. PMNCH HRH for MNH Country Policy Assessment (Excel file) Version 2.  2010.
Notes: Excel spreadsheet profiling various countries policies regarding HRH and MNH.

World Health Organization. Notes from the Technical Consultation on Optimizing the Delivery of Key Healthcare Interventions to attain MDGs 4 & 5 (Optimize4MNH), 6-8 December 2010, Geneva, Switzerland.  2010 Dec 16.
Ref ID: 146
Notes: This document presents a summary of a meeting held to draw the boundaries of the work on WHO Recommendations on Optimizing the Delivery of Key Healthcare Interventions to Attain MDGs 4 & 5. The WHO in-house working group and the Norwegian Knowledge Centre (NOKC) counterpart have had several meetings and electronic discussions in preparing for the consultation. The meeting was aimed to formulate and agree on priority questions that would inform the development of WHO guidance on Optimize4MNH in PICOT (participation/population, intervention, comparator, outcomes, timeline) format. General considerations of the meeting conclude that competence and qualification may differ between cadres and should be considered separate issues, that there is a limit to the number of functions that can be accommodated by a particular cadre, and that 'optimization' should not be regarded as a stopgap approach but rather a permanent solution, particularly in settings where serious coverage gaps exist.

World Health Organization. PMNCH HRH for MNH Country Policy Assessment.  2010.
Notes: Excel spreadsheet profiling various countries policies regarding HRH and MNH

World Health Organization. HRH for MNH Summary Table.  2010.
Notes: This document presents a table of HRH data relating to midwifery and MNH. Statistics show numbers of health professionals working in various countries. Complete source not provided.

World Health Organization, UNFPA, UNICEF, AMDD. Surveillance des Soins Obstétricaux d'Urgence - Manuel d'Utilisation. Geneva: World Health Organization; 2011.
Ref ID: 392
Notes: This document, produced by WHO, UNFPA, UNICEF and AMDD is a French language handbook for emergency obstetric care services.  The purpose of this handbook is to act as a guide for practitioners working in maternal and newborn health. The handbook lists the different types of services available and provides a description and suggested use of each indicator. This handbook is based on the publication: Guidelines for Monitoring the Availability and Use of Obstetric Services. The handbook provides a description of each indicator and how it is constructed and how it can be used; the minimum and/or maximum acceptable level (if appropriate); the background of the indicator; data collection and analysis; interpretation and presentation of the indicator; and suggestions for supplementary studies. There is a further section on interpretation of the full set of indicators.

World Health Organization. Sexual and Reproductive Health Core Competencies in Primary Care: Attitudes, Knowledge, Ethics, Human Rights, Leadership, Management, Teamwork, Community Work, Education, Counselling, Clinical Settings, Service, Provision. Geneva: World Health Organization; 2011.
Ref ID: 355
Notes: This is WHO document providing the core sexual and reproductive health (SRH) competencies desirable for use in primary health care. The competencies serve as the first step for policy-makers, planners, service organizations and academic training establishments to understand and meet education and training requirements and support service delivery as needed by SRH staff. This document explains the WHO's increasing focus on SRH, the development of primary health care and its interaction with SRH, and the importance of good policies, planning and training. Domains of the core competencies cover attitudes for providing high quality SRH, leadership and management, general SRH competencies for health providers, and specific clinical competencies.

World Health Organization, UNFPA, UNICEF, AMDD. Seguimiento de los Servicios Obstétricos de Urgencia - Manual . Geneva: World Health Organization; 2011.
Ref ID: 391
Notes: This document, produced by WHO, UNFPA, UNICEF and AMDD is a Spanish language handbook for emergency obstetric care services.  The purpose of this handbook is to act as a guide for practitioners working in maternal and newborn health. The handbook lists the different types of services available and provides a description and suggested use of each indicator. This manual is based on the publication: Guidelines for Monitoring the Availability and Use of Obstetric Services. The handbook provides a description of each indicator and how it is constructed and how it can be used; the minimum and/or maximum acceptable level (if appropriate); the background of the indicator; data collection and analysis; interpretation and presentation of the indicator; and suggestions for supplementary studies. There is a further section on interpretation of the full set of indicators.

World Health Organization Regional Office for Africa. Nursing and Midwifery Education Scale Up Plan 2010-2020 - Draft 1.  2010 May.
Ref ID: 152
Notes: This is a WHO-AFRO draft report outlining the scale-up plan for nursing and midwifery education in the Africa region. Central to this scale up plan is to strengthen nursing and midwifery services to save lives and promote health of women and newborns and to ensure availability of well, motivated and competent nursing and midwifery workforce in the right numbers, at the right time and in the right place and responsive to the dynamic health needs in each country. This document outlines three goals of the plan: that all member states meet the human resources for nursing and midwifery requirements in line with the national health and human resources for health development, that all member states of the region provide quality and relevant nursing and midwifery basic and post-basic education and training programs, and to improve nursing and midwifery leadership and positive workplace environment including regulation at all levels of service delivery.

World Vision. Information and Communication Technologies for Health Care: Midwife Mobile-Phone Project in Aceh Besar.  2008 Feb.
Ref ID: 316
Notes: This is report conducted by World Vision in Indonesia presenting the results from a midwife mobile-phone project. The project was implemented in 15 health centers in Aceh Besar involving 223 midwives, 15 midwife coordinators and OB/GYNs. The study group, consisting of 122 midwives used their project cell phones to send in health statistics to a central database, contact coordinators for health advice and information, and communicate with obstetricians and their patients. Results from the study indicate that the mobile phone is an effective and efficient device for facilitating smoother communication among health workers and between them and the community. Mobile devices aid in communication through disseminating medical and health-related information to midwives, who in turn convey knowledge to their village or community. Recommendations include suggestions for cost-subsidy programmes and issues relating to poor cellular reception.

Yemen. Yemen: Private Midwives Serve the Hard-to-Reach: A Promising Practice Model. Establishing Private Midwifery Project. 
Notes: This document presents an overview of the Private Midwifery Project in Yemen. Women's access to essential health services in Yemen is limited and many rural areas lack health facilities or where health facilities exist, quality of service is often poor. This document addresses the need for well qualified midwives to improve neonate and child health services coverage in underserved areas. Objectives of the project are to increase women's access to services, increase the percentage of SBA's, and to create work opportunities for trained but unemployed midwives. Activities of the project include community mapping, refresher training courses in safe motherhood and best practices, and business management training skills. Source not provided.

Yemen. List of Medicines.  2010.
Ref ID: 359
Notes: This document is an excel spreadsheet listing medicines according to region in Yemen.

Zanzibar. Deployment and Training Needs for Nurse/Midwives and Community Health Nurses Unguja and Pemba Islands Briefing Document. 20th February 2011. 2011.
Ref ID: 326
Notes: This document presents a brief of deployment and training needs for nurses, nurse/midwives and community health workers in Zanzibar. This document outlines the training programmes and structure of midwifery qualifications and requirements. The Health Sector in Zanzibar is striving to attain a decline of two thirds in maternal mortality to meet the MDG 5. One of the strategies recognized as crucial to attaining this target is the increase in the number and proportion of women who deliver with the assistance of a trained health worker. The global definition of a skilled health worker for deliveries is a midwife or a medical doctor. Therefore, while the MOH have a plethora or cadres trained to a lesser degree in obstetric care, the focus of the Ministry of Health is to increase the number of deliveries assisted by a trained midwife.

Zeidenstein, L. Midwifery and Gender Equality. 2007. The Journal of Midwifery & Women’s Health, 52: 1–2.
Ref ID: 439

Ziraba AK, Mills S, Madise N, Saliku T, Fotso JC. The State of Emergency Obstetric Care Services in Nairobi Informal Settlements and Environs: Results from a Maternity Health Facility Survey. BMC Health Services Research 2009;9:46.
Ref ID: 312

Zurn P, Vujicic M, Diallo K, Pantoja A, Dal Poz M, Adams O. Planning for Human Resources for Health: Human Resources for Health and the Production of Outcomes/Outputs.  World Health Organization; 2009.
Ref ID: 361
Notes: This document is a World Health Organization report written under the direction of the WHO's Department of Human Resources for Health (HRH). The objectives of the paper are to understand the role of HRH in the production of health services and health outcomes in order to facilitate the identification of pertinent HRH policies. This paper looks at the role of HRH in the production of health care interventions and in the achievements of health outcomes. The paper recognizes the importance of HRH to policy planning and finds that physicians in particular play an important role to reducing maternal mortality. The authors further discuss the idea of production efficiency as being of value to health policy makers in that it can facilitate the identification of "best practices" and contribute to better resource allocation.

Zurn P, Codjia L, Sall FL. La Fidélisation des Personnels de Santé dans les Zones Difficiles au Sénégal. Geneva: World Health Organization; 2010.
Ref ID: 349
Notes: This is a report produced by WHO in collaboration with the Ministry of Health, Prevention and Hygiene in Senegal. This document reports findings from a study conducted examining the loyalties of health personnel working in difficult environments. The intent of this study is to examine motives of these workers with the broader goal to contribute to strategies aimed at increasing the workforce in difficult areas. This report analyzes the geographic distribution of health personnel and potential factors that contribute to the unequal distribution, specifically in rural, isolated or generally unfavorable regions. Findings indicate a variety of attributing factors to the unequal distribution, including professional factors, family obligations, and feelings of isolation while working in these areas.



Library Sections: Bibliography | Bibliography by Country | Photos

Bibliography by Country

Afghanistan

Aitken I. Reproductive Health in Post-conflict Afghanistan: Case Study of the Formation of Health Services for Women in the Recovery from Twenty Years of War.  2009 Sep 4. 

Notes: This is a joint document produced with support from Escuela Andaluza de Salud Publica, Consejeria de Salud; UNFPA and WHO. This report presents an assessment of the state of reproductive health services before and after the Soviet war in Afghanistan. The report assesses issues such as available services and resources, health and reproductive health policies, human resources and other support systems such as financing and reporting, monitoring and evaluation.

Currie S, Azfar P, Fowler RC. A Bold New Beginning for Midwifery in Afghanistan. Midwifery 2007 Sep;23(3):226-34.

This article discusses maternal mortality in Afghanistan, particularly in regards to the post-conflict situation. Given the high rates of maternal mortality, the authors identify that rapid mobilization of female healthcare providers, especially in rural areas is essential to improving these statistics. The article recommends an overall strengthening of midwives and the midwifery profession in Afghanistan. Challenges that still need to be overcome are identified as improving the services provided by midwives who were already in practice at the beginning of the reconstruction and whose earlier training was interrupted, not standardized, or otherwise inadequate according to new standards; Afghan midwives need to be more respectful towards clients; and gender barriers need to be addressed.

Smith JM, Currie S, Azfar P, Rahmanzai AJ. Establishment of an Accreditation System for Midwifery Education in Afghanistan: Maintaining Quality During National Expansion. Public Health 2008 Jun;122(6):558-67.

Abstract: OBJECTIVE: To establish a mechanism for ensuring and regulating quality of pre-service midwifery education in Afghanistan during a period of intense expansion. STUDY DESIGN: Case study of public health practice in health workforce development. METHODS: Afghanistan's high maternal mortality is due, in part, to a lack of competent skilled midwives. In post-conflict Afghanistan, 21 midwifery schools were re-opened or established between 2003 and 2007 in an atmosphere without proper regulatory mechanisms for ensuring educational quality. A national accreditation programme for midwifery education was developed with the following components: an appropriate policy foundation; educational standards and tools to assess achievement of these standards; technical support to programmes to identify gaps and solve problems; and a system of official recognition. RESULTS: All midwifery schools were mandated to achieve accreditation. Nineteen schools had been accredited by early 2007, with an average achievement of 91% of the agreed and mandated national standards for running a midwifery school. One school has been closed by the National Midwifery Education Accreditation Board due to inability to achieve the standards. CONCLUSION: Establishment of a national mechanism to accredit midwifery schools and ensure quality education can be achieved during a period of rapid expansion.

USAID. Program Evaluation of the Pre-service Midwifery Education Program in Afghanistan. Final Phase One Report.  2009 Sep 16.

Notes: This is a programmatic evaluation of midwifery education in Afghanistan to identify the strengths and weaknesses of these programs. The evaluation was funded by USAID and implemented by Health Services Support Project. Pre-service midwifery programs were assessed to describe needs (of Afghan women and their families for available and good quality maternal and newborn care), processes (such as student recruitment), outputs (to increase the number of graduate midwives in Afghanistan and time estimated to reach national coverage with current output of midwife graduates), outcomes (delivery of maternal health care and services, and impact (estimated maternal deaths averted by midwifery graduates. The report finds that women in the communities were satisfied with care received from midwives and viewed them as having a positive impact as role models.

Bangladesh

Banu M, Nahar S, Nasreen HE. Assessing the MANOSHI Referral System: Addressing Delays in Seeking Emergency Obstetric Care in Dhaka's Slums. Dhaka: ICDDR,B. & BRAC; 2010 Jan. Report No.: MANOSHI Working Paper Series No. 10.

Notes: This report is an assessment of the Manoshi project, developed by BRAC to establish a community based health programme targeted at reducing maternal, neonatal, and child deaths and diseases in urban slums of Bangladesh. Under the Manoshi project, BRAC established delivery centres (birthing huts) to ensure safe delivery and access to appropriate emergency obstetric care services whenever needed. This report finds that out of the three delays, the first delay was more prolonged and was significantly higher compared to the other two. Potential reasons for delaying the decision to transfer women are cited as fear of medical interventions, complications arising at midnight, traditional thinking, lack of money and inability to recognize the severity of illnesses irrespective of place of referral.

Koblinsky M, Matthews Z, Hussein J, Mavalankar D, Mridha MK, Anwar I, et al. Going to Scale with Professional Skilled Care. Lancet 2006 Oct 14;368(9544):1377-86.

Abstract: Because most women prefer professionally provided maternity care when they have access to it, and since the needed clinical interventions are well known, we discuss in their paper what is needed to move forward from apparent global stagnation in provision and use of maternal health care where maternal mortality is high. The main obstacles to the expansion of care are the dire scarcity of skilled providers and health-system infrastructure, substandard quality of care, and women's reluctance to use maternity care where there are high costs and poorly attuned services. To increase the supply of professional skilled birthing care, strategic decisions must be made in three areas: training, deployment, and retention of health workers. Based on results from simulations, teams of midwives and midwife assistants working in facilities could increase coverage of maternity care by up to 40% by 2015. Teams of providers are the efficient option, creating the possibility of scaling up as much as 10 times more quickly than would be the case with deployment of solo health workers in home deliveries with dedicated or multipurpose workers. This article is part of the Maternal Survival Series and discusses issues associated with scaling up midwifery workforce. The authors discuss the necessity for addressing political constraints to emphasise the speed and visibility of results.

Nahar S, Banu M, Nasreen HE. Women-Focused Development Intervention Reduces Delays in Accessing Emergency Obstetric Care in Urban Slums in Bangladesh: A Cross-Sectional Study. BMC Pregnancy and Childbirth 2011 Jan 30;11(1):11.

Abstract: ABSTRACT: BACKGROUND: Recognizing the burden of maternal mortality in urban slums, in 2007 BRAC (formally known as Bangladesh Rural Advancement Committee) has established a woman-focused development intervention, Manoshi (the Bangla abbreviation of mother, neonate and child), in urban slums of Bangladesh. The intervention emphasizes strengthening the continuum of maternal, newborn and child care through community, delivery centre (DC) and timely referral of the obstetric complications to the emergency obstetric care (EmOC) facilities. This study aimed to assess whether Manoshi DCs reduces delays in accessing EmOC. METHODS: This cross-sectional study was conducted during October 2008 to January 2009 in the slums of Dhaka city among 450 obstetric complicated cases referred either from DCs of Manoshi or from their home to the EmOC facilities. Trained female interviewers interviewed at their homestead with structured questionnaire. Pearson's chi-square test, t-test and Mann-Whitney test were performed. RESULTS: The median time for making the decision to seek care was significantly longer among women who were referred from home than referred from DCs (9.7 hours vs. 5.0 hours p<0.001). The median time to reach a facility and to receive treatment was found to be similar in both groups. Time taken to decide to seek care was significantly shorter in the case of life-threatening complications among those who were referred from DC than home (0.9 hours vs.2.3 hours, p=0.002). Financial assistance from Manoshi significantly reduced the first delay in accessing EmOC services for life-threatening complications referred from DC (p=0.006). Reasons for first delay include fear of medical intervention, inability to judge maternal condition, traditional beliefs and financial constraints. Role of gender was found to be an important issue in decision making. First delay was significantly higher among elderly women, multiparity, non life-threatening complications and who were not involved in income-generating activities. CONCLUSIONS: Manoshi program reduces the first delay for life-threatening conditions but not non-life-threatening complications even though providing financial assistance. Programme should give more emphasis on raising awareness through couple/family-based education about maternal complications and dispel fear of clinical care to accelerate seeking EmOC.

Oulton J, Hickey B. Review of the Nursing Crisis in Bangladesh, India, Nepal and Pakistan - Draft for Internal Review. Barcelona, Spain: Instituto de Cooperación Social, INTEGRARE; 2009 Feb. 

Notes: This document is a report produced by Integrare and commissioned by DFID, Regional Team for South Asia. This report outlines shared concerns relating to the nursing crisis in the four countries: quality assurance in education and practice; working conditions; faculty numbers and competence, teaching resources and student clinical experiences; and absenteeism, deployment policy, and planning skills. The document states that all four countries show weaknesses of varying degrees in planning, administration, education, practice, leadership, policy, and regulation.

Parkhurst JO, Rahman SA. Non-Professional Health Practitioners and Referrals to Facilities: Lessons from Maternal Care in Bangladesh. Health Policy and Planning 2007 May;22(3):149-55.

Abstract: Over half a million women in the developing world die of pregnancy and childbirth related causes each year, despite well-known interventions to manage most maternal complications. One problem facing policy makers is that women in low-income settings often seek care from a range of non-professional sources when they have trouble with pregnancy and childbirth. Questions remain as to the best way to engage with such providers to encourage use of professional care, in part because little policy-oriented research has attempted to study the roles of non-professional practitioners, and the specific situations which can encourage or discourage referral behavior. This paper investigates the roles played by alternative health practitioners in referral to facilities for maternal care in Bangladesh. In-depth case studies were used to investigate labour experiences, decision-making processes and the roles played by key individuals in deciding to use professional services. Findings show that the commonly used heading of 'traditional birth attendant' is often too broad for programmatic use, as it encompasses a range of individuals with different reasons to work with, or oppose, professional services. It was found that women seek care from multiple non-professional cadres who each have differing services, scopes and linkages to professional care. Policy makers need to understand the roles of different providers and potential links to professional care which can be built upon to encourage the use of professional emergency care for maternal complications in low-income settings.

Streatfield PK, El Arifeen S. Bangladesh Maternal Mortality and Health Care Survey 2010 Summary of Key Findings and Implications.  2010. 

Notes: With contribution from USAID, Australian Government Aid Program, UNFPA, Measure Evaluation, ICDDR,B and NIPORT. This document presents findings from a 2010 survey to provide a maternal mortality estimate for the period 2008-2010. The objective of this survey was to determine whether MMR has significantly declined from 1998-2001 when the first national survey was conducted. Other stated objectives are to identify specific causes of maternal deaths, to assess the level of use of antenatal and postnatal care, to collect information on birth planning and to assess the experience of and care seeking for maternal complications and changes in care seeking pattern during 2005-2009. The findings suggest that MMR has declined and that Bangladesh appears to be on track to achieving MDG 5.

USAID. Achieving the MDGs. The Contribution of Family Planning: Bangladesh.  2009 Jul. 

Notes: This document is a 2 page country brief for Bangladesh as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Bangladesh. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 6 to 1.

Benin

Bénin. Évaluation des Besoins en Soins Obstétricaux et Néonataux d'Urgence au Bénin. 2009 Dec.

Notes: 2nd edition.This document presents an evaluation of emergency obstetric and neonatal care needs in Benin. The report provides a general overview of Benin, such as demography, characteristics of the health system, and services that are currently available. The remainder of the document provides an overview of human resources and the structure of health personnel. The purpose of the evaluation is to guide the Ministry of Health in developing strategies to strengthen the existing health system, with particular emphasis on MDG goals 4 and 5.

Harvey SA, Ayabaca P, Bucagu M, Djibrina S, Edson WN, Gbangbade S, et al. Skilled Birth Attendant Competence: An Initial Assessment in Four Countries, and Implications for the Safe Motherhood Movement. International Journal Of Gynecology And Obstetrics 2004 Nov;87(2):203-10.

Abstract: OBJECTIVES: Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda. METHODS: We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries. RESULTS: On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic. CONCLUSION: A wide gap exists between current evidence-based standards and current levels of provider competence.

Harvey SA, Blandon YC, McCaw-Binns A, Sandino I, Urbina L, Rodriguez C, et al. Are Skilled Birth Attendants Really Skilled? A Measurement Method, Some Disturbing Results and a Potential Way Forward. Bulletin of the World Health Organization 2007 Oct;85(10):783-90.

Abstract: OBJECTIVE: Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide -- the fifth Millennium Development Goal. Though WHO tracks the proportion of women delivered by SBAs, we know little about their competence to manage common life-threatening obstetric complications. We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement. METHODS: The WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines served as our competency standard. Evaluation included a written knowledge test, partograph (used to record all observations of a woman in labour) case studies and assessment of procedures demonstrated on anatomical models at five skills stations. We tested a purposive sample of 166 SBAs in Benin, Ecuador, Jamaica and Rwanda (Phase I). These initial results were used to refine the instruments, which were then used to evaluate 1358 SBAs throughout Nicaragua (Phase II). FINDINGS: On average, Phase I participants were correct for 56% of the knowledge questions and 48% of the skills steps. Phase II participants were correct for 62% of the knowledge questions. Their average skills scores by area were: active management of the third stage of labour -- 46%; manual removal of placenta -- 52%; bimanual uterine compression -- 46%; immediate newborn care -- 71%; and neonatal resuscitation -- 55%. CONCLUSION: There is a wide gap between current evidence-based standards and provider competence to manage selected obstetric and neonatal complications. We discuss the significance of that gap, suggest approaches to close it and describe briefly current efforts to do so in Ecuador, Nicaragua and Niger.

Hutchinson C, Lange I, Kanhonou L, Filippi V, Borchert M. Exploring the Sustainability of Obstetric Near-miss Case Reviews: A Qualitative Study in the South of Benin. Midwifery 2010;26(5):537-43.

Abstract: INTRODUCTION: near-miss case reviews are one of a number of audit approaches currently being used and evaluated by those with an interest in reducing high rates of maternal mortality in developing countries. Researchers are beginning to take an interest in issues relating to the sustainability of audits. OBJECTIVE: to develop an understanding of the barriers and facilitators to the sustainability of obstetric near-miss case reviews in five hospitals in southern Benin. DESIGN AND METHODS: semi-structured interviews were designed to explore health workers' and policy makers' views and experiences of the sustainability of near-miss case reviews aimed to improve quality of care and reduce maternal mortality. SETTING: five hospitals in three regions in the south of Benin. PARTICIPANTS: two Ministry of Health officials and eight health-care workers involved in a feasibility study conducted in 1998-2001 that introduced near-miss case reviews. ANALYSIS: framework analysis to identify themes. FINDINGS: while all participants believed in the importance and value of audit, all hospitals had stopped performing near-miss case reviews within two years of completing the feasibility study. Ten qualitative interviews identified six themes relating to the sustainability of case reviews: clear advantages in ensuring quality of care, fear of blame and punishment, availability of resources, training, supportive hospital work environment, and broader policy issues. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: implementing and sustaining audit is a complex intervention that requires careful planning and consideration. It is important to consider both the content and the context in which audit takes place when developing strategies for sustainability.

Ministère de la Santé République du Benin. Évaluation des Besoins en Soins Obstetricaux et Neonatals d'Urgence au Benin - Rapport Préliminaire.  2010 Dec. 

Notes: This report was jointly issued by Benin's Ministry of Health, UNFPA, UNICEF, WHO and AMDD. This report presents an evaluation of the state of Benin's emergency obstetric and neonatal health needs and services in an effort to aid in the reduction of maternal and neonatal mortality. This study states as its objective that it is intended as an entry point to guide policy related to MDG's 4 and 5. It calls for the strengthening of health systems, strengthening human resources and building personnel capacity.

Bhutan

Bhutan. Organogram of Referral System.

Notes: This is a slide depicting an organogram of the referral system in Bhutan.

Ministry of Health Bhutan. Bhutan Ministry of Health Organogram.

Notes: This is an organogram of the structure of Bhutan's Ministry of Health.

Bolivia (Plurinational State of)

Calderón L. Una Estrategia Efectiva para la Reducción de la Mortalidad Materna: La Atención Calificada del Parto con Enfoque Intercultural.  Bolivia, UNFPA.

Notes: This is a strategy document written by Lilian Calderon, maternal health division, UNFPA Bolivia. This document outlines Bolivia's strategy to reduce maternal mortality with specific attention to skilled care during childbirth through an intercultural approach. This documents highlights the main cause of maternal mortality as being when there is no access to skilled care. The majority of deaths occur among indigenous people, particularly in rural areas. In this context, all pregnancies should be considered as at risk. In consideration of the multi-cultural make up of Bolivia, skilled personnel are required who will promote and practice culturally sensitive health services.

Estado Plurinacional de Bolivia Ministerio de Salud y Deportes. Proyecto de Ley de Systema Único de Salud - 21 de septiembre de 2010. La Paz, Bolivia; 2011 Jan. 

Notes: This document outlines the universal health system law of Bolivia. This law is intended to guarantee the rights to universal health care to all inhabitants within Bolivia. This includes universal coverage for all services and that such services are provided in an equitable manner. This law is complementary to the implementation of the Politica de Salud Familiar Comunitaria Intercultural (policy for intercultural community family health) which prioritizes health promotion and prevention of illnesses related to the social determinants of health. This document written on the premise that health is a universal human right and that interaction between sectors, social and community participation, equity and quality of care are among the key principals in achieving this.

Estado Plurinacional de Bolivia Ministerio de Salud y Deportes. Plan Estratégico Nacional Para Mejorar la Salud Perinatal y Neonatal en Bolivia 2009-2015. La Paz, Bolivia; 2009. 

Notes: This report is a document produced by Bolivia's Ministry of Health and Sport and is supported by PAHO and WHO Bolivia. This document presents a national strategic plan to improve health of Bolivia's people, in particular perinatal, maternal and neonatal health. This report highlights barriers caused by exclusionary factors and considers options which allow health to be seen as holistic and culturally sensitive. The plan outlines a systematic approach towards guiding interventions relating to improving information networks, referral systmes and the categorization of health facilities. This policy document complements the national sexual and reproductive health plan, the plan to prevent uterine cancer, and the national plan for adolescents.

Maldonado Canedo AM. Propuesta de Perfil Profesional de la Licenciada en Enfermería Obstetriz Basado en Competencias. La Paz: Colegio de Enfermeras de Bolivia; UNFPA; 2008 Dec.

Notes: This document outlines the proposal for the professional profile of certified obstetric nurses based on competencies. It defines obstetric nurses as individuals who have completed the proper requirements for professional licensure such as a nationally accredited education that comprises an integrated multi-disciplinary knowledge base of science, technology, human rights, ethics and morality with respect to health and quality of life mothers and neonates. The professional profile based on competencies is constituted by key objectives of belonging to the nursing profession (reasons why), general competencies (grouping of essential functions) and specific competencies (actions and behaviours that the obstetric nurse should demonstrate).

Maldonado Canedo AM. Anteproyecto de Ley del Ejercicio Profesional de Enfermería (Tercer Borrador). La Paz: Colegio de Enfermeras de Bolivia; UNFPA; 2008 Dec. 

Notes: Draft 3. This document is a draft outlining the preliminary law regarding professional nursing practice in Bolivia. The objective of the law is to present norms, regulations and guidelines which guarantee the protection of professional nurses and nursing practice in all sectors. This law is to be applied to the national health system and was coordinated with respect to the fundamental principals and values of nursing practice in line with the Constitution and Universal Declaration of Human Rights. The document presents guidelines regarding male/female nurses, auxiliary nurses, obstetric nurses and outlines categories and concepts of nursing practice in general.

Nurse College of Bolivia, Autonomous University Juan Misael Saracho of Tarija, UNFPA. Pilot Project to the Institute for the Career in Midwifery within the University System of Bolivia.  2006. 

Notes: This document presents an overview of a pilot project conducted in Bolivia to implement midwifery into the Bolivian university system.  The program aims to offer university level training that is sensitive to the varied socio-cultural needs of the population. Specific objectives of the project were to design and implement a midwifery program within the faculty of health sciences of the universities of La Paz, Sucre, Tarija and Llallagua (Potosí), to propose a legal framework for a Bachelor's of Midwifery, and to educate teachers in midwifery with competencies in sexual and reproductive health within the intercultural, gender and human rights framework, both in practice and in training. The project was executed by a committee composed of members from the Ministry of Health and Sport, university authorities (national and international), the collaboration center as designated by PAHO/WHO to strengthen midwifery, the Nurse College of Bolivia and UNFPA.

Rööst M, Altamirano VC, Liljestrand J, Essén B. Priorities in Emergency Obstetric Care in Bolivia - Maternal Mortality and Near-Miss Morbidity in Metropolitan La Paz. BJOG 2009;116(9):1210-7.

Abstract: OBJECTIVE: To document the frequency and causes of maternal mortality and severe (near-miss) morbidity in metropolitan La Paz, Bolivia. DESIGN: Facility-based cross-sectional study. SETTING: Four maternity hospitals in La Paz and El Alto, Bolivia, where free maternal health care is provided through a government-subsidised programme. POPULATION: All maternal deaths and women with near-miss morbidity. METHODS: Inclusion of near-miss using clinical and management-based criteria. MAIN OUTCOME MEASURES: Maternal mortality ratio (MMR), severe morbidity ratio (SMR), mortality indices and proportion of near-miss cases at hospital admission. RESULTS: MMR was 187/100,000 live births and SMR was 50/1000 live births, with a relatively low mortality index of 3.6%. Severe haemorrhage and severe hypertensive disorders were the main causes of near-miss, with 26% of severe haemorrhages occurring in early pregnancy. Sepsis was the most common cause of death. The majority of near-miss cases (74%) were in critical condition at hospital admission and differed from those fulfilling the criteria after admission as to diagnostic categories and socio-demographic variables. CONCLUSIONS: Pre-hospital barriers remain to be of great importance in a setting of this type, where there is wide availability of free maternal health care. Such barriers, together with haemorrhage in early pregnancy, pre-eclampsia detection and referral patterns, should be priority areas for future research and interventions to improve maternal health. Near-miss upon arrival and near-miss after arrival at hospital should be analysed separately as that provides additional information about factors that contribute to maternal ill-health.

Silva E, Batista R. Bolivian Maternal and Child Health Policies: Successes and Failures.  The Canadian Foundation for the Americas (FOCAL); 2010 May. 

Notes: This document is a report for the Canadian Foundation for the Americas (FOCAL), undertaken with financial support of the Government of Canada provided through the Canadian International Development Agency (CIDA). This report provides an overview of maternal and newborn health policy reform efforts undertaken in Bolivia and suggests that despite efforts such as the implementation of new health insurances, conditional cash transfers, and decentralization to give local governments more power to deliver more focused and effective policies, the results have fallen short. Improvements in access and supply of health services have been confined to urban and surrounding areas while rural and marginalized populations face growing levels of inequalities and inequities.

Silva E, Batista R. Seguros de Salud y su Impacto en la Salud Materno Infantil de las Poblaciónes Indígenas y Rurales de Bolivia.  2009. 

Notes: This document is a series of slides providing an overview of maternal and newborn health policy in Bolivia. It outlines the context of the situation and provides data on maternal and newborn health indicators and the different types of health insurances available. Implications for policy indicate that any strategy to reduce maternal and neonatal deaths needs to be accompanied by reproductive health programs. The authors cite a need for policies and interventions to be developed in accordance with the differing needs of rural and indigenous populations.

USAID. Achieving the MDGs. The Contribution of Family Planning: Bolivia.  2009 Jul. 

Notes: This document is a 2 page country brief for Bolivia as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Bolivia. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 8 to 1.

Burkina Faso

Family Care International. Saving Women's Lives: The Skilled Care Initiative.  2000. 

Notes: This document is a two page brief providing an overview of Family Care International's Skilled Care Initiative. The initiative, launched in 2000, is a multi-faceted, five-year project to increase the number of women who receive skilled care before, during, and after childbirth. The project is being implemented in four rural, underserved districts in Burkina Faso, Kenya, and Tanzania. It also includes advocacy and information-sharing in the Latin America and Caribbean (LAC) region, and with global partners. The initiative focuses specifically on "skilled care" as a strategy for reducing maternal mortality and morbidity. The initiative emphasizes the critical importance of the environment where the provider works, such as the need for supportive policies, equipment, efficient communication systems and infrastructure. The project works in collaboration with government agencies and aims to offer project activities that are sustainable and replicable.

Hounton SH, Newlands D, Meda N, De Brouwere V. A Cost-Effectiveness Study of Caesarean-Section Deliveries by Clinical Officers, General Practitioners and Obstetricians in Burkina Faso. Human Resources for Health 2009 Apr 16;7.

Abstract: Background: The aim of this paper was to evaluate the effectiveness and cost-effectiveness of alternative training strategies for increasing access to emergency obstetric care in Burkina Faso. Methods: Case extraction forms were used to record data on 2305 caesarean sections performed in 2004 and 2005 in hospitals in six out of the 13 health regions of Burkina Faso. Main effectiveness outcomes were mothers' and newborns' case fatality rates. The costs of performing caesarean sections were estimated from a health system perspective and Incremental Cost-Effectiveness Ratios were computed using the newborn case fatality rates. Results: Overall, case mixes per provider were comparable. Newborn case fatality rates (per thousand) varied significantly among obstetricians, general practitioners and clinical officers, at 99, 125 and 198, respectively. The estimated average cost per averted newborn death (x 1000 live births) for an obstetrician-led team compared to a general practitioner-led team was 11 757 international dollars, and for a general practitioner-led team compared to a clinical officer-led team it was 200 international dollars. Training of general practitioners appears therefore to be both effective and cost-effective in the short run. Clinical officers are associated with a high newborn case fatality rate. Conclusion: Training substitutes is a viable option to increase access to life-saving operations in district hospitals. The high newborn case fatality rate among clinical officers could be addressed by a refresher course and closer supervision. These findings may assist in addressing supply shortages of skilled health personnel in sub-Saharan Africa.

Institut national de la statistique et de la démographie. Burkina Faso Annuaire Statistique Edition 2008.  2009 Apr. 

Notes: This document produced by the National Institute of Statistics and Demograpy Burkina Faso presents the 2008 annual report of statistics. This 2008 edition is the third in a series beginning in 2006 and presents a general synthesis of the social and economic state of Burkina Faso over a period of 10 years. Statistics mentioned include geography, demography, economy, finance and commerce, and external affairs.

LOI No 030-2008/ AN: Portant Lutte Contre Le VIH/SIDA et Protection des Droits des Personnes Vivant Avec le HIV/SIDA. JO No26 du 26 juin 2008, Burkina Faso, (2008).

Notes: This document outlines Burkina Faso's HIV/AIDS law for the protection and rights of people living with HIV/AIDS. The document defines HIV/AIDS and measures of protection, in particular towards health services, vulnerable people, and their families and community.

LOI No 049-2005/ AN: Portant Santé de la Reproduction, Burkina Faso, (2005).

Notes: This document presents Burkina Faso's law for good reproductive health. It outlines all aspects relating to good health such as physical mental and social, and addresses the health of women, men, children and adolescents, and neonates.

Ministère de la Santé Burkina Faso. Annuaire Statistique 2009. Burkina Faso; 2010 May.

Notes: This document produced by MOH Burkina Faso presents the 2009 annual report of health related statistics. In recognition of the importance of tracking changes in demography and epidemiology toward strengthening health systems, this document presents an important source of capital for the planning and implementation of health policies. This document reports on 63 health districts, 13 health regions and 12 regional and national hospitals throughout Burkina Faso.

Ministère de la Santé Burkina Faso. Plan d'Accélération de Réduction de la Mortalité Maternelle et Néonatale au Burkina Faso (Feuille de Route).  2006 Oct. Report No.: Draft Version: Octobre 2006.

Notes: Draft Version: October 2006, Draft outline set out by the Burkina Faso Ministry of Health, division of family health, to accelerate the reduction of maternal and neonatal mortality in accordance with the Millennium Development Goals. This document is intended as a guide for governments in the development of a national plan to achieve the MDGs. It calls for the partnering of all actors in the health systems, financial, and technical to work together over the next ten years.

Ministère de la Santé Burkina Faso. Politique et Normes en Matiere de Santé de la Reproduction.  2010 May. 

Notes: Burkina Faso Ministry of Health document together with support from WHO, UNFPA, and UNICEF; outlining the policies, norms and protocols relating to reproductive health. This docment presents an overview of the state of reproductive health in Burkina Faso and outlines government measures produced in response to the worldwide need to improve maternal mortality such as policies relating to reproductive health in general as well as norms and protocols in regards to reproductive health services.

Ministère de la Santé Burkina Faso. Rapport d'Analyse Situationelle de la Profession Sage Femme et Maïeuticien d'Etat au Burkina Faso en 2009.  2009 Aug. 

Notes: Burkina Faso Ministry of Health document together with support from UNFPA and the International Confederation of Midwives. This is a situational analysis of the current state of the midwifery profession looking at 3 key domains, education, regulation and associations. The report highlights the need for competent health personnel and improvements in the curriculum.Editor’s note in French: Ce rapport ignore complètement les deux catégories associées d'Accoucheuse Brevetée et d'Accoucheuse Auxiliaire, pourtant très sollicitées pour les accouchements en particulier en milieu rural  (voir Charlemagne Ouedraogo).

USAID. Atteindre les OMDs. La Contribution de la Planification Familiale: Burkina Faso.  2009 Jul.

Notes: This document is a 2 page country brief for Burkina Faso as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Burkina Faso. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 3 to 1.

Burundi

Kenya. Proposed Resolution on Strengthening Nursing and Midwifery for the 128th Executive Board and the Sixty-Fourth World Health Assembly.  2011 Jan 13. 

Notes: Edited draft. This report is a proposed resolution for strengthening nursing and midwifery for Kenya. The resolution is proposed by Kenya and co-sponsored by Burundi. The report lists a series of recommendations for the Sixty-fourth World Health Assembly which include recognizing the need to build sustainable national health systems and to strengthen national capacities and to improve the availability of basic health services. The report outlines requests to the Director General such as continued investment and appointment of qualified nurses and midwives to headquarters and regional and country posts, technical support for the development and implementations of policies, strategies and programmes on interprofessional education and collaborative practice, and to continue to promote cooperation between agencies and organizations concerned with the development of nursing and midwifery. Source not provided.

Ministère de la Santé Publique République du Burundi. Politique de Developpement des Ressources Humaines Pour la Santé. Bujumbura; 2010 Jan. 

Notes: A document produced by the Ministry of Public Health in Burundi (final draft) calling for the development of improved human resources for health. This document outlines aims and objectives for improving the HRH crisis in Burundi and states that it recognises that poor HRH is a principal constraint to an effective health system. The document provides a brief background to the situation in Burundi and specifies areas for action as decentralization, finance, HR policies, and information system and structural reforms.

Ministère de la Santé Publique République du Burundi. Politique National de la Santé de la Reproduction. Bujumbura; 2007 Sep. 

Notes: A document produced by the Ministry of Public Health in Burundi together with support from UNFPA, KFW Entwicklungsbank, WHO, and UNICEF. This document presents Burundi's national programme to improve sexual and reproductive health and highlights the importance of coordination between policy makers, health professionals, development partners and the general population.

Nizigama J, Batungwanayo C. Profil du Pays - Programme de Promotion des Sages-Femmes (Burundi). Bujumbura; 2008. 

Notes: This is a table put together by Dr. Nizigama from the Reproductive Health Programme at the UNFPA in collaboration with Dr. Batungwanayo from Burundi's Ministry of Public Health and the Struggle against HIV/AIDS, Faculty of Medicine, Bujumbura. It outlines categories of health personnel responsible for childbirth and obstetrics and their level of experience.

Cambodia

Ministry of Health Kingdom of Cambodia. The MOH Health Workforce Development Plan 2006-2015 DRAFT.  2004 Nov. 

Notes: This is a draft document of Cambodia's Ministry of Health plan to produce a pool of health personnel from which health worker activity occurs in both the public and other sectors. The health workforce development plan presented in this document is based on a projection of the level of staffing of the health system in Cambodia for the period 2006-2015. This plan emphasizes workforce planning priorities to be recognized in the context of principal indicators of population health status, such as nutritional status, life expectancy, infant and under-five mortality, maternal mortality and morbidity rates for communicable diseases. This plan calls for the prioritization of adequate staffing, encouragement for service utilization and maximization of preventative activity.

Ministry of Health Kingdom of Cambodia. National Emergency Obstetric and Newborn Care Assessment in Cambodia.  2009 May. 

Notes: This report is conducted by the National Institute of Public Health, Cambodia and supported by the National Maternal and Child Health Center and National Reproductive Health Program. This study is an assessment of the level of readiness of the Cambodia's health facilities to provide emergency obstetric care to mothers and newborns. The evidence of this report is intended as a baseline for future monitoring and evaluation and to assist policy makers and program managers to design effective strategies to reduce maternal and newborn mortality. The study finds that underreporting of maternal deaths is a common problem in Cambodia and that availability and utilization of EmONC facilities fall short. The study cites 'policy issues' and infrastructure as key barriers and calls for standards, guidelines and protocols to be put in place to address this.

Ministry of Health Kingdom of Cambodia. Cambodia EmONC Improvement Plan - For Implementation January 2010-December 2015. A Plan to Support and Increase the Availability and Utilisation of Quality Functional EmONC throughout Cambodia. 2009 Dec. 

Notes: This document outlines an improvement plan created following a national assessment of availability, quality and utilisation of emergency obstetric and newborn care in 2008 conducted by Cambodia's MInistry of Health to help understand why the country has one of the highest numbers of maternal and newborn deaths in the Southeast Asia region. The plan outlines 7 intended outputs: policy and minimum standards to support implementation of EmONC at all levels of care, improved availability and access to EmONC, strengthened capacity to support the development of skilled care, increased utilisation of quality functional EmONC and services, functioning referral system, provincial EmONC plans developed and implemented by provincial health departments, and strengthened links to communities and increased utilisation of EmONC.

Ministry of Health Kingdom of Cambodia. Fast Track Initiative - Road Map for Reducing Maternal and Newborn Mortality 2010-2015.  2010 May. 

Notes: This document outlines the initiatives and strategies that help reduce maternal and newborn mortality. This document describes components of the government's existing maternal and newborn health programs. The report highlights the strong association between family planning, skilled attendance at birth, access to safe abortions and rates of mortality. This road map is to be used in the context of the existing continuum of care encompassing reproductive, maternal, newborn and child health. The document calls for a scaling up and quality improvement of already existing initiatives. Critical areas of intervention identified include: emergency obstetric and newborn care, skilled birth attendance, family planning, safe abortion, behavior change communication, removing financial barriers, and maternal death and surveillance response.

NSRKT 0906 389 Royal Decree Establishment of Cambodian Midwife Council, The Royal Government of Cambodia, (2006).

Notes: Informal translation of a royal decree establishing a midwife council. This document orders the establishment of a midwife committee with the purpose of gathering all qualified midwives who performmedical professional and para-clinic professional in the Kingdom of Cambodia. This does not include an already separate policy for traditional midwives. The document outlines the necessary moral, administrative, judicial, counseling, and mutual assistance functions.

Sherratt DR, White P, Chhuong CK. Report of Comprehensive Midwifery Review (Cambodia). 2006 Sep.

Notes: Report produced by the Ministry of Health, Kingdom of Cambodia. This report contains the results and recommendations from a comprehensive review of midwifery in Cambodia undertaken as an important component of the Mid-Term Review (MTR) of the Health Sector Strategic Plan, 2003-07 (HSP), and the Health Sector Support Project, 2003-07 (HSSP).Efforts to date appear to be having a positive impact. However, the results of this Comprehensive Midwifery Review do indicate that, to be able to move onto the next phase there is need for a change of focus. An emphasis that looks more towards quality of services, and focuses on ensuring that midwifery practitioners have minimum competencies. The document calls for a modification to the curriculum as well as highlights the need to establish a national, independent and an externally verifiable examination process.

Cameroon

African Health Workforce Observatory, World Health Organization. Profil en Ressources Humaines pour la Santé du Cameroun - Guide de Rédaction du Profil en Ressources Humaines pour la Santé du Pays.  2009 Mar. 

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Cameroon. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Uganda.  2009 Oct. 

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Uganda. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: The Gambia.  2009 Mar.

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in the Gambia. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

Central African Republic

Ministère de la Santé Publique de la Population et de la Lutte Contre le SIDA - République Centrafricaine, UNFPA. Évaluation de la Disponibilité, de l'Utilisation et de la Qualité des Soins Obstetricaux d'Urgence dans la Zone d'Intervention de L'UNFPA en République Centrafricaine.  2010 Aug.

Notes: This document is a joint report by the CAR's Ministry of Public Health and UNFPA. The report presents an evaluation of the availability, utilization and quality of emergency obstetric services within the UNFPA intervention zone. The objective of this study is to present an evaluation that can later be used as a basis for the strengthening and reinforcement of interventions to reduce maternal mortality in the CAR.

Ministère de la Santé Publique et de la Population République Centrafricaine. Politique Nationale de la Santé de la Reproduction.  2003 Oct. 

Notes: This document outlines CAR's national reproductive health policy. It presents an analysis of key issues relating to health in general and reports on the state of reproductive health. The document details the key priorities which need to be addressed. The objective to the compilation of this report is to present a policy which will be of benefit to the reduction of maternal and neonatal mortality.

Ministère de la Santé Publique et de la Population République Centrafricaine, World Health Organization Regional Office for Africa. Cartographie de l'Offre des Services de Santé - Rapport Final.  2006. 

Notes: This document presents a mapping of available health services in the CAR. This document details the state of health services at regional and district levels. The general objective of the mapping of health services is to reinforce information systems in the context of public health and to outline useful and modern methods for data collection and analysis.

Chad

Ministère de la Santé Publique République du Tchad. Rapport d'Élaboration d'un Projet de Renforcement des Capacités de la Pratique de Sage-Femme au Tchad.  2010 Jan.

Notes: This report is intended as a first phase in the development of a national plan of action for midwifery in Chad. This report is focused on the premise that midwives are a valuable and essential human resource in a health systems approach to reaching MDG 4 and 5. It highlights the importance of capacity building and strengthening competencies of midwives and the midwifery profession. This report makes various recommendations relating to midwifery education and training, employment structures and laws, and strengthening regulation capacities.

Comoros

Affane S. Rapport d'Étude sur les Indicateurs de Processus pour le Suivi et la Surveillance de la Mortalité Maternelle.  2005.

Notes: This document has been produced for the Ministry of Health, Comoros. This document presents a report of a study on process indicators for monitoring and surveillance of mortality. The report was written as part of the Union of Comoros' roadmap to meet the MDG goals, specifically MDG 5. The report indicates that the establishment of process indicators can provide essential data in the context of monitoring progress towards reducing maternal mortality. The study was based on a national survey, using a questionnaire to determine the number of services delivering essential obstetric care.

Ministère de la Santé de la Solidarité et de la Promotion du Genre - Union de Comores. Plan Stratégique de Développement des Ressources Humaines pour la Santé.  2010 Jan 25. 

Notes: This document outlines the Comoros Ministry of Health strategic plan for the development of human resources for help. The objective of this plan is to promote an enhanced quality and quanitity of human resources in the Comoros. This report details current weaknesses in this sector such as insufficient salaries, a lack of employment descriptions, poor working conditions, a lack of effective evaluating mechanisms, and a general feeling of demotivation among health personnel. This report states that there needs to be a national policy regarding staff motivation.

Côte D'Ivoire

Ministère de la Santé et de l'Hygiene Publiqe Côte d'Ivoire, International Conferdation of Midwives, UNFPA. Rapport d'Analyse Situationnelle des Institutes de Formations et la Pratique des Sages Femmes en Côte D'Ivoire.  2009 Jul. 

Notes: This document presents an evaluation of the state of midwifery in the Ivory Coast. The intent of this document is to provide an account which highlights the importance of midwives and promotes the development of the profession. Areas of concern outlined in the document are finance and budgeting, training and education, and improve working conditions and incentive structures.

UNFPA, International Confederation of Midwives. Programme Investir dans les Sages-Femmes en Côte d'Ivoire: Experience en Matière de Renforcement des Compétences d'Environ 300 Sage Femmes en Instance d'Affectation.

Notes: This document is a UNFPA/ICM factsheet discussing a programme for the reinforcement of midwifery competencies and the development of the midwifery profession in the Ivory Coast. The UNFPA/ICM programme created in 2009, aimed to identify the insufficiencies relating to midwife formation and the level of quality of training to become a midwife. Working with the MOH, the program oversaw the retraining of 290 new midwives.

Democratic Republic of the Congo

African Health Workforce Observatory, World Health Organization. Profil en Ressources Humaines pour la Santé du Congo - Guide de Rédaction du Profil en Ressources Humaines pour la Santé du Pays.  2009 Mar. 

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in the Congo. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

USAID. Achieving the MDGs. The Contribution of Family Planning: Democratic Republic of Congo. Health Policy Initiative.

Notes: This document is a 2 page country brief for the Democratic Republic of Congo as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in the DRC. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of nearly 4 to 1.

Djibouti

Ghérissi A. Programme d'Études de Sage Femme àDjibouti.  2006 May.

Notes: This document provides an overview of the midwifery profession in Djibouti.The report is a WHO document and outlines midwifery education programmes in the country. The report provides a definition for midwifery practice and what it means to be a midwife in Djibouti. It covers the general competencies necessary to practice, the philosophical foundation of midwifery curriculums and the role of the midwife in the community. Regarding programmes of study, it outlines the structure of curriculums, organization, and teaching and evaluation methods.

Ministère de la Santé Djibouti, UNFPA. Plan de Travail Annuel 2009 pour l'Accélération de la Réduction de la Mortalité Maternelle (Fonds Thématique pour la Santé maternelle).  2009 May 25.

Notes: This document is a work plan proposal for the 2009 UNFPA/Djibouti Ministry of Health project to accelerate the reduction of maternal mortality in Djibouti. This is a 5 year project to take place between 2009 and 2013 which aims to improve the availability and quality of reproductive health care services, in particular making family planning and emergency obstetric care accessible to underserved populations. Improving human resources is included in the strategy. The document includes a table of expected results, outputs and indicators, planned activities, timeframe and planned budget.

UNICEF, Ministry of Health Djibouti. Évaluation des Besoins en Soins Obstétricaux et Néonataux d'Urgence en République de Djibouti.  2005 Nov. 

Notes: This document presents an evaluation of emergency obstetric and neonatal care needs in Djibouti. The report, produced by the Reproductive Health Team and UNICEF/Djibouti provides a general overview of maternal and neonatal mortality in Djibouti and presents an evaluation of emergency obstetric care needs in the context of the availability and quality of services within the health system. The document provides an overview of available human resources, in particular maternal and neonatal health workers.

Ethiopia

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Ethiopia.  2010 Jun. 

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Ethiopia. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

Fullerton JT, Johnson PG, Thompson JB, Vivio D. Quality Considerations in Midwifery Pre-service Education: Exemplars from Africa. Midwifery 2010 Dec 1.

Abstract: OBJECTIVE: this paper uses comparisons and contrasts identified during an assessment of pre-service education for midwives in three countries in sub-Saharan Africa. The purpose of the paper is to stimulate discussion about issues that must be carefully considered in the context of midwifery educational programming and the expansion of the midwifery workforce. DESIGN AND SETTING: a mixed qualitative and quantitative participatory assessment was conducted in Ethiopia, Ghana and Malawi, in the context of a final review of outcomes of a USAID-funded global project (ACCESS). Quantitative surveys were distributed. Individual and focus group interviews were conducted. PARTICIPANTS: participants included key informants at donor, government and policy-making levels, representatives of collaborating and supporting agencies, midwives and students in education programmes, and midwives in clinical practice. FINDINGS: information is presented concerning the challenges encountered by those responsible for midwifery pre-service education related to issues in programming including: pathways to midwifery, student recruitment and admission, midwifery curricula, preparation of faculty to engage in academic teaching and clinical mentorship, modes of curriculum dissemination and teaching/learning strategies, programme accreditation, qualifications for entry-into practice and the assessment of continued competence. KEY CONCLUSIONS: quality issues must be carefully considered when designing and implementing midwifery pre-service education programmes, and planning for the integration of new graduates into the health workforce. These issues, such as the availability of qualified tutors and clinical teachers, and measures for the implementation of competency-based teaching and learner-assessment strategies, are particularly relevant in countries that experience health manpower shortages. IMPLICATIONS FOR PRACTICE: this review highlights important strategic choices that can be made to enhance the quality of pre-service midwifery education. The deployment, appropriate utilisation and increased number of highly qualified midwifery graduates can improve the quality of maternal and newborn health-care service, and reduce maternal and newborn mortality.

Mahmood Q. Ethiopia Country Profile: Midwifery Workforce.  2008. 

Notes: This document is a country profile for Ethiopia's midwifery workforce. It is presented in table form and provides data for the name of cadre, length of pre-service training, time spent on midwifery during pre-service, age of entry into pre-service, number of years schooling required for entry, whether home births are conducted and allowed, whether births are conducted in a community facility or hospital, and if there is a formal programme in place for career advancement.

USAID. Achieving the MDGs. The Contribution of Family Planning: Ethiopia.  2009 Jul. 

Notes: This document is a 2 page country brief for Ethiopia as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Ethiopia. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 2 to 1.

World Health Organization. Report on the National Situational Analysis of Pre-Service Midwifery Training in Ethiopia. Addis Ababa; 2008 Jan. 

Notes: This is a national midwifery survey conducted as part of WHO's contribution to address gaps and issues identified during the subsequent review of Ethiopia's Health Sector Development Program initiated in 1997. The primary objective of this assessment is to appraise the status of infrastructural, human resources, programmatic and governance aspects of the pre-service midwifery training in the country. The survey finds that the number of midwifery training facilities has increased in the last decade but the number and capacity of midwifery training facilities is still very small compared to potential demand.

Gabon

Association des Sages-Femmes du Gabon. La Profession de Sage-Femme au Gabon.  2009 Dec. 

Notes: This document is written by the Association for Midwifery in Gabon and provides a description of the midwifery profession in the country, including the roles and responsibilities of the midwife and their professional capacity. This document also provides an overview of the role of the association itself.

Fauveau V. Program Note: Using UN Process Indicators to Assess Needs in Emergency Obstetric Services: Gabon, Guinea-Bissau, and The Gambia. International Journal Of Gynecology And Obstetrics 2007 Mar;96(3):233-40.

Abstract: PURPOSE: We report on assessments of the needs for emergency obstetric care in 3 West African countries. METHODS: All (or almost all) medical facilities were visited to determine whether there are sufficient facilities of adequate quality to manage the expected number of obstetric emergencies. RESULTS: Medical facilities able to provide emergency obstetric care were poorly distributed and often were unable to provide needed procedures. Too few obstetricians and other providers, lack of on-the-job training and supervision were among the challenges faced in these countries.

Ministère de la Santé République du Gabon, UNFPA. Rapport Final de l'Enquête sur l'Évaluation des Besoins en Matière des Soins Obstétricaux et Néonataux d'Urgence (SONU) au Gabon.  2010 May 31.

Notes: This document presents findings from a survey conducted by the Ministry of Health, Gabon and UNFPA on emergency obstetric and neonatal care services in Gabon. The survey was carried out with the objectives to determine the availability, quality and level of utilization of EmONC services, geographic distribution of facilities, availability of essential supplies and medicines, and the availability and level of training of health personnel. This survey was conducted with the aim to contribute to reinforcing the national health system in order to facilitate improved EmONC services. Findings of the study indicate considerable health workforce shortages, a lack of supplies and equipment, organizational challenges, and insufficient EmONC services.

Gambia

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: The Gambia.  2009 Mar. 

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in the Gambia. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

Fauveau V. Program Note: Using UN Process Indicators to Assess Needs in Emergency Obstetric Services: Gabon, Guinea-Bissau, and The Gambia. International Journal Of Gynecology And Obstetrics 2007 Mar;96(3):233-40.

Abstract: PURPOSE: We report on assessments of the needs for emergency obstetric care in 3 West African countries. METHODS: All (or almost all) medical facilities were visited to determine whether there are sufficient facilities of adequate quality to manage the expected number of obstetric emergencies. RESULTS: Medical facilities able to provide emergency obstetric care were poorly distributed and often were unable to provide needed procedures. Too few obstetricians and other providers, lack of on-the-job training and supervision were among the challenges faced in these countries.

Republic of the Gambia: National Planning Commission. Level of Achievement of the Millennium Development Goals (MDGs), MDG Status Report.  2009. 

Notes: This document presents the 2009 MDG status report for the Gambia. This is the fourth national report on the implementation status of the MDGs. This report is based on data from the 2003 Integrated Household Survey, the round three of the Multiple Indicator Cluster Survey (MICS III), 2005/2006, the 2003 census as well as sector specific data on education and health. The findings at national level state: Goal 2 (proportion of pupils starting grade 1 who reach last grade of primary) has been attained. On track to attaining net enrolment in primary education and literacy among 15-24 year olds, Goal 3 (gender parity in primary and lower basic has been attained and parity at senior secondary is within reach). Goal 4 (proportion of 1 year old children immunized against measles has been attained). Goal 6 (proportion of under-fives sleeping under ITNs is on track). The country is on course to meet both the Abuja and MDG targets of .80% of children sleeping under ITNs. Goal 7 (proportion of population using improved drinking water source has been attained). Goal 8 (partnership for development). Completion point under the enhanced HIPC Initiative has been reached and the country is eligible for debt relief under the HIPC to the tune of US$66.6 million and under MDRI to the tune of approximately US$373.5 million in nominal terms over the next 43 years (IMF Press Release No. 07/302, December 20, 2007. In addition, significant strides have been made in the fight against malaria prevention and control.

Ghana

Fullerton JT, Johnson PG, Thompson JB, Vivio D. Quality Considerations in Midwifery Pre-service Education: Exemplars from Africa. Midwifery 2010 Dec 1.

Abstract: OBJECTIVE: this paper uses comparisons and contrasts identified during an assessment of pre-service education for midwives in three countries in sub-Saharan Africa. The purpose of the paper is to stimulate discussion about issues that must be carefully considered in the context of midwifery educational programming and the expansion of the midwifery workforce. DESIGN AND SETTING: a mixed qualitative and quantitative participatory assessment was conducted in Ethiopia, Ghana and Malawi, in the context of a final review of outcomes of a USAID-funded global project (ACCESS). Quantitative surveys were distributed. Individual and focus group interviews were conducted. PARTICIPANTS: participants included key informants at donor, government and policy-making levels, representatives of collaborating and supporting agencies, midwives and students in education programmes, and midwives in clinical practice. FINDINGS: information is presented concerning the challenges encountered by those responsible for midwifery pre-service education related to issues in programming including: pathways to midwifery, student recruitment and admission, midwifery curricula, preparation of faculty to engage in academic teaching and clinical mentorship, modes of curriculum dissemination and teaching/learning strategies, programme accreditation, qualifications for entry-into practice and the assessment of continued competence. KEY CONCLUSIONS: quality issues must be carefully considered when designing and implementing midwifery pre-service education programmes, and planning for the integration of new graduates into the health workforce. These issues, such as the availability of qualified tutors and clinical teachers, and measures for the implementation of competency-based teaching and learner-assessment strategies, are particularly relevant in countries that experience health manpower shortages. IMPLICATIONS FOR PRACTICE: this review highlights important strategic choices that can be made to enhance the quality of pre-service midwifery education. The deployment, appropriate utilisation and increased number of highly qualified midwifery graduates can improve the quality of maternal and newborn health-care service, and reduce maternal and newborn mortality.

Hussein J, Phoya A, Tornui JA, Okiwelu T. Midwifery Practice in Ghana and Malawi: Influences of the Health System. In: Reid L.Churchill Livingstone, editor. Freedom to Practise: An International Exploration of Midwifery Practice.London: Elsevier; 2007. p. 75-99.

Notes: This document is a book chapter about midwifery practice and the health system. This chapter discusses the health system's influence on midwifery practice and how this is an essential part of how midwives define their role and practice. Health system in this chapter refers to the wider context or environment in which midwives practice including the systems which train, govern, and regulate midwifery practice, provide essential supplies and equipment, set up referral mechanisms and organize private and public care provision. This chapter discusses how factors of the health system can both help and hinder the practice of midwives, with specific reference to Ghana and Malawi.

USAID. The Emerging Midwifery Crisis in Ghana: Mapping of Midwives and Service Availability Highlights Gaps in Maternal Care.  2006 Jun.

Notes: This document reports findings from a study of midwives in 10 districts of five regions in Ghana to examine specific sill sets, scopes of practice, and referral systems to identify gaps in access and service delivery, legal and operation barriers to practice, and geographical disparities in coverage. The report finds that midwives in Ghana share similar concerns and challenges as other critical healthcare providers despite differences in professional affiliation and training. Midwives require expanded pre- and in-service training opportunities and more resources to enhance the scope and quality of the services they are able to provide. The combination of an aging midwife population, inadequate salaries, and few incentives to remain in rural areas all pose challenges to reducing maternal and child mortality by supplying skilled providers who attend deliveries and provide services.

Voetagbe G, Yellu N, Mills J, Mitchell E, Adu-Amankwah A, Jehu-Appiah K, et al. Midwifery Tutors' Capacity and Willingness to Teach Contraception, Post-Abortion Care, and Legal Pregnancy Termination in Ghana. Human Resources for Health 2010;8:2.

Abstract: BACKGROUND: Ghana has a high maternal mortality rate of 540 per 100 000. Although abortion complications usually are treatable, the risks of morbidity and death increase when treatment is delayed. Delay in care may occur when women have difficulty accessing treatment because health care providers are not trained, equipped, or willing to treat the complications of abortion. Gaps in the midwifery tutors' knowledge on comprehensive abortion care (CAC) have resulted in most midwives in Ghana not knowing the legal indications under which safe abortion care can be provided, and lacking the skills and competencies for CAC services. The aim of this study is to assess the capacity and willingness of midwifery tutors to teach contraception, post abortion care and legal termination in Ghana. METHODS: This study focused on all 14 midwifery schools in the country. A total of 74 midwifery tutors were interviewed for this study. Structured self-administered questionnaires were used for data collection. The data were entered and checked for consistencies using Epiinfo 6.04 and analyzed using Stata 8. Descriptive analysis was used and frequencies reported with percentages. RESULTS: In total, 74 midwifery tutors were interviewed. Of these, 66 (89.2%) were females. The tutors had mainly been trained as midwives (51.4%) and graduate nurses (33.8%). Respondents were predominantly Christians (97.3%).The study discovered that only 18.9% of the tutors knew all the legal indications under which safe abortion care could be provided. The content of pre-service training of tutors did not include uterine evacuation with manual vacuum aspirator (MVA).The study also highlighted some factors that influence midwifery tutors' willingness to teach comprehensive abortion care. It was also revealed that personal and religious beliefs greatly influence teaching of Comprehensive Abortion Care. CONCLUSION: The findings of this survey suggest that the majority of tutors did not know the abortion law in Ghana as well as the Ghana Health Service Reproductive Health Standards and Protocol. Thus, there is a need to enhance their capacities to teach the present pre-service students the necessary skills to offer CAC after school and to understand related issues such as related legal matters.

Guinea

Institut de Perfectionnement du Personnel de Santé (IPPS) République de Guinée. Projet Création de la Filière Sage Femme.  2010 Jun. 

Notes: This document presents a general overview of the situation in Guinea such as socio-economic demographics, cultural make-up, and health indicators. This report is issued by the Institute for the Improvement of Health Personnel which appears to be a subdivision of the Ministry of Health Guinea. The report outlines a project dedicated to the development of practical competencies of midwives and to increasing the availability of midwifery services so as to reduce maternal mortality. It presents an analysis of human resources for health and finds that there is a shortage of qualified midwives. This report specifies areas to be acted such as: recruitment, education, curriculum, and student fees.

Ministère de la Santé Publique République de Guinée. Plan National de Développement Sanitaire 2005 –2014.  2004 Aug.

Notes: This plan outlines Guinea's national plan for the development of health and sanitation. This document is in response to prior Ministry of Health recommendations which call for the strengthening of the health system. There are two essential phases of this strategy plan: first, an analysis of the health sector, and second, the formation of strategic directions.This document looks at health systems through a social context and presents an evaluation in the context of finances, human resources, infrastructure and other health determinants.

Guinea Bissau

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Guinea-Bissau.  2010 Aug. 

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Guinea-Bissau. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

Fauveau V. Program Note: Using UN Process Indicators to Assess Needs in Emergency Obstetric Services: Gabon, Guinea-Bissau, and The Gambia. International Journal Of Gynecology And Obstetrics 2007 Mar;96(3):233-40.

Abstract: PURPOSE: We report on assessments of the needs for emergency obstetric care in 3 West African countries. METHODS: All (or almost all) medical facilities were visited to determine whether there are sufficient facilities of adequate quality to manage the expected number of obstetric emergencies. RESULTS: Medical facilities able to provide emergency obstetric care were poorly distributed and often were unable to provide needed procedures. Too few obstetricians and other providers, lack of on-the-job training and supervision were among the challenges faced in these countries.

Guyana

Butts-Garnett G. Midwifery Assessment in Guyana.  2010.

Notes: This document is an assessment to determine the baseline number of midwife graduates, their deployment to different levels of health facilities, geographical distribution and national needs in these areas. The report cites 494 midwives working in Guyana with 334 post basic and 157 trained at direct-entry level. The assessment revealed that while Single Trained midwives are trained specifically for community level facilities such as health centres and health posts, they are assigned at all levels of hospital, including the national referral and teaching hospital. Many post basic trained midwives also work at supervisory level and in administration, but do not necessarily work in maternal and reproductive health as some may be assigned to surgical and medical nursing wards/clinics. The report finds that the number of midwives working in the system is inadequate and poor distribution continues to make the situation worse.

Gordon SJ. Final Report - Consultancy for the Conduct of an Assessment to Determine the Baseline Number of Midwife Graduates, Their Deployment to Different Levels of Health Facilities, Geographical Distribution and National Needs in These Areas.  2009. 

Notes: This Consultancy was done as a part of the support provided to the Guyana Nurses Association by the UNFPA Caribbean Sub-Regional Office/ Guyana Work plan to determine the baseline number of midwife graduates, their deployment to different levels of health facilities, geographical distribution and national needs in these areas. This document reports that the importance of the role of the midwife in Guyana's achieving MDG 5 requires adequate numbers of midwife, an organised programme of continuing education and supervision and support of midwives, especially those at the periphery.

Guyana Country Summary.  2011.

Notes: This document presents a general overview of Guyana. It details estimates of demographics relating to MDG 5: demographics, education, midwifery workforce and policies and challenges. Source not provided.

Haji M, Durairaj V, Zurn P, Stormont L, Mapunda M. Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce Through Decentralized Health Financing Systems. Bulletin of the World Health Organization 2010 May;88(5):397-9.

This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector, better use of existing financial resources, and creation of financial incentives for health workers. The paper also considers the conditions under which decentralized health financing systems can lead to improved health workforce retention using examples from several countries including Brazil, China, Costa Rica, Guyana, India, Kenya, Pakistan, the Philippines, Romania, Rwanda, Thailand, Uganda, Tanzania, and Zambia. The document concludes that it is evident that providing the ministry of health with autonomy, by delinking the health workforce from the civil workforce and providing strategic performance incentives, are means by which health workers can be successfully recruited and retained. The authors also note that such policies only work if health system objectives are aligned with appropriate institutional and incentive structures.

Pan American Health Organization, World Health Organization. Health Sector Analysis, Guyana.  2003 Feb.

Notes: Unedited Draft Version. This document is a health sector analysis for Guyana. This analysis was conducted per request of the Ministry of Health of Guyana to provide input into the elaboration of the National Health Plan. It covers the political, social and economic contexts, human resources, health financing and spending, analysis of service delivery, essential public health functions and policy options and recommendations.

UNFPA. The Maternal Health Thematic Fund. Preliminary EmONC Results from Data Analysis Workshop: Guyana. 

Notes: This document is a UNFPA report on the Maternal Health Thematic Fund (MHTF) in Guyana. This report provides an update to CORE team members on the main findings of the EmONC census of all maternity facilities in Guyana.  In addition to the main findings some background information is included on the indicators (Monitoring Obstetric Care Handbook) for ease of reference and assistance in interpreting the results. Based on country indicators, Guyana was selected in 2008 and began receiving support in 2009 from the MHTF for four areas of work: human resources for maternal health, emergency obstetric and newborn Care (EmONC), family planning, monitoring and evaluation. This document provides preliminary results from a data analysis workshop.

Haiti

Haiti. Nurse Midwives - Key Players in Maternal Mortality Reduction Efforts in Haiti. 2009.

Notes: This document provides a brief summary of the Maternity of Petite Rivière de l'Artibonite, a maternity centre in Haiti that offers a range of services including antenatal consultations, partum and postpartum care, family planning, and attention to the prevention of mother to child HIV transmission. These services are ensured by nurse midwives as part of compulsory social service, and by students of the National School of Nurse Midwives (ENISF), during their internships, supervised by seniors. Source not provided but appears to be written for UNFPA/Haiti.

Haiti. Rapport Enquête SONU.  2009. 

Notes: This document presents an analysis of the availability, use, and quality of emergency obstetric care in Haiti. The specific objectives of this analysis include an evaluation of the availability of establishments that are equipped for EmONC care, the availability and types of medical schools, specifically midwifery and nursing, training programmes available, the number of actual health personnel working, and human resource policies. Results of the analysis are presented in table form.

Jacobs AM. Renforcement des Capacités du Programme de la Santé Maternelle et Néonatale. Ressources Humaines des Infirmières Sages Femmes et Autres.  2010 Feb. 

Notes: IMA/UNFPA-Haiti. This document presents an overview of the available human resources relating to midwives and nurses in Haiti. The report outlines issues relating to the existing competencies of midwives, retention and problems with out-migration, training programmes, and monitoring and evaluation. The report emphasizes strengthening midwifery education programmes and establishing direct-entry programmes for midwifery students.

Lynch B, de Bernis L. Document de Réflexion - Formation et Régulation des Sages-femmes en Haïti.  2010 Mar. 

Notes: This document is a reflection on the formation and regulation of midwives in Haiti. This document was developed under the order of the director of the Haitian Ministry of Health, Department of Family Health unit, as a result of a meeting between representatives from UNFPA (Luc de Bernis) and ICM (Bridget Lynch). The document presents an overview of challenges met in strengthening the health workforce, mainly formation, regulation and association. Recommendations include presenting diplomas to eligible students whose studies were affected by the 2010 earthquake, reforming the curriculum, including adding direct-entry programmes, ensuring practical experience is gained for a minimum of 3 years through employment in the public sector, and creating advanced practice opportunities for midwives who have completed their training and practical experience.

Pierre MR, Jacobs AM. Atelier de Réflexion - Autour de la Profession de Sage-femme en Haïti. 14 au 16 Décembre 2010.

Notes: This document is a report on the proceedings of a workshop held at Club Indigo in Haiti. The focus of the workshop, backed by ICM and UNFPA was to discuss issues relating to the midwifery profession in Haiti. Midwives attending the workshop were able to discuss their experiences and reflect on challenges encountered. The overall aim of the workshop was to contribute to improving maternal and neonatal health, particularly in the context of MDGs 4 and 5 and focused specifically on the importance of the midwife to meeting these challenges.

Women Deliver. Atelier sur la Réforme du Système Educationnel des Sages-femmes en Haïti.

Notes: This document is a report on the proceedings of a workshop held by Women Deliver in Washington D.C. discussing the education system for midwives in Haiti. Participants of the workshop included professionals from UNFPA, the Haitian Ministry of Public Health, and midwives and other health professionals working in Haiti. The focus of the workshop was to discuss possibilities for reforming the current midwifery education system. The participants discussed the length of required education for midwives and agreed it was too long. Suggestions for reform included strengthening supervision capacity, introducing direct-entry programmes, strengthening regulation procedures, and developing policies specific to midwifery.

India

Center for Reproductive Rights. Maternal Mortality in India: Using International and Constitutional Law to Promote Accountability and Change.  2008. 

Notes: This report focuses primarily on maternal mortality as a human rights concern. This report is intended to serve as a resource for those interested in using international and constitutional legal norms and mechanisms to establish government accountability for maternal deaths and pregnancy-related morbidity through public interest litigation and human rights advocacy. A human right to survive pregnancy implies the need for constitutional guarantees of access to pre- and postnatal health care and emergency obstetric care for all pregnant women, as well as the need for legal protection against discrimination that puts women's physical integrity and reproductive health in jeopardy. By highlighting stories of women who have died giving birth, this report illustrates the connections between their experiences and state action or inaction. Information from studies undertaken by local non-governmental organizations (NGOs) has been used to draw attention to important trends and challenges in implementing maternal health policies. Some of these studies contain data that may be used as a basis for public interest litigation. Finally, this report showcases a few important legal initiatives being undertaken in parts of India that seek accountability for maternal deaths and morbidity in order to inspire further action.

Evans CL, Maine D, McCloskey L, Feeley FG, Sanghvi H. Where There is No Obstetrician - Increasing Capacity for Emergency Obstetric Care in Rural India: An Evaluation of a Pilot Program to Train General Doctors. International Journal Of Gynecology And Obstetrics 2009 Dec;107(3):277-82.

Abstract: BACKGROUND: Maternal mortality continues to be high in rural India. Chief among the reasons for this is a severe shortage of obstetricians to perform cesarean delivery and other skills required for emergency obstetric care (EmOC). In 2006, the Government of India and the Federation of Obstetric and Gynecological Societies of India (FOGSI) with technical assistance from Jhpiego, instituted a nationwide, 16-week comprehensive EmOC (CEmOC) training program for general medical officers (MOs). This program is based on an earlier pilot project (2004-2006). OBJECTIVE: To evaluate the pilot project, and identify lessons learned to inform the nationwide scale-up. METHODS: The lead author (CE) visited trainees and their facilities to evaluate the project. Eight data collection tools were created, which included interviews with informants (program/government staff, regional/international experts, trainees and trainers), facility observation, and facility-based data collection of births and maternal/newborn deaths during the study period. RESULTS: More trainees performed each of the basic EmOC skills after the training than before. After training, 10 of 15 facilities to which trainees returned could provide all signal functions for basic EmOC whereas only 2 could do so before. For comprehensive EmOC, 2 facilities with obstetricians were providing all functions before and 2 were doing so after, even though the specialists had left those facilities and services were being provided by CEmOC trainees. Barriers to providing, or continuing to provide, EmOC for some trainees included insufficient training for cesarean delivery, lack of anesthetists, equipment and infrastructure (operating theater, blood services, forceps/vacuum, manual vacuum aspiration syringes). CONCLUSION: Although MOs can be trained to provide CEmOC (including cesarean delivery), without proper selection of facilities and trainees, adequate training, and support, this strategy will not substantially improve the availability of comprehensive EmOC in India. RECOMMENDATIONS: To implement a successful nationwide scale-up, several steps should be taken. These include, selecting motivated trainees, implementing the training as it was designed, improving support for trainees, and ensuring appropriate staff and infrastructure for trainees at their facilities before they return from training.

Fauveau V, Donnay F. Can the Process Indicators for Emergency Obstetric Care Assess the Progress of Maternal Mortality Reduction Programs? An Examination of UNFPA Projects 2000-2004. International Journal Of Gynecology And Obstetrics 2006 Jun;93(3):308-16.

Abstract: BACKGROUND: In view of the disappointing progress made in the last 20 years in reducing maternal mortality in low-income countries and before going to scale in implementing the new evidence-based strategies, it is crucial to review and assess the progress made in pilot countries where maternal mortality reduction programs focused on emergency obstetric care. OBJECTIVE: To review the process indicators recommended for monitoring emergency obstetric care and their application in field situations, examining the conditions under which they can be used to assess the progress of maternal mortality reduction programs. METHODS: Five of the six UN recommended process indicators were monitored annually for 5 years in selected districts of Morocco, Mozambique, India and Nicaragua. Trends are presented and discussed. RESULTS: With specific variations due to different local situations in the four countries and in spite of variations in quality of data collection, all indicators showed a consistent positive trend, in response to the inputs of the programs. CONCLUSIONS: The UN process indicators for emergency obstetric care should continue to be promoted, but with two important conditions: (1) data collection is carefully checked for quality and coverage; (2) efforts are made to match process and outcome indicators (maternal and perinatal mortality, incidence of complications).

Haji M, Durairaj V, Zurn P, Stormont L, Mapunda M. Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce Through Decentralized Health Financing Systems. Bulletin of the World Health Organization 2010 May;88(5):397-9.

This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector, better use of existing financial resources, and creation of financial incentives for health workers. The paper also considers the conditions under which decentralized health financing systems can lead to improved health workforce retention using examples from several countries including Brazil, China, Costa Rica, Guyana, India, Kenya, Pakistan, the Philippines, Romania, Rwanda, Thailand, Uganda, Tanzania, and Zambia. The document concludes that it is evident that providing the ministry of health with autonomy, by delinking the health workforce from the civil workforce and providing strategic performance incentives, are means by which health workers can be successfully recruited and retained. The authors also note that such policies only work if health system objectives are aligned with appropriate institutional and incentive structures.

Indian Nursing Council Act, 1947, ACT NO. 48 of 1947, India Nursing Council, (1947).

Notes: This document is a copy of Act number 48 of 1947, and act to constitute an India Nursing Council. The objective is stated as: "Act to constitute an Indian Nursing Council.. WHERE AS it is expedient to constitute an Indian Nursing Council in order to establish a uniform standard of training for nurses, midwives and health visitors". At time of enactment this act extends to the whole of India except the state of Jammu and Kashmir. The document defines the composition and constitution of the council and requirements for standardizing training for nurses, midwives and health visitors.

India Nursing Council. Statistics: Distribution of Nursing Educational Institutions Recognized by the Indian Nursing Council and Number of Registered Nurses in India.  2010. 

Notes: This document is a table depicting the distribution of nursing educational institutions recognized by the Indian Nursing Council and the number of registered nurses working in India. The table provides data on numbers divided by state and level of qualification.

Iyengar K, Iyengar SD. Emergency Obstetric Care and Referral: Experience of Two Midwife-Led Health Centres in Rural Rajasthan, India. Reproductive Health Matters 2009 May;17(33):9-20.

Abstract: This paper documents the experience of two health centres in a primary health service located in interior rural areas of southern Rajasthan, northern India, where trained nurse-midwives are providing skilled maternal and newborn care round the clock daily. The nurse-midwives independently detect and manage complications and decide when to refer women to the nearest hospital for emergency care, in telephonic consultation with a doctor if required. From 2000-2008, 2,771 women in labour and 202 women with maternal emergencies who were not in labour were attended by nurse-midwives. Of women in labour, 21% had a life-threatening complication or its antecedent condition and 16% were advised referral, of which two-thirds complied. Compliance with referral was higher for maternal conditions than fetal conditions. Among the 202 women who came with complications antenatally, post-abortion or post-partum, referral was advised for 70%, of whom 72% complied. The referral system included counseling, arranging transport, accompanying women, facilitating admission and supporting inpatient care, and led to higher referral compliance rates. There was only one maternal death in nine years. We conclude that trained nurse-midwives can significantly improve access to skilled maternal and neonatal care in rural areas, and manage maternal complications with and without the need for referral. Protocols must acknowledge that some families might not comply with referral advice, and also that initial care by nurse-midwives can reverse progression of certain complications and thereby avert the need for referral.

Mavalankar D, Vora K, Prakasamma M. Achieving Millennium Development Goal 5: Is India serious? Bulletin of the World Health Organization 2008 Apr;86(4):243-243A.

This document is one page editorial regarding the high rate of maternal mortality in India in the context of meeting MDG 5 - which is currently off target. Despite rapid economic growth in India, there are still extremely high rates. The authors believe the key reasons for this are political, administrative and managerial rather than a lack of technical knowledge. The authors assert that there is a lack of focus and limited management capacity on emergency obstetric care. Other problems include the absence of a specific midwifery cadre, lack of management capacity in the health system, and an absence of comprehensive maternal health services.

Namshum N. Recommendations of the Expert Advisory Group Meeting on the 14th Oct, 2004.

Notes: This document presents recommendations following an expert advisory group meeting in India. The Expert Advisory Group Meeting held on 140.10.2004 as a follow up the meeting held on the 19th of July 2004 was to suggest recommendations on various issues which needed policy decisions related to the use of selected life saving drugs and interventions in obstetric emergencies by Staff Nurses LHVs and ANMs. The report provides a list in table form of potential drugs and interventions followed by recommendations for their administration. The procedures and drugs listed have been specifically recommended by WHO for use by skilled birth attendants for prevention of maternal deaths and that use of these drugs should be permitted to ANMs only after adequate training in the knowledge and use of each one.

Oulton J, Hickey B. Review of the Nursing Crisis in Bangladesh, India, Nepal and Pakistan - Draft for Internal Review. Barcelona, Spain: Instituto de Cooperación Social, INTEGRARE; 2009 Feb. 

Notes: This document is a report produced by Integrare and commissioned by DFID, Regional Team for South Asia. This report outlines shared concerns relating to the nursing crisis in the four countries: quality assurance in education and practice; working conditions; faculty numbers and competence, teaching resources and student clinical experiences; and absenteeism, deployment policy, and planning skills. The document states that all four countries show weaknesses of varying degrees in planning, administration, education, practice, leadership, policy, and regulation.

Rao M, Rao KD, Kumar AS, Chatterjee M, Sundararaman T. Human Resources for Health in India. Lancet 2011 Jan 10.

Abstract: India has a severe shortage of human resources for health. It has a shortage of qualified health workers and the workforce is concentrated in urban areas. Bringing qualified health workers to rural, remote, and underserved areas is very challenging. Many Indians, especially those living in rural areas, receive care from unqualified providers. The migration of qualified allopathic doctors and nurses is substantial and further strains the system. Nurses do not have much authority or say within the health system, and the resources to train them are still inadequate. Little attention is paid during medical education to the medical and public health needs of the population, and the rapid privatisation of medical and nursing education has implications for its quality and governance. Such issues are a result of underinvestment in and poor governance of the health sector-two issues that the government urgently needs to address. A comprehensive national policy for human resources is needed to achieve universal health care in India. The public sector will need to redesign appropriate packages of monetary and non-monetary incentives to encourage qualified health workers to work in rural and remote areas. Such a policy might also encourage task-shifting and mainstreaming doctors and practitioners who practice traditional Indian medicine (ayurveda, yoga and naturopathy, unani, and siddha) and homoeopathy to work in these areas while adopting other innovative ways of augmenting human resources for health. At the same time, additional investments will be needed to improve the relevance, quantity, and quality of nursing, medical, and public health education in the country.

Sharma B, Mavalankar D. Towards Midwifery for Maternal Care: A Road Map for India - Discussion Paper Prepared Based on Work Done by Consortium on Midwifery & EmOC.  2009 Sep 4. 

Notes: This document is a road map for midwifery prepared for the Centre for Management of Health Services, Indian Institute of Management, Ahmedabad. This paper suggests short and long-term actions to professionalize midwifery for community and institution based maternal and newborn care services. The short-term actions suggested are to increase the duration of in-service SBA training. Long-term actions suggested are to restart and upgrade the auxiliary nurse midwife course and make it into two streams: public health midwife and public health nurse with separate registrations. The paper also suggests the need to strengthen supervision of midwives and to improve the quality of midwifery pre-service education by creating dedicated midwifery teachers with joint posting in hospitals and schools and colleges so that they can practice and teach midwifery enriching both teaching and practice.

Shiffman J, Ved RR. The State of Political Priority for Safe Motherhood in India. BJOG 2007 Jul;114(7):785-90.

Abstract: Approximately one-quarter of all maternal deaths occur in India, far more than in any other nation on earth. Until 2005, maternal mortality reduction was not a priority in the country. In that year, the cause emerged on the national political agenda in a meaningful way for the first time. An unpredictable confluence of events concerning problem definition, policy alternative generation and politics led to this outcome. By 2005, evidence had accumulated that maternal mortality in India was stagnating and that existing initiatives were not addressing the problem effectively. Also in that year, national government officials and donors came to a consensus on a strategy to address the problem. In addition, a new government with social equity aims came to power in 2004, and in 2005, it began a national initiative to expand healthcare access to the poor in rural areas. The convergence of these developments pushed the issue on to the national agenda. This paper draws on public policy theory to analyse the Indian experience and to develop guidance for safe motherhood policy communities in other high maternal mortality countries seeking to make this cause a political priority.

UNICEF. 2009 Coverage Evaluation Survey: All India Report.  2010.

Notes: This document is a UNICEF report on the 2009 coverage evaluation survey conducted in India. At the request of Government of India, UNICEF planned and conducted a coverage evaluation survey in 2009 (CES 2009) to assess the impact of NRHM (National Rural Health Mission )strategies on coverage levels of maternal, newborn and child-health services including immunization among women and children. CES 2009 covered all the States and Union Territories of India. The NRHM was launched by the government in India in 2005 to improve health care for rural populations and included goals such as increasing contraceptive use by eligible couples, reducing unmet need for birth spacing, increase the use of skilled care during childbirth, improve postnatal and newborn care, better access to emergency obstetric services and care of sick children, and improved coverage for childhood immunization. This document presents the results in table form.

USAID. The Health and Population Policy of Uttarakhand: A Review.  2009 Aug. 

Notes: This document presents a review of the health and population policy in Uttarakhand, India as part of the USAID Health Policy Initiative, Task Order 1. The policy is designed to improve the health status and quality of life of the population; alleviate inequalities in access to healthcare; address leading and emerging health concerns; and, eventually, stabilize growth of the population. As the first state in India to adopt an integrated health and population policy, this document reviews the policy six years after its implementation and is designed as an assessment of its progress and achievements, as well as identifying barriers. Recommendations from the assessment include: decentralized planning, integrated approaches between programmes and social development departments, clearer financial guidelines and systems, infrastructure development, human resource planning and development, and public private partnerships.

USAID. Achieving the MDGs. The Contribution of Family Planning: India.  2009 Jul. 

Notes: This document is a 2 page country brief for India as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in India. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 13 to 1.

Indonesia

Bruce K. Economic Analysis of the Indonesian Village Midwife Program Case Studies from West and East Java.  2002.

Keywords: Indonesia/Java/Midwife/health/Research/COST/Cross-Sectional Studies/methods/Drugs/medicines/Financing/Government/education/Midwives

Notes: This document presents an Executive Summary written by Kerry Bruce, MPH for PATH, based on the findings from the paper, Pembiayaan Program Bidan di Desa: Kabupaten Cianjur, Kediri dan Blita, written for PATH by Mardiati Nadjib, Purnawan Junadi, Prastuti Soewondo et.al. from the Centre for Health Research at the University of Indonesia in 2002.  The purpose of this study was to inform central and district level decision makers in ASUH program areas on: the cost of the village midwife program to date, a five year projection of expenses and the possible consequences of a decision to continue or discontinue the program. The research looked at the situation in three districts on Java (Cianjur in West Java, Kediri and Blitar in East Java). This research was a cross-sectional study using both quantitative and qualitative methods. Recommendations include continued subsidization of the village midwife program, potential subsidies for drugs and medicines, that financing of subsidies should be clearly delineated between central and district governments, and that deciding on the standard of education of the midwives should occur prior to deciding whether the program should be continued.

Bruce K. Reducing Early Neonatal Mortality on Java, Indonesia: Increasing Homevisits During the First Week of Life.  2004 Apr. 

Notes: This paper examines the use of the homevisit in four districts on Java as a method to reduce early neonatal mortality. The paper outlines the goals and aims of the intervention, examines the methods and design of the intervention, looks at who it targets, the results to date, how the intervention might be generalized for wider implementation and the implications of these findings for the program. On Java in Indonesia, where resources are limited and the IMR is still relatively high compared with developed countries, providing a homevisit to a postpartum woman within seven days of the birth is one strategy that is used to reduce early neonatal mortality. The strategy has strengths in that it can identify problems for neonates early and initiates the process of Hepatitis B immunization which can reduce rates of chronic Hepatitis B infection. The strategy of providing homevisits also has weaknesses in that its impact is difficult to measure and the capacity of the Indonesian neonatal medical facilities to deal with problems has not been evaluated or addressed as part of the intervention. Economic, social and logistic barriers to care identified as a result of a homevisit have also not been rigorously evaluated and addressed.

Hull T, Rusman R, Hayes A. Village Midwives and the Improvement of Maternal and Infant Health in NTT and NTB.  1998 Dec 4.

Notes: This document is a report prepared for the Australian Agency for International Development (AusAid). It is a report of a study undertaken to examine concerns regarding the recruitment, training, placement, management and career prospects of young term-contract nurse-midwives in villages of East and West Nusatenggara in Indonesia. Findings from the study indicate that the problems of the village midwife system are serious, however they are recognized as such by collaborating agencies. The village midwife scheme (Bidan di Desa) introduced by Indonesian government in 1989 is cited by the authors as flawed, where one of the greatest weaknesses of the system was the pressure to reach overly optimistic recruitment targets. Other problems reported include issues regarding to the design and implementation of the program, personal security of the midwives, integration in the local community, the level of demand of their services, their relationships with other health personnel and local officials, and the length of time they stay in their respective villages.

Indonesia. Referral Mechanism.

Notes: This document is a chart of the referral mechanism in Indonesia.

Indonesia. Administrative Structure of Health Organization.

Notes: This document is a chart of the administrative structure of Health organization in Indonesia.

Indonesia. The Health Referral System in Indonesia.  2005. 

Notes: The principal aims of the investigation were to review and document the existing public health referral systems and attendant health service delivery mechanisms focusing on: a) medical and laboratory services; and, b) selected programme operations, against the background of the current decentralization process.This has involved an examination of public health referral systems in various districts in Indonesia in order to ascertain their effectiveness. The following activities were undertaken: Categorizing of services that are provided by health facilities at all levels primary, secondary and tertiary (village, district, province, centre and teaching/specialized) taking into consideration what is practiced, Examining the referral services between hospitals and their linkages with other hospitals both horizontally and vertically, and Reviewing the current health service referral system and critically assess the strengths and weaknesses of the system.This report recognizes that unless and until there is an effective third party purchasing arrangement (health insurance) that covers more of the population than at present health professionals will have little or no incentive to change their current 'for profit' practices with regard to appropriate and more equitable referral practices.Author not provided.

Indonesia. Neither Dukun nor Doctor: The Concept of Bidan Desa as a Means to Reduce Maternal and Infant Mortality.

Notes: This document is the English language version of a paper titled: Tinjauan Tentang Program Bidan di Desa di Kawasan Timur Indonesia. The paper presents an overview of a village midwifery scheme introduced by the Indonesian government in 1989. The basic concept of the village midwife program was that a trained nurse with an additional year of training in midwifery skills could significantly improve the quality and quality of antenatal, obstetric, post-natal and contraceptive services in a village. The government then recruited large numbers of these nurses, trained them through special crash programs, and hired them on limited term appointments. The authors indicate that this strategy resulted in most of the candidates being young, unmarried and lacking in relevant work experience. This paper offers critiques of the program citing problems at the policy design level where most of the problems relate to the policy decisions leading the program into a target oriented emergency effort which in turn compromised professional and administrative standards in the name of quick coverage and inexpensive implementation. Full source not provided.

Manca R. Maternal and Neonatal Health Seeking Behaviour, Referral and Delivery Waiting House - Socio-Anthropological Research Report.  2005.

Notes: This report is written for WHO. It provides an anthropological analysis of health seeking behaviour in non-Western countries, specifically Indonesia. This report highlights the importance of taking into consideration the cultural specificity of illness and illness cognition in each given region of the world. The report draws material from university student theses and attempts to synthesize the data. The author recommends that WHO and the Indonesian Department of Health work in cooperation with the Indonesian Department of Education in order to prepare effective reproductive health education programs to be included in school curricula.

Ministry of Health Indonesia, Provincial Government of West Nusa Tenggara, Provincial Government of East Nusa Tenggara. Measuring the Fulfilment of Human Rights in Maternal and Neonatal Health - Using WHO Tools.  2008. 

Notes: This document reports on 2 cities and 2 districts in West and East Nusa Tenggara, Indonesia. It is a report produced for the Ministry of Health and the provincial governments of each of these districts with support from the Indonesian German Development Cooperation Health Sector Support Team. This report summarizes the outcomes of exploratory research on human rights in maternal and neonatal health in two cities and two rural districts of Eastern Indonesia, and considers the research findings in the context of Indonesia's national human rights commitments. The research was conducted in 2007, following completion of a national level enquiry that was conducted from 2005 to 2006. The national enquiry was conducted in partnership between the Ministry of Health, WHO and various other stakeholders. The enquiry was part of a pilot to test the WHO Tool - Using human rights for maternal and neonatal health: a Tool for strengthening laws, policies and standards of care in three countries; Brazil, Mozambique and Indonesia. Priority health issues described in this report are: 1) Pregnancy, childbirth and the postpartum period: access to health services 2) Family planning: levels of knowledge about family planning methods; accessibility of family planning for unmarried people; husband authorization to seek services 3) Levels of birth registration 4) STIs and HIV/AIDS: knowledge, education and access to services for prevention and treatment 5) Violence against women 6) Unmet need for safe abortion services 7) Adolescent reproductive health: early marriage and pregnancy, and limited access to sexual and reproductive health education and services 8) This report also identifies vulnerable groups, as well as discrimination and equity issues, related to the fulfillment of human rights in maternal and neonatal health in the community.

Mize L, Pambudi E, Koblinsky M, Stout S, Marzoeki P, Harimurti P, et al. "...and then she died" Indonesia Maternal Health Assessment.  2010 Feb. 

Notes: This is a report produced as part of the World Bank inputs to the Government of Indonesia Health Sector Review and Health System Performance Assessment and funded by DFID under the Health System Strengthening for Maternal Health Initiative. This report is aimed to contribute to strengthening the health workforce in Indonesia. The assessment finds that the approach to improve maternal health through emphasizing the use of a midwife for deliver and community based interventions has not had the expected impact. Evidence indicates that providing midwives alone is too narrow a strategy. Additional areas that need to be addressed include availability of services, standardizing quality of care, enhancing linkages between community facilities and village midwives and increase opportunities for the utilization of the national health insurance plan.

Shankar A, Sebayang S, Guarenti L, Utomo B, Islam M, Fauveau V, et al. The Village-Based Midwife Programme in Indonesia. Lancet 2008 Apr 12;371(9620):1226-9.

This article describes the Village-Based Midwife Programme launched by the Government of Indonesia in 1989 in response to the high maternal mortality rate. The programme goal was to place a skilled birth attendant in every village to provide antenatal and perinatal care, family planning and other reproductive health services, and nutrition counseling. This article outlines lessons learned from the programme. Key points for the scaling up of skilled birth attendance include a health-systems approach that is both top-down (with clear policies, standards and training) and bottom-up (from communities for participation, demand, and accountability). Quality care for all births and affordable and accessible high quality emergency obstetric care is essential. Programmes should also aim to establish a platform that can readily adapt to advances in service standards and other community-based interventions and be context-specific.

World Vision. Information and Communication Technologies for Health Care: Midwife Mobile-Phone Project in Aceh Besar.  2008 Feb. 

Keywords: health/Health Personnel/health statistics/Indonesia/Midwife/Midwives/statistics

Notes: This is report conducted by World Vision in Indonesia presenting the results from a midwife mobile-phone project. The project was implemented in 15 health centers in Aceh Besar involving 223 midwives, 15 midwife coordinators and OB/GYNs. The study group, consisting of 122 midwives used their project cell phones to send in health statistics to a central database, contact coordinators for health advice and information, and communicate with obstetricians and their patients. Results from the study indicate that the mobile phone is an effective and efficient device for facilitating smoother communication among health workers and between them and the community. Mobile devices aid in communication through disseminating medical and health-related information to midwives, who in turn convey knowledge to their village or community. Recommendations include suggestions for cost-subsidy programmes and issues relating to poor cellular reception.

Wiknjosastro G, Basuki B, Danukusumo D. Several Contributing Factors Related to Maternal Near-Miss and Death at Selected Referral Hospitals in Jakarta and Tangerang. 2008 Mar. 

Notes: This document presents a report of a study funded by WHO. This study was conducted to identify the medical and non-medical causes of and circumstances surrounding maternal near miss deaths occurring at health facilities and to expand to personal, family or community that contributed to the maternal near-miss and death. Data was collected by special trained midwives from each participating hospitals. Near miss subject was interviewed on the second day after emergency situation was over, and for death cases data was collected from the husband and/or her closed relative. Additional data was also taken from hospital medical and registration records. Results of the study indicate that half of contributing factors of maternal deaths related to inappropriate care by the first providers (mainly midwives and some TBAs). Human resources, infrastructure, management as well as standard of emergency obstetric were noted inappropriate.

Kenya

Center for Reproductive Rights, Federation of Women Lawyers-Kenya (FIDA). Failure to Deliver: Violations of Women's Human Rights in Kenyan Health Facilities.  2007. 

Keywords: childbirth/Contraception/DELIVERY/Facility/Family Planning/health/Health Facility/Health Services/Kenya/Pregnancy/Reproductive health/Reproductive health services/rights/Access/Barriers/Maternal/maternal health/health care system

Notes: This document is a report jointly produced by the Center for Reproductive Rights and the Federation of Women Lawyers -Kenya.The main objective of this report is to highlight the existing flaws in reproductive health care in Kenya. This report covers two decades of women's experiences, with the most recent delivery experiences occurring in the past six months. Women were asked about their experiences with contraception, pregnancy, and delivery throughout their lives in order to understand the long-term repercussions of mistreatment in the health care context. This report does not encompass all reproductive health services, but focuses primarily on women's experiences with family planning, pregnancy, and childbirth. The report identified difficulties in access to family planning services and information, cases of abuse and neglect during delivery, structural barriers to quality maternal health care, and discrimination in the health care system.

Essendi H, Mills S, Fotso JC. Barriers to Formal Emergency Obstetric Care Services' Utilization. Journal of Urban Health 2010.

Abstract: Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be put in place to enhance security in the slums at night.

Family Care International. Saving Women's Lives: The Skilled Care Initiative.  2000. 

Notes: This document is a two page brief providing an overview of Family Care International's Skilled Care Initiative. The initiative, launched in 2000, is a multi-faceted, five-year project to increase the number of women who receive skilled care before, during, and after childbirth. The project is being implemented in four rural, underserved districts in Burkina Faso, Kenya, and Tanzania. It also includes advocacy and information-sharing in the Latin America and Caribbean (LAC) region, and with global partners. The initiative focuses specifically on "skilled care" as a strategy for reducing maternal mortality and morbidity. The initiative emphasizes the critical importance of the environment where the provider works, such as the need for supportive policies, equipment, efficient communication systems and infrastructure. The project works in collaboration with government agencies and aims to offer project activities that are sustainable and replicable.

Gross JM, Rogers MF, Teplinskiy I, Oywer E, Wambua D, Kamenju A, et al. The Impact of Out-Migration on the Nursing Workforce in Kenya.  2010. 

Notes: This is a study examining the impact of out-migration on Kenya's nursing workforce. This study analyzed nursing data from the Kenya Health Workforce Informatics System, collected by the Nursing Council of Kenya and the Department of Nursing in the Ministry of Medical Services. The study design comprised an analysis of trends in Kenya's nursing workforce from 1999-2007. Findings identified high nurse migration and a potential reduction in the ability to maintain Kenya's nursing workforce through training. The study concludes that this represents a substantial economic loss to the country.

Haji M, Durairaj V, Zurn P, Stormont L, Mapunda M. Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce Through Decentralized Health Financing Systems. Bulletin of the World Health Organization 2010 May;88(5):397-9.

This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector, better use of existing financial resources, and creation of financial incentives for health workers. The paper also considers the conditions under which decentralized health financing systems can lead to improved health workforce retention using examples from several countries including Brazil, China, Costa Rica, Guyana, India, Kenya, Pakistan, the Philippines, Romania, Rwanda, Thailand, Uganda, Tanzania, and Zambia. The document concludes that it is evident that providing the ministry of health with autonomy, by delinking the health workforce from the civil workforce and providing strategic performance incentives, are means by which health workers can be successfully recruited and retained. The authors also note that such policies only work if health system objectives are aligned with appropriate institutional and incentive structures.

Kenya. Community Midwifery Implementation Guidelines in Kenya.  2006 Apr. 

Notes: This document presents guidelines for midwifery implementation in Kenya. This document highlights the importance of skilled care at birth in particular community based interventions as essential to achieving MDGs 4 and 5. This document gives a general overview of maternal care in Kenya and what it means to be a midwife (concepts, practice etc). The document outlines strategies to increase skilled attendance in the community as well as the process for introducing community midwifery and criteria for selection. Challenges documented include linkages with formal health system, communication and transport for referral, source of initial supplies, drugs and equipment, and financial, policy and sustainability factors. Source not provided.

Kenya. Kenya Nursing and Midwifery Strategy.  2007. 

Notes: This document is letter providing the author's personal suggestions regarding strategic plans to improve maternal and child mortality in Kenya, particularly through strengthening the midwifery workforce. The author provides quotes from the original document and responds to each in turn. The original document highlights the need for an improved nursing strategy in order to aid in reversing the current health related mortality trends. The author recommends that the vision should perhaps be broken up into smaller steps such as differentiating more between midwifery and nursing. Midwives in Kenya are currently only qualified as such after training as nurses. The author recommends that this "one package" is a very big expectation and could potentially negatively impact retention rates. Source not provided.

Kenya. Proposed Resolution on Strenthening Nursing and Midwifery for the 128th Executive Board and the Sixty-Fourth World Health Assembly.  2011 Jan 13. 

Notes: Edited draft. This report is a proposed resolution for strengthening nursing and midwifery for Kenya. The resolution is proposed by Kenya and co-sponsored by Burundi. The report lists a series of recommendations for the Sixty-fourth World Health Assembly which include recognizing the need to build sustainable national health systems and to strengthen national capacities and to improve the availability of basic health services. The report outlines requests to the Director General such as continued investment and appointment of qualified nurses and midwives to headquarters and regional and country posts, technical support for the development and implementations of policies, strategies and programmes on interprofessional education and collaborative practice, and to continue to promote cooperation between agencies and organizations concerned with the development of nursing and midwifery. Source not provided.

Kenya Health Workforce Project. Kenya's Health Workforce Training Capacity: A Situation Analysis.  2010. 

Notes: The purpose of this report is to provide CDC-Kenya and other US government agencies with information regarding the current supply of healthcare workers in Kenya and the current capacity for training new workers.  This report is being provided by the Kenya Health Workforce Information System (KHWIS) project funded by CDC/PEPFAR and administered by the Nell Hodgson Woodruff School of Nursing, Emory University, in collaboration with the Ministry of Medical Services (MoMS) and Kenya's health professional regulatory bodies. This report presents an analysis of interventions to scale-up Kenya's health workforce and seeks to provide a situation assessment of Kenya's current health workforce training capacity to inform evidence-based workforce planning and scale-up initiatives.

Kenya Health Workforce Project. Kenya's Health Workforce Informatics System (KHWIS). 2010. 

Notes: This document outlines the Kenya Health Workforce Informatics System, the longest running and most comprehensive human resources information system in sub-Saharan Africa. The system computerizes and streamlines an existing MOH documentation and reporting process for health care workers and produces accurate and timely workforce information for decision-makers. Components of the system include a national database of qualified health workers including nurses, physicians, laboratory professionals and clinical officers, as well as data on their current deployment status.

Kenya National Bureau of Statistics (KNBS), ICF Macro. Kenya Demographic and Health Survey 2008-2009. Calverton, Maryland: KNBS and ICF Macro; 2010. 

Notes: This document is the 2008-2009 DHS for Kenya. This report summarises the findings of the 2008-09 Kenya Demographic and Health Survey (KDHS) carried out by the Kenya National Bureau of Statistics (KNBS) in partnership with the National AIDS Control Council (NACC), the National AIDS/STD Control Programme (NASCOP), the Ministry of Health and Sanitation, the Kenya Medical Research Institute (KEMRI), and the National Coordinating Agency for Population and Development (NCAPD). ICF Macro provided technical assistance for the survey through the USAID-funded MEASURE DHS programme, which is designed to assist developing countries to collect data on fertility, family planning, and maternal and child health. The survey provides data on general demography as well as detailed information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood and maternal mortality, maternal and child health, and awareness and behavior regarding HIV/AIDS.

Ministry of Health Republic of Kenya, Population Council. Community Midwifery Implementation Guidelines in Kenya - Taking Midwifery Services to the Community.  2007 Jan.

Notes: This document is produced by the MOH Kenya Division of Reproductive Health and the Population Council. This document sets out the approach to be taken to sure that the Kenyan communities have the capacity and motivation to take up their essential role in health care delivery. This in turn enhances community access to health care and thus improves the productivity, reducing poverty, hunger and maternal and child mortality as well as improving education performance across all cycles of life. This can only be achieved through the establishment of sustainable Level One Services that aim at promoting dignified livelihoods throughout the country through decentralization of services and accountability.It is within this context that the community midwife is seen as an agent of change in the community and can contribute positively to the reduction of maternal and perinatal morbidity and mortality. The community midwife is in a position to provide health care services and assume the responsibilities of a professional health service provider deep in the community that include; health promotion, disease and prevention and detection, care giving and compliance with treatment and advice, and claim the health rights of the community.

Riley PL, Vindigni SM, Arudo J, Waudo AN, Kamenju A, Ngoya J, et al. Developing a Nursing Database System in Kenya. Health Services Research 2007 Jun;42(3 Pt 2):1389-405.

Abstract: OBJECTIVE: To describe the development, initial findings, and implications of a national nursing workforce database system in Kenya. PRINCIPAL FINDINGS: Creating a national electronic nursing workforce database provides more reliable information on nurse demographics, migration patterns, and workforce capacity. Data analyses are most useful for human resources for health (HRH) planning when workforce capacity data can be linked to worksite staffing requirements. As a result of establishing this database, the Kenya Ministry of Health has improved capability to assess its nursing workforce and document important workforce trends, such as out-migration. Current data identify the United States as the leading recipient country of Kenyan nurses. The overwhelming majority of Kenyan nurses who elect to out-migrate are among Kenya's most qualified. CONCLUSIONS: The Kenya nursing database is a first step toward facilitating evidence-based decision making in HRH. This database is unique to developing countries in sub-Saharan Africa. Establishing an electronic workforce database requires long-term investment and sustained support by national and global stakeholders.

USAID. Achieving the MDGs. The Contribution of Family Planning: Kenya.  2009 Jul. 

Notes: This document is a 2 page country brief for Kenya as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Kenya. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 4 to 1.

Ziraba AK, Mills S, Madise N, Saliku T, Fotso JC. The State of Emergency Obstetric Care Services in Nairobi Informal Settlements and Environs: Results from a Maternity Health Facility Survey. BMC Health Services Research 2009;9:46.

Abstract: BACKGROUND: Maternal mortality in Sub-Saharan Africa remains a challenge with estimates exceeding 1,000 maternal deaths per 100,000 live births in some countries. Successful prevention of maternal deaths hinges on adequate and quality emergency obstetric care. In addition to skilled personnel, there is need for a supportive environment in terms of essential drugs and supplies, equipment, and a referral system. Many household surveys report a reasonably high proportion of women delivering in health facilities. However, the quality and adequacy of facilities and personnel are often not assessed. The three delay model; 1) delay in making the decision to seek care; 2) delay in reaching an appropriate obstetric facility; and 3) delay in receiving appropriate care once at the facility guided this project. This paper examines aspects of the third delay by assessing quality of emergency obstetric care in terms of staffing, skills equipment and supplies. METHODS: We used data from a survey of 25 maternity health facilities within or near two slums in Nairobi that were mentioned by women in a household survey as places that they delivered. Ethical clearance was obtained from the Kenya Medical Research Institute. Permission was also sought from the Ministry of Health and the Medical Officer of Health. Data collection included interviews with the staff in-charge of maternity wards using structured questionnaires. We collected information on staffing levels, obstetric procedures performed, availability of equipment and supplies, referral system and health management information system. RESULTS: Out of the 25 health facilities, only two met the criteria for comprehensive emergency obstetric care (both located outside the two slums) while the others provided less than basic emergency obstetric care. Lack of obstetric skills, equipment, and supplies hamper many facilities from providing lifesaving emergency obstetric procedures. Accurate estimation of burden of morbidity and mortality was a challenge due to poor and incomplete medical records. CONCLUSION: The quality of emergency obstetric care services in Nairobi slums is poor and needs improvement. Specific areas that require attention include supervision, regulation of maternity facilities; and ensuring that basic equipment, supplies, and trained personnel are available in order to handle obstetric complications in both public and private facilities.

Lao People’s Democratic Republic

Lao. Curriculum for Post-basic Community Midwifery (Part 1 - text).  2010. 

Notes: This document is a copy of the first section of the revised curriculum for community midwifery in Lao. The purpose of the curriculum is to develop existing and low-grade staff at the 1st level of health care into professional mid-level community midwife with the appropriate knowledge and capacity to deliver quality maternal, newborn and child health and in keeping with national standards and protocols. The curriculum builds on that developed and presented for approval in 2009 by the Faculty of Nursing University of Health Sciences, then called the College of Health Technology (CHT).  The curriculum developed by CHT was a 2 -year (11/12+2) curriculum for Technician Diploma majoring in Community Midwife. The curriculum presented in this document corresponds to year II of this 2-year curriculum for Technician Diploma majoring in Community Midwife. This section of the document goes up to page 20. For the remainder of the document including subject outlines, refer to ‘Lao. Revised Curriculum for Community Midwifery (part 2 - text).  2010’.

Lao. Revised Curriculum for Community Midwifery (part 2 - text).  2010. 

Notes: This document is a copy of the second section of the revised curriculum for community midwifery in Lao. This section outlines the details of the curriculum, specifically covering subjects available, the orientation programme, learning objectives and the incorporation of specific contents from Year 1 Technical (Direct Entry) CMW Programme into the orientation programme. This document outlines classes and number of credits granted for each, instruction methods and evaluation procedures. Refer to ‘Lao. Curriculum for Post-basic Community Midwifery (Part 1 - text).  2010’  for the first part of this document.

Ministry of Health Lao PDR, UNFPA. Assessment of Skilled Birth Attendance in Lao PDR. 2008 Mar. 

Notes: The purpose of this review is to answer the question: "What is the current capacity of Lao PDR to provide skilled birth attendance, also called skilled care, to its population?" Resulting from a workshop in July 2007 where national MCHexperts examined the situation on skilled care in Lao PDR, the Ministry of Health requested a comprehensive review of skilled birth attendance in the country. The document finds that the lack of adequate human resources is the primary gap found in the assessment of skilled birth attendance in Lao, PDR. Creating a new cadre of skilled birth attendant and the up-grading of existing MCH workforce to become skilled birth attendants, is the foremost need. Nonetheless, making these urgent human resource improvements cannot occur in a vacuum. There must be concurrent attention to all the other factors that establish the enabling environment. These are: political will to make change happen, the funding for it, functional facilities that provide the suitable level of EmONC, good education and training programs for skilled birth attendants/midwives, access, and a community ready to utilize and benefit from a good maternal child health delivery system.

Liberia

Lori JR, Starke AE. A Critical Analysis of Maternal Morbidity and Mortality in Liberia, West Africa. Midwifery 2011 Jan 11.

Abstract: OBJECTIVE: to conduct a secondary analysis of maternal death and near-miss audits conducted at the community and facility level to explore the causes and circumstances surrounding maternal mortality and severe morbidity in one rural county in Liberia, West Africa. DESIGN: a non-experimental, descriptive design utilising maternal death and near-miss audit surveys was utilised for data collection. Thaddeus and Maine's Three Delays Model was used as a framework for analysis. SETTING: one rural county in north-central Liberia. PARTICIPANTS: interviews were conducted with (1) women who suffered a severe morbidity or near miss event, (2) family members of women who died or presented with a severe morbidity, and (3) community members or health workers involved in the care of the woman. MEASUREMENTS: (1) maternal mortality, (2) near-miss events, and (3) delays related to problem identification, transportation challenges and delays after reaching the referral site. FINDINGS: 120 near-miss events and 28 maternal mortalities were analysed. 16% of all deliveries at the referral hospital were classified as near-miss events. Near-miss events were six times more common than deaths. The majority of women experiencing a near-miss event (85%) were in critical condition upon arrival at the hospital suggesting important delays were encountered in reaching the facility. KEY CONCLUSIONS: maternal mortality and near-miss audits allow exploration of medical and non-medical factors leading up to a severe complication or maternal death. Delays in reaching a referral hospital can have a significant impact on maternal survival rates. IMPLICATIONS FOR PRACTICE: audits can stimulate a change in clinical practice and help identify areas for county health departments to focus their scant resources. Audits can be used as a quality improvement tool in facilities. Results can be used to identify communities with high rates of delay to target educational programmes.

Madagascar

Ministère de la Santé République de Madagascar. Revue Documentaire sur la Formation, la Réglementation, la Supervision et l'Association des Sages-Femmes en Exercice à Madagascar.  2009 Jul. 

Notes: This is a joint report issued by The Republic of Madagascar, UNFPA and International Confederation of Midwives. It documents the formation, regulation, and supervision of midwives and associations. This document presents as its objective an analysis of the actual situation of Madagascar's midwives in relation to programmes aimed at reducing maternal and neonatal mortality. It highlights the complexities of the development of human resources in developing countries and calls for a review into midwifery and nursing professions within a context of the specific cultural and socio-economic conditions in Madagascar.

Ministère de la Santé et du Planning Familial République de Madagascar, UNFPA, International Confederation of Midwives. La Profession de Sage-Femme à Madagascar: Revue Documentaire sur la Formation, la Réglementation, la Supervision et l'Association des Sages-Femmes en Exercice à Madagascar.  2009 Jul.

Notes: This document provides a review of the formation, regulation, supervision and association of midwives working in Madagascar. This document is produced with support from the Madagascar Ministry of Public Health, UNFPA and ICM. This report offers a definition of the profession of midwifery and discusses challenges particular to the organization, formation and regulation of midwifery in Madagascar, such as insufficient numbers of working midwives.

Ministère de la Santé Republique de Madagascar. Santé de la Mère et de l'Enfant.

Notes: This document, written by the Ministry of Public Health in Madagascar, provides an overview of the country's involvement in the global strategy to reduce maternal and newborn mortality. It provides a bulleted list of goals that are intended to meet the 2015 targets. This includes: ensuring the availability of emergency obstetric and neonatal care, caesarean sections and family planning; reducing maternal deaths by reinforcing activities such as applying a law where the minimum age of marriage is 18; ensuring the availability of skilled providers; and increasing the budget to address these challenges.

Ranjalahy Rasolofomanana J, Ralisimalala A. Evaluation des Besoins en Matière de soins Obstétricaux et Néo-natals d'Urgence à Madagascar.  2004. 

Notes: This document is a report of an EmONC needs assessment conducted in Madagascar. The objectives of the study were to determine the availability and quality of EmONC for mothers and newborns, to identify the means of increasing the utilization of services within the community, and to evaluate the costs associated with increasing or extending these services. Findings include unsatisfactory availability of EmONC equipment, uneven distribution of the availability of supplies in the country, and a shortage of skilled providers such as obstetricians, gynaecologists, or anaesthetists.

USAID. Atteindre les OMDs. La Contribution de la Planification Familiale: Madagascar. 2009 Jul. 

Notes: This document is a 2 page country brief for Madagascar as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Madagascar. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 3 to 1.

UNFPA, UNICEF, World Health Organization, AMDD, MSIS. Évaluation des Besoins en Matière de Soins Obstétricaux et Néonatals d'Urgence à Madagascar.  2010 Mar. 

Notes: This document presents a report on emergency obstetric care in Madagascar. This report is an evaluation produced by UNFPA and the Madagascar Ministry of Publich Health, with collaboration from UNICEF, WHO, AMDD, and PACT MSIS. The aim of the evaluation is to determine the actual capacity of health facilities in regards to meeting the needs of pregnant women and newborns, such as the availability of EmONC facilities. The report identifies that a number of facilities providing EmONC do not meet preferred standards. Many lack proper infrastructure, materials, and knowledge of basic competencies. The report highlights the value of reinforcing community capacity and mobilization as a potential contribution to improving the situation.

Malawi

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Malawi.  2009 Oct. 

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Malawi. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

Bradley S, McAuliffe E. Mid-Level Providers in Emergency Obstetric and Newborn Health Care: Factors Affecting their Performance and Retention Within the Malawian Health System. Human Resources for Health 2009;7:14.

Abstract: BACKGROUND: Malawi has a chronic shortage of human resources for health. This has a significant impact on maternal health, with mortality rates amongst the highest in the world. Mid-level cadres of health workers provide the bulk of emergency obstetric and neonatal care. In this context these cadres are defined as those who undertake roles and tasks that are more usually the province of internationally recognised cadres, such as doctors and nurses. While there have been several studies addressing retention factors for doctors and registered nurses, data and studies addressing the perceptions of these mid-level cadres on the factors that influence their performance and retention within health care systems are scarce. METHODS: This exploratory qualitative study took place in four rural mission hospitals in Malawi. The study population was mid-level providers of emergency obstetric and neonatal care. Focus group discussions took place with nursing and medical cadres. Semi-structured interviews with key human resources, training and administrative personnel were used to provide context and background. Data were analysed using a framework analysis. RESULTS: Participants confirmed the difficulties of their working conditions and the clear commitment they have to serving the rural Malawian population. Although insufficient financial remuneration had a negative impact on retention and performance, the main factors identified were limited opportunities for career development and further education (particularly for clinical officers) and inadequate or non-existent human resources management systems. The lack of performance-related rewards and recognition were perceived to be particularly demotivating. CONCLUSION: Mid-level cadres are being used to stem Africa's brain drain. It is in the interests of both the government and mission organizations to protect their investment in these workers. For optimal performance and quality of care they need to be supported and properly motivated. A structured system of continuing professional development and functioning human resources management would show commitment to these cadres and support them as professionals. Action needs to be taken to prevent staff members from leaving the health sector for less stressful, more financially rewarding alternatives.

Fullerton JT, Johnson PG, Thompson JB, Vivio D. Quality Considerations in Midwifery Pre-service Education: Exemplars from Africa. Midwifery 2010 Dec 1.

Abstract: OBJECTIVE: this paper uses comparisons and contrasts identified during an assessment of pre-service education for midwives in three countries in sub-Saharan Africa. The purpose of the paper is to stimulate discussion about issues that must be carefully considered in the context of midwifery educational programming and the expansion of the midwifery workforce. DESIGN AND SETTING: a mixed qualitative and quantitative participatory assessment was conducted in Ethiopia, Ghana and Malawi, in the context of a final review of outcomes of a USAID-funded global project (ACCESS). Quantitative surveys were distributed. Individual and focus group interviews were conducted. PARTICIPANTS: participants included key informants at donor, government and policy-making levels, representatives of collaborating and supporting agencies, midwives and students in education programmes, and midwives in clinical practice. FINDINGS: information is presented concerning the challenges encountered by those responsible for midwifery pre-service education related to issues in programming including: pathways to midwifery, student recruitment and admission, midwifery curricula, preparation of faculty to engage in academic teaching and clinical mentorship, modes of curriculum dissemination and teaching/learning strategies, programme accreditation, qualifications for entry-into practice and the assessment of continued competence. KEY CONCLUSIONS: quality issues must be carefully considered when designing and implementing midwifery pre-service education programmes, and planning for the integration of new graduates into the health workforce. These issues, such as the availability of qualified tutors and clinical teachers, and measures for the implementation of competency-based teaching and learner-assessment strategies, are particularly relevant in countries that experience health manpower shortages. IMPLICATIONS FOR PRACTICE: this review highlights important strategic choices that can be made to enhance the quality of pre-service midwifery education. The deployment, appropriate utilisation and increased number of highly qualified midwifery graduates can improve the quality of maternal and newborn health-care service, and reduce maternal and newborn mortality.

Hussein J, Phoya A, Tornui JA, Okiwelu T. Midwifery Practice in Ghana and Malawi: Influences of the Health System. In: Reid L.Churchill Livingstone, editor. Freedom to Practise: An International Exploration of Midwifery Practice.London: Elsevier; 2007. p. 75-99.

Notes: This document is a book chapter about midwifery practice and the health system. This chapter discusses the health system's influence on midwifery practice and how this is an essential part of how midwives define their role and practice. Health system in this chapter refers to the wider context or environment in which midwives practice including the systems which train, govern, and regulate midwifery practice, provide essential supplies and equipment, set up referral mechanisms and organize private and public care provision. This chapter discusses how factors of the health system can both help and hinder the practice of midwives, with specific reference to Ghana and Malawi.

Kongnyuy EJ, Hofman J, Mlava G, Mhango C, van den Broek N. Availability, Utilisation and Quality of Basic and Comprehensive Emergency Obstetric Care Services in Malawi. Maternal and Child Health Journal 2009 Sep;13(5):687-94.

Abstract: OBJECTIVE: To establish a baseline for the availability, utilisation and quality of maternal and neonatal health care services for monitoring and evaluation of a maternal and neonatal morbidity/mortality reduction programme in three districts in the Central Region of Malawi. METHODS: Survey of all the 73 health facilities (13 hospitals and 60 health centres) that provide maternity services in the three districts (population, 2,812,183). RESULTS: There were 1.6 comprehensive emergency obstetric care (CEmOC) facilities per 500,000 population and 0.8 basic emergency obstetric care (BEmOC) facilities per 125,000 population. About 23% of deliveries were conducted in emergency obstetric care (EmOC) facilities and the met need for emergency obstetric complications was 20.7%. The case fatality rate for emergency obstetric complications treated in health facilities was 2.0%. Up to 86.7% of pregnant women attended antenatal clinic at least once and only 12.0% of them attend postnatal clinic at least once. There is a shortage of qualified staff and unequal distribution with more staff in hospitals leaving health centres severely understaffed. CONCLUSIONS: The total number of CEmOC facilities is adequate but the distribution is unequal, leaving some rural areas with poor access to CEmOC services. There are no functional BEmOC facilities in the three districts. In order to reduce maternal mortality in Malawi and countries with similar socio-economic profile, there is a need to upgrade some health facilities to at least BEmOC level by training staff and providing equipment and supplies.

Lunan B, Clements Z, Mahony S, Hope-Jones D. Maternal Health in Malawi: Challenges and Successes.  2010 Dec. 

Notes: This document is a draft report produced by the Scotland Malawi Partnership (SMP), released in Dec 2010 for external consultation among key Scottish and Malawian stakeholders. The SMP provides a forum for the sharing of ideas and information for those organizations and individuals in Scotland who are engaged in efforts to alleviate poverty in Malawi. This draft document is the result of a 2010 study focused on maternal health. This study involved ascertaining the work being carried out by SMP affiliated groups, how it was done, and barriers being faced. The aim of this is to enhance partnership and to reduce duplication to promote and share positive practice. The major issues raised in this document are lack of resources and healthcare systems, limited access to services, the role of skilled attendants at birth and and gender equality.

Sharan M, Ahmed S, Malata A, Rogo K. Quality of Maternal Health System in Malawi - Are Health Systems Ready for MDG 5?

Notes: This document presents findings from a study which examined the quality of health systems in Malawi, specifically relating to availability, accessibility, infrastructure, process of care and management. The report highlights gaps in the care seeking process as contributing to maternal mortality and morbidity. Such gaps are found at the community level where lack of recognition of danger signs and cultural and financial barriers cause delays in seeking care, as well as at the facility level where quality of services are important determinants of patient survival. The findings confirm the shortage of human resources for health and identify a critical gap in the health system as low quality of patient care and management of maternity services.

USAID. Achieving the MDGs. The Contribution of Family Planning: Malawi.  2009 Jul. 

Notes: This document is a 2 page country brief for Malawi as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Malawi. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 2 to 1.

Mali

El-Khoury M, Gandaho T, Arur A, Keita B, Nichols L. Improving Access to Life-Saving Maternal Health Services: The Effects of Removing User Fees for Caesareans in Mali. Bethesda, MD: Abt Associates Inc.; 2011 Apr. 

Notes: This document was produced for review by USAID as part of the Health Systems 20/20 Cooperative Agreement, a project that supports countries to address health systems barriers to the use of life-saving priority health services. Health Systems 20/20 works to strengthen health systems through integrated approaches to improving financing, governance,  and operations, and building sustainable capacity of local institutions.The objectives of this particular study were to: a. assess the effects of removing caesarean user fees in the public sector in Mali on access to caesareans, especially among women of low socioeconomic status (SES); b. understand how the policy is being implemented at the facility level; and c. identify key remaining barriers to accessing caesareans in order to inform appropriate future interventions or programmatic changes to reduce maternal mortality in Mali. Findings from the study include that service providers, communities, and local political actors support the free policy. Since the launch of the free caesarean initiative, institutional delivery and c-section rates in Mali have increased and post caesarean maternal and neonatal deaths declined in most regions. However, the free policy seems to be disproportionally benefiting the wealthier groups and although information about the policy is becoming increasingly well known, information about the specific components of the policy remains fragmented.

Ministère de la Santé Republique du Mali. Programme de Developpement Socio-Sanitaire 2005-2009.  2004 Dec. 

Notes: This document presents a report by the Ministry of Health in Mali. The PRODESS programme was developed to identify the relationships between public health and social issues such as poverty and poor health. The report discusses issues such as accessibility and quality of services, the roles of the public and private sectors in the health system and financing.

USAID. Atteindre les OMDs. La Contribution de la Planification Familiale: Mali.  2009 Jul. 

Notes: This document is a 2 page country brief for Mali as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Mali. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 3 to 1.

Mauritania

African Health Workforce Observatory, World Health Organization. Profil en Ressources Humaines en Santé République Islamique de Mauritanie.  2009 Sep.

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Mauritania. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

Renaudin P, Ould Abdelkader M, Ould Abdelaziz SM, Ould Mujtaba M, Ould Saleck M, Vangeenderhuysen C, et al. La Mutualisation du Risque Comme Solution à l'Accès aux Soins Obstétricaux d'Urgence. Expérience du Forfait Obstétrical en Mauritanie. Studies in Health Service Organization and Policy 2008;25:93-125.

Notes: This document is a journal article discussing financial barriers to accessing emergency obstetric care in Mauritania, specifically in the context of risk pooling as a potential solution. Financial restrictions in accessing emergency obstetric care are a leading cause of high maternal mortality ratios in developing countries and particularly in Mauritania. Risk pooling allows all pregnant women to monitor their entire pregnancy for a much smaller sum.  In addition to facilitating access to care, this strategy aims improving the quality of emergency obstetric care and insurance better working conditions for providers.

Renaudin P, Prual A, Vangeenderhuysen C, Ould AM, Ould M, V, Ould El JD. Ensuring Financial Access to Emergency Obstetric Care: Three Years of Experience with Obstetric Risk Insurance in Nouakchott, Mauritania. International Journal Of Gynecology And Obstetrics 2007 Nov;99(2):183-90.

Abstract: INTRODUCTION: The high cost of emergency obstetric care (EmOC) is a catastrophic health expenditure for households, causing delay in seeking and providing care in poor countries. METHODS: In Nouakchott, the Ministry of Health instituted Obstetric Risk Insurance to allow obstetric risk sharing among all pregnant women on a voluntary basis. The fixed premium (US$21.60) entitles women to an obstetric package including EmOC and hospital care as well as post-natal care. The poorest are enrolled at no charge, addressing the problem of equity. RESULTS: 95% of pregnant women in the catchment area (48.3% of the city's deliveries) enrolled. Utilization rates increased over the 3-year period of implementation causing quality of care to decline. Basic and comprehensive EmOC are now provided 24/7. The program has generated US$382,320 in revenues, more than twice as much as current user fees. All recurrent costs other than salaries are covered. CONCLUSION: This innovative sustainable financing scheme guarantees access to obstetric care to all women at an affordable cost.

Morocco

Fauveau V, Donnay F. Can the Process Indicators for Emergency Obstetric Care Assess the Progress of Maternal Mortality Reduction Programs? An Examination of UNFPA Projects 2000-2004. International Journal Of Gynecology And Obstetrics 2006 Jun;93(3):308-16.

Abstract: BACKGROUND: In view of the disappointing progress made in the last 20 years in reducing maternal mortality in low-income countries and before going to scale in implementing the new evidence-based strategies, it is crucial to review and assess the progress made in pilot countries where maternal mortality reduction programs focused on emergency obstetric care. OBJECTIVE: To review the process indicators recommended for monitoring emergency obstetric care and their application in field situations, examining the conditions under which they can be used to assess the progress of maternal mortality reduction programs. METHODS: Five of the six UN recommended process indicators were monitored annually for 5 years in selected districts of Morocco, Mozambique, India and Nicaragua. Trends are presented and discussed. RESULTS: With specific variations due to different local situations in the four countries and in spite of variations in quality of data collection, all indicators showed a consistent positive trend, in response to the inputs of the programs. CONCLUSIONS: The UN process indicators for emergency obstetric care should continue to be promoted, but with two important conditions: (1) data collection is carefully checked for quality and coverage; (2) efforts are made to match process and outcome indicators (maternal and perinatal mortality, incidence of complications).

Temmar F. La Formation de la Sage-Femme au Maroc.  2005.

Notes: Produced by Division de la Formation Ministère de la santé Maroc, this document presents a history of the development of the midwifery profession and training in Morocco before and after 1994 when an education reform took place and subsequently identifies challenges which need to be met. Maternal mortality is high in the country and there still seem to be shortages of professional recognition of midwifery practice. This document stresses the importance of midwifery training and a focus on women-centered care to make midwiftery services more visible in the professional community.

Temmar F. La Formation des Sages Femmes au Maroc Comme Ressource Déterminante dans la Réduction de la Mortalité et la Morbidité Maternelle et Périnatale.

Notes: Produced by Division de la Formation, Ministère de la Santé Maroc, this document details the formation of the midwifery profession in Morocco and highlights the role of the midwife as a key determinant in the reduction of maternal and neonatal mortality. This document provides a description of the midwifery education reform which took place in 1994. The document details encouraging results of the state of Morocco's midwifery such as an increased number of operational training institutes and qualified midwives.

Temmar F. Midwifery Training in Morocco: A Crucial Resource for MNMMR.

Notes: This document provides a short overview of the reform of midwifery training in Morocco. The MOH in Morocco underwent an in-depth reform of human resources, with particular emphasis on professionals concerned with maternal and neonatal mortality and morbidity reduction as well as reproductive health. The author cites encouraging results after 10 years of reform including: the implementation of more training institutes in all parts of the country, new posts created in peripheral facilities, improved pedagogic methods and revised curricula.

Mozambique

Fauveau V, Donnay F. Can the Process Indicators for Emergency Obstetric Care Assess the Progress of Maternal Mortality Reduction Programs? An Examination of UNFPA Projects 2000-2004. International Journal Of Gynecology And Obstetrics 2006 Jun;93(3):308-16.

Abstract: BACKGROUND: In view of the disappointing progress made in the last 20 years in reducing maternal mortality in low-income countries and before going to scale in implementing the new evidence-based strategies, it is crucial to review and assess the progress made in pilot countries where maternal mortality reduction programs focused on emergency obstetric care. OBJECTIVE: To review the process indicators recommended for monitoring emergency obstetric care and their application in field situations, examining the conditions under which they can be used to assess the progress of maternal mortality reduction programs. METHODS: Five of the six UN recommended process indicators were monitored annually for 5 years in selected districts of Morocco, Mozambique, India and Nicaragua. Trends are presented and discussed. RESULTS: With specific variations due to different local situations in the four countries and in spite of variations in quality of data collection, all indicators showed a consistent positive trend, in response to the inputs of the programs. CONCLUSIONS: The UN process indicators for emergency obstetric care should continue to be promoted, but with two important conditions: (1) data collection is carefully checked for quality and coverage; (2) efforts are made to match process and outcome indicators (maternal and perinatal mortality, incidence of complications).

Nepal

Clapham S, Pokharel D, Bird C, Basnett I. Addressing the Attitudes of Service Providers: Increasing Access to Professional Midwifery Care in Nepal. Tropical Doctor 2008;38(4):197-201.

Abstract: Increasing access to professional care during labour and delivery is the central strategy in Nepal's commitment to reducing its maternal mortality ratio. This paper outlines a number of complementary interventions used by the Nepal Safer Motherhood Project to address the negative attitudes prevalent among service providers, which is a contributing factor to the under-utilization of the health-care services. The perspectives of the community and the service providers are presented, with a discussion of the importance of effective communication, the establishment of positive relationships and a demonstration of the critical role of local ownership and involvement in bringing about a positive change.

Department of Health Services Nepal. Health Facility Mapping Survey 2009/2010: An Initiative to Institutionalize Health-GIS in Nepal.  2010 Mar.

Notes: Project supported by WHO, KOFIH, and SAIPAL. This survey is intended to initiate a foundation for health-GIS in Nepal as a way to improve health system management by modeling environmental and spatial factors relating to service availability and health workforce. The survey found high variation in health facility population ratio, doctor and nurse population, and bed population. This implies an unequal distribution of health facilities with respect to population density.

Midwifery Society of Nepal. International Day of the Midwife' - 5th May 2010 and Midwifery Care: "The World Needs Midwives Now More Than Ever!". 2010.

Notes: This is a document put out to for the International Day of Midwives and is written to bring awareness of the importance of midwifery. Maternal, perinatal and neonatal rates are high in Nepal. This document details the need for greater institutional deliveries and greater use of skilled birth attendants and states that professional midwives are a crucial human resource for safe motherhood.

Ministry of Health and Population Government of Nepal. Strategic Plan for Human Resources for Health 2003 - 2017.  2003 Apr.

Notes: This document specifies a strategic human resource plan of action for the health sector over the next fourteen years (2003-2017). It is based on a draft plan produced in the year 2000 and subsequently reviewed by the Ministry of Health. The plan has been updated to converge with the changing situation in Nepal and improved with the use of more accurate and more comprehensive information than was available during the preparation of the draft strategic plan. This document details the importance of HR planning as a subsidiary to health service planning as concerning the planning of resources to support health service development.

Ministry of Health and Population Government of Nepal. National Policy on Skilled Birth Attendants (Supplementary to Safe Motherhood Policy 1994).  2006 Jul.

Notes: This document outlines Nepal's SBA policy which is intended to improve maternal and neonatal health services at all levels of the health care delivery system and to ensure skilled care at every birth. The strategy calls for rapid expansion of accredited SBA training sites and capacity enhancement of trainers. It highlights the importance of service provision, strengthening training, professional accreditation and legal issues, and deployment and retention of SBA's.

Ministry of Health and Population Government of Nepal. National Safe Motherhood and Newborn Health - Long Term Plan (2006 - 2017).  2006.

Notes: This document is thesecond version of the National Safe Motherhood Long Term Plan 2002-2017 and was revised so as to ensure compliance with the MDGs and the Nepal Health Sector Programme - Implementation Plan 2004-2009. It is a guidelines document intended for policy makers, line ministries, external development partner, local NGOs and private health sector organisations. This revised plan takes into account increased emphasis on neonatal health, recognition of the importance of skilled birth attendance in reducing maternal and neonatal mortalities, health sector reform initiatives, legalization of abortion, mother to child transmission of HIV/AIDS and equity issues in safe motherhood services. It identifies 8 key outputs: equity and access, services, public private partnership, decentralization, human resource development, information management, physical assets and procurement, and finance.

Ministry of Health and Population Government of Nepal. National In-Service Training Strategy for Skilled Birth Attendants 2006 - 2012.  2007 Mar.

Notes: This document outlines a training strategy to produce skilled birth attendants who are able to provide quality midwifery services and strengthen midwifery services in Nepal. It serves as an essential step to support the implementation of the National Policy for Skilled Birth Attendants. Key elements of the strategy are to provide sufficient SBAs to meet the MDG target, and to meet in-service training needs and the implementation of training.

Ministry of Health and Population Government of Nepal. Human Resource Strategy Options for Safe Delivery.  2009 Jan. Report No.: HSRSP Report No. 2.11-01-09.

Notes: This report examines the current and future availability of skilled health workers for safe delivery services and the factors influencing their retention in government health facilities, particularly in rural areas. The report presents strategy options to address the main obstacles to adequate and appropriate staffing for safe delivery. The report details a shortage of trained staff and states that a root cause of the staffing problem is the government's inability to attract and retain sufficient numbers of trained staff in the publicly funded health system.

Ministry of Health and Population Government of Nepal. Post Training Follow-up for Skilled Birth Attendants: Review of Implementation Experiences.  2009 Sep.

Notes: This is a document issued by Nepal following up on the National In-Service Training Strategy for Skilled Birth Attendants. This rationale for this document as stated is that in addition to strengthening SBA training, successful implementation of effective follow up within this major programme would help to establish systems for follow up in other programmes and generate trainer commitment to this practice. Some recommendations from the findings include    scaling up the strategy, orientation meetings for supervisors, clear objectives to follow up visits, equipped facilities for SBA services, skill retention strategies, and more support for rural/remote SBA's.

Ministry of Health and Population Government of Nepal. National List of Essential Medicines Nepal (Fourth Revision).  2009.

Notes: This is a list put out by the Department of Drug Administration in Nepal and lists all essential medicines. The document defines essential medicines as those that satisfy the priority health needs of the population. The medicines selected are done so with due regard to disease prevalence, evidence on safety and efficacy, and comparative cost-effectiveness. The purpose of the list is to assure the availability of essential medicines within the context of functioning health systems.

Ministry of Health and Population Government of Nepal. Nepal Health Sector Programme Implementation Plan II (NHSP - IP 2) 2010 - 2015.  2010 Apr 7.

Notes: This report details the MInistry of Nepal's plan to improve the health and nutritional status of the Nepali population and provide equal opportunity for all to receive quality health care services. The plan emphasizes services directed towards women, children, poor and excluded, and other at-risk populations. This will be done through behaviour change and communication interventions.

Ministry of Health Nepal. Reproductive Health Clinical Protocol for Auxiliary Nurse Midwife.  1999.

Notes: This document produced by MOH Nepal, Family Health Division outlines the clinical protocol for auxiliary nurse midwives. Produced in the context of recommendations from ICPD Cairo in 1994, the government of Nepal undertook and intensive process of consensus building to identify the basic minimum RH services. A national Reproductive Health Strategy was developed to provide an overall policy framework. These RH clinical protocols outline exactly what is expected from managers and service providers of government and non government organizations at each level of the national health care system.

Oulton J, Hickey B. Review of the Nursing Crisis in Bangladesh, India, Nepal and Pakistan - Draft for Internal Review. Barcelona, Spain: Instituto de Cooperación Social, INTEGRARE; 2009 Feb.

Notes: This document is a report produced by Integrare and commissioned by DFID, Regional Team for South Asia. This report outlines shared concerns relating to the nursing crisis in the four countries: quality assurance in education and practice; working conditions; faculty numbers and competence, teaching resources and student clinical experiences; and absenteeism, deployment policy, and planning skills. The document states that all four countries show weaknesses of varying degrees in planning, administration, education, practice, leadership, policy, and regulation.

Pradhan A, Barnett S. An Assessment of the Impact of the Aama Programme - Changes in the Utilisation of Emergency Obstetric Care (EOC) Services.  2010 Jun.

Notes: This report is an assessment of the Aama programme on the utilisation of EOC services in Nepal. The Aama programme is a universal health care scheme designed to promote the usage of institutional care. It provides incentives to women in the form of cash payment at the time of discharge after delivery at a health institution, free delivery services at all public health facilities, and incentives to health workers. This assessment compares service utilisation data from Comprehensive Emergency Obstetric Care (CEOC) and Basic Emergency Obstetric Care (BEOC) facilities before and after the introduction of the Aama programme. The study finds that there was a substantial increase in the total number of deliveries at selected EOC facilities.

Safe Motherhood Programme Nepal. Ensuring Adequate Human Resources for Safe Delivery Services - Factsheet. 

Notes: Produced with support from DFID and Options. This is a factsheet that details the need for skilled human resources and the need for th a human resource strategy to establish a system for rational development, deployment and management of trained staff to support quality services at all levels of health facility across the country. It presents various facts relating to the state of delivery care and services available and highlights the need for action.

Tamang L. Project Development on Addressing shortage of Skilled Birth Attendants in Nepal Through Bachelor of Midwifery Program.  2009.

Notes: This document provides details of a programme to produce competent midwives in Nepal through a multidisciplinary healthcare team providing safe, sensitive, ethical care meeting the physical, psychological, spiritual, cultural and religious needs of women and their families, especially on the area of safe motherhood, reproductive health and child health services. It is a three year Bachelor programme to address the shortage of Skilled Birth Attendants. This program is governed under the Government of Nepal Public-Private Partnership Policy.

Tamang L. A Summary of Nurse-Midwife Education in Nepal.  2011.

Notes: This document is an email of a digest (source not provided) about nursing and midwifery Schools in Nepal. It provides a summary of the types of nursing and auxiliary nurse-midwife courses available. The author cites limited job opportunities due to a mismatch of supply versus demand in the context of available training courses. The author provides a general overview of the situation and states that there is still a vast amount of work which needs to be done to improve the quality of nursing education in Nepal.

UNICEF. Support to the Safe Motherhood Programme Maternal and Newborn Health Project - Needs Assessment of the Availability of Emergency Obstetric Services in Eight Districts.  2006.

Notes: This document details a needs assessment survey which was conducted in eight districts in Nepal selected for implementation of the Maternal and Newborn Health Project. The objectives of this assessment are stated as to assess the status of MNH services and to compare the present status of EmOC services and assess changes in service delivery. The survey assesses infrastructure of health facilities, human resources, evidence based practices, and travel time and utilization of EmOC services. The document finds the human resource situation to be inadequate for MNH service provision and poor infrastructure of hospitals. Positive results showed that newborn care practices are being practiced reasonably well in health facilities but further strengthening is still needed.

USAID. Achieving the MDGs. The Contribution of Family Planning: Nepal.  2009 Jul. 

Notes: This document is a 2 page country brief for Nepal as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Nepal. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 4 to 1.

Nicaragua

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Agencia Sueca de Cooperación International para el Desarrollo (ASDI), Ministerio de Salud Nicaragua. Sistematizacion Proyecto "Formation de Enfermeras Obstetras" 2004-2010. Nicaragua: ALVA Consultorías y Asesorías; 2010 May.

Notes: This document is produced jointly by the Ministry of Health, Nicaragua and ASDI (Swedish International Development Cooperation Agency). The report presents an analysis of an obstetric nurse training project undertaken in 2004-2010. The goal of this joint project was to reduce maternal and perinatal mortality and morbidity and to improve the quality of sexual and reproductive health care services in Nicaragua.

Fauveau V, Donnay F. Can the Process Indicators for Emergency Obstetric Care Assess the Progress of Maternal Mortality Reduction Programs? An Examination of UNFPA Projects 2000-2004. International Journal Of Gynecology And Obstetrics 2006 Jun;93(3):308-16.
Abstract: BACKGROUND: In view of the disappointing progress made in the last 20 years in reducing maternal mortality in low-income countries and before going to scale in implementing the new evidence-based strategies, it is crucial to review and assess the progress made in pilot countries where maternal mortality reduction programs focused on emergency obstetric care. OBJECTIVE: To review the process indicators recommended for monitoring emergency obstetric care and their application in field situations, examining the conditions under which they can be used to assess the progress of maternal mortality reduction programs. METHODS: Five of the six UN recommended process indicators were monitored annually for 5 years in selected districts of Morocco, Mozambique, India and Nicaragua. Trends are presented and discussed. RESULTS: With specific variations due to different local situations in the four countries and in spite of variations in quality of data collection, all indicators showed a consistent positive trend, in response to the inputs of the programs. CONCLUSIONS: The UN process indicators for emergency obstetric care should continue to be promoted, but with two important conditions: (1) data collection is carefully checked for quality and coverage; (2) efforts are made to match process and outcome indicators (maternal and perinatal mortality, incidence of complications).

Harvey SA, Blandon YC, McCaw-Binns A, Sandino I, Urbina L, Rodriguez C, et al. Are Skilled Birth Attendants Really Skilled? A Measurement Method, Some Disturbing Results and a Potential Way Forward. Bulletin of the World Health Organization 2007 Oct;85(10):783-90.

Abstract: OBJECTIVE: Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide -- the fifth Millennium Development Goal. Though WHO tracks the proportion of women delivered by SBAs, we know little about their competence to manage common life-threatening obstetric complications. We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement. METHODS: The WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines served as our competency standard. Evaluation included a written knowledge test, partograph (used to record all observations of a woman in labour) case studies and assessment of procedures demonstrated on anatomical models at five skills stations. We tested a purposive sample of 166 SBAs in Benin, Ecuador, Jamaica and Rwanda (Phase I). These initial results were used to refine the instruments, which were then used to evaluate 1358 SBAs throughout Nicaragua (Phase II). FINDINGS: On average, Phase I participants were correct for 56% of the knowledge questions and 48% of the skills steps. Phase II participants were correct for 62% of the knowledge questions. Their average skills scores by area were: active management of the third stage of labour -- 46%; manual removal of placenta -- 52%; bimanual uterine compression -- 46%; immediate newborn care -- 71%; and neonatal resuscitation -- 55%. CONCLUSION: There is a wide gap between current evidence-based standards and provider competence to manage selected obstetric and neonatal complications. We discuss the significance of that gap, suggest approaches to close it and describe briefly current efforts to do so in Ecuador, Nicaragua and Niger.

Notes: DA - 20071126IS - 0042-9686 (Print)IS - 0042-9686 (Linking)LA - engPT - Journal ArticlePT - Research Support, Non-U.S. Gov'tPT - Research Support, U.S. Gov't, Non-P.H.SSB – IM

Ministerio de Salud Nicaragua. Ley de Regulación de la Profesión de Enfermería.

Notes: This document presents the law for the regulation of professional nursing in Nicaragua. The law refers to male and female nurses and auxiliary nurses with varying levels of diploma/certification. It defines key principals, roles and responsibilities of nursing and the nursing profession.

Niger

Harvey SA, Blandon YC, McCaw-Binns A, Sandino I, Urbina L, Rodriguez C, et al. Are Skilled Birth Attendants Really Skilled? A Measurement Method, Some Disturbing Results and a Potential Way Forward. Bulletin of the World Health Organization 2007 Oct;85(10):783-90.

Abstract: OBJECTIVE: Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide -- the fifth Millennium Development Goal. Though WHO tracks the proportion of women delivered by SBAs, we know little about their competence to manage common life-threatening obstetric complications. We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement. METHODS: The WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines served as our competency standard. Evaluation included a written knowledge test, partograph (used to record all observations of a woman in labour) case studies and assessment of procedures demonstrated on anatomical models at five skills stations. We tested a purposive sample of 166 SBAs in Benin, Ecuador, Jamaica and Rwanda (Phase I). These initial results were used to refine the instruments, which were then used to evaluate 1358 SBAs throughout Nicaragua (Phase II). FINDINGS: On average, Phase I participants were correct for 56% of the knowledge questions and 48% of the skills steps. Phase II participants were correct for 62% of the knowledge questions. Their average skills scores by area were: active management of the third stage of labour -- 46%; manual removal of placenta -- 52%; bimanual uterine compression -- 46%; immediate newborn care -- 71%; and neonatal resuscitation -- 55%. CONCLUSION: There is a wide gap between current evidence-based standards and provider competence to manage selected obstetric and neonatal complications. We discuss the significance of that gap, suggest approaches to close it and describe briefly current efforts to do so in Ecuador, Nicaragua and Niger.

Ministère de la Santé Publique République du Niger. Document de Stratégie National de Survie de l'Enfant.  2008 Oct.

Notes: This document is Niger's National Strategy for Child Survival. The strategy was developed as part of Niger's goal to meet MDGs 4 and 5. This document presents an overview of programmes designed to improve maternal and child health including: enhancing the availability and quality of health services, addressing issues of cost, reproductive health, continuing to promote decentralized health services, promoting community participation, increasing institutional capacities, adopting policies for human resources, and ensuring the availability of essential supplies, equipment and medicines.

Ministère de la Santé Publique Niger. Enquête SONU AU NIGER 2010 – EmONC Needs Assessment in NIGER 2010.  2010 Oct.

Notes: This document is a report of an EmONC needs assessment conducted in Niger. This project was conducted with joint support from the Ministry of Health, UNFPA, UNICEF, the Common Fund (FC), the West African Organization for Health (OOAS) and AMDD. The report provides an overview of maternal and newborn health in Niger. Findings from the study indicate variations in numbers of births carried out by nurses or midwives per region.

Ministère de la Santé Publique Rèpublique du Niger. Plan de Développement de Ressources Humaines 2011 - 2020 en Santé.  2010 Nov.

Notes: This document is Niger's national plan for the development of human resources for health 2011-2020 adopted by the Ministry of Health. The human resource plans forms an integral part of the broader national plan for health development 2011-2015 and shares the same objectives. Objectives specific to the human resources as outlined in this plan include providing an estimate of personnel, proposing measures to enhance incentives and benefits, and strengthen organizational capacities.

Ministère de la Santé Publique Rèpublique du Niger. Plan de Développement Sanitaire (PDS) 2011-2015. 2011 Jan 27.

Notes: This document is the National Health Development Plan (PDS) for 2011 to 2015. This plan, adopted by the Niger Ministry of Public Health is the 3rd of its kind following the PDS 1994-2000 and 2005-2010. Strategies covered under this plan include extending health coverage, developing reproductive health services, strengthening human resources, ensuring the availability of essential medicines and treatments, reinforcing governance at all levels of the health system, developing mechanisms for financing the health sector, and the promotion of health related research.

Ministère de la Santé Publique et de la Lutte contre les Endémies Rèpublique du Niger. Programme National de Santé de la Reproduction 2005 - 2009.  2005 Jun 15.

Notes: This document outlines Niger's National Reproductive Health Plan 2005-2009. This plan is a part of the National Plan for Health Development 2005-2009.  The reproductive health plan is the Niger's national policy. This document presents an overview of the situation in Niger, including demographics, maternal mortality figures, quality of reproductive health services, availability of EmONC, family planning, and HIV/AIDS, and outlines strategies to address these issues.

Niger. Déclaration pour Objet d'Exposer la Politique de Santé du Gouvernement de la République du Niger.  2002 May 7.

Notes: This document is a declaration adopted by the Council of Ministers in May 2002 presenting an overview of health in Niger. The objective of the declaration is to define Niger's health policy as set in the context of developing the health system. The document outlines the policy and puts forth strategies to develop the health system such as strengthening human resources, extending basic health coverage, improving communication systems, and addressing challenges to quality of care.

USAID. Achieving the MDGs. The Contribution of Family Planning: Niger.  2009 Jul.

Notes: This document is a 2 page country brief for Niger as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Niger. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 3 to 1.

Nigeria

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Nigeria.  2008 Oct.

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Nigeria.  This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

Akiode A, Fetters T, Daroda R, Okeke B, Oji E. An evaluation of a national intervention to improve the postabortion care content of midwifery education in Nigeria. International Journal of Gynecology and Obstetrics 110 (2010) 186–190

Center for Reproductive Rights, Women Advocates Research and Documentation Centre. Broken Promises: Human Rights, Accountability, and Maternal Death in Nigeria.  2008.

Notes: This report is a joint publication of the Center for Reproductive Rights (CRR) and the Women Advocates Research and Documentation Centre (WARDC). This report is based on desk and field research conducted between October 2007 and May 2008. The desk research involved a literature review of research publications such as books, journals, newspaper articles, and documentary analysis, as well as a synthesis of policies, legislation, and national demographic and health surveys published by the federal and state governments of Nigeria. In addition, it included reviews of civil society and non-governmental organisation surveys and publications on health and reproductive health care. This report focuses specifically on the Nigerian government's responsibility for the dire state of maternal health in the country. While the Nigerian government has repeatedly identified maternal mortality and morbidity as a pressing problem and developed laws and policies in response, these actions have not translated into a significant improvement in maternal health throughout the country. A number of factors inhibit the provision and availability of maternal health care in the country, including: the inadequacy or lack of implementation of laws and policies, the prevalence of systemic corruption, weak infrastructure, ineffective health services, and the lack of access to skilled health-care providers. The separation of responsibilities for the provision of health care among the country's three tiers of government both contributes to and exacerbates the harmful impact of these various factors.

Ijadunola KT, Ijadunola MY, Esimai OA, Abiona TC. New Paradigm Old Thinking: The case for Emergency Obstetric Care in the Prevention of Maternal Mortality in Nigeria. BMC Womens Health 2010;10:6.

Abstract: BACKGROUND: The continuing burden of maternal mortality, especially in developing countries has prompted a shift in paradigm from the traditional risk assessment approach to the provision of access to emergency obstetric care services for all women who are pregnant. This study assessed the knowledge of maternity unit operatives at the primary and secondary levels of care about the concept of emergency obstetric care (EmOC) and investigated the contents of antenatal care (ANC) counseling services they delivered to clients. It also described the operatives' preferred strategies and practices for promoting safe motherhood and averting maternal mortality in South-west Nigeria. METHODS: The study population included all the 152 health workers (doctors, midwives, nurses and community health extension workers) employed in the maternity units of all the public health facilities (n = 22) offering maternity care in five cities of 2 states. Data were collected with the aid of a self-administered, semi-structured questionnaire and non-participant observation checklist. Results were presented using descriptive statistics. RESULTS: Ninety one percent of the maternity unit staff had poor knowledge concerning the concept of EmOC, with no difference in knowledge of respondents across age groups. While consistently more than 60% of staff reported the inclusion of specific client-centered messages such as birth preparedness and warning/danger signs of pregnancy and delivery in the (ANC) delivered to clients, structured observations revealed that less than a quarter of staff actually did this. Furthermore, only 40% of staff reported counseling clients on complication readiness, but structured observations revealed that no staff did. Only 9% of staff had ever been trained in lifesaving skills (LSS). Concerning strategies for averting maternal deaths, 70% of respondents still preferred the strengthening of routine ANC services in the health facilities to the provision of access to EmOC services for all pregnant women who need it. CONCLUSION: We concluded that maternity unit operatives at the primary and secondary care levels in South-west Nigeria were poorly knowledgeable about the concept of emergency obstetric care services and they still prioritized the strengthening of routine antenatal care services based on the risk approach over other interventions for promoting safe motherhood despite a global current shift in paradigm. There is an urgent need to reorientate/retrain the staff in line with global best practices.

Pakistan

Ariff S, Soofi SB, Sadiq K, Feroze AB, Khan S, Jafarey SN, et al. Evaluation of Health Workforce Competence in Maternal and Neonatal Issues in Public Health Sector of Pakistan: an Assessment of Their Training needs. BMC Health Services Research 2010;10:319.

Abstract: BACKGROUND: More than 450 newborns die every hour worldwide, before they reach the age of four weeks (neonatal period) and over 500,000 women die from complications related to childbirth. The major direct causes of neonatal death are infections (36%), Prematurity (28%) and Asphyxia (23%). Pakistan has one of the highest perinatal and neonatal mortality rates in the region and contributes significantly to global neonatal mortality. The high mortality rates are partially attributable to scarcity of trained skilled birth attendants and paucity of resources. Empowerment of health care providers with adequate knowledge and skills can serve as instrument of change. METHODS: We carried out training needs assessment analysis in the public health sector of Pakistan to recognize gaps in the processes and quality of MNCH care provided. An assessment of Knowledge, Attitude, and Practices of Health Care Providers on key aspects was evaluated through a standardized pragmatic approach. Meticulously designed tools were tested on three tiers of health care personnel providing MNCH in the community and across the public health care system. The Lady Health Workers (LHWs) form the first tier of trained cadre that provides MNCH at primary care level (BHU) and in the community. The Lady Health Visitor (LHVs), Nurses, midwives) cadre follow next and provide facility based MNCH care at secondary and tertiary level (RHCs, Taluka/Tehsil, and DHQ Hospitals). The physician/doctor is the specialized cadre that forms the third tier of health care providers positioned in secondary and tertiary care hospitals (Taluka/Tehsil and DHQ Hospitals). The evaluation tools were designed to provide quantitative estimates across various domains of knowledge and skills. A priori thresholds were established for performance rating. RESULTS: The performance of LHWs in knowledge of MNCH was good with 30% scoring more than 70%. The Medical officers (MOs), in comparison, performed poorly in their knowledge of MNCH with only 6% scoring more than 70%. All three cadres of health care providers performed poorly in the resuscitation skill and only 50% were able to demonstrate steps of immediate newborn care. The MOs performed far better in counselling skills compare to the LHWs. Only 50 per cent of LHWs could secure competency scale in this critical component of skills assessment. CONCLUSIONS: All three cadres of health care providers performed well below competency levels for MNCH knowledge and skills. Standardized training and counselling modules, tailored to the needs and resources at district level need to be developed and implemented. This evaluation highlighted the need for periodic assessment of health worker training and skills to address gaps and develop targeted continuing education modules. To achieve MDG4 and 5 goals, it is imperative that such deficiencies are identified and addressed.

Haji M, Durairaj V, Zurn P, Stormont L, Mapunda M. Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce Through Decentralized Health Financing Systems. Bulletin of the World Health Organization 2010 May;88(5):397-9.

This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector, better use of existing financial resources, and creation of financial incentives for health workers. The paper also considers the conditions under which decentralized health financing systems can lead to improved health workforce retention using examples from several countries including Brazil, China, Costa Rica, Guyana, India, Kenya, Pakistan, the Philippines, Romania, Rwanda, Thailand, Uganda, Tanzania, and Zambia. The document concludes that it is evident that providing the ministry of health with autonomy, by delinking the health workforce from the civil workforce and providing strategic performance incentives, are means by which health workers can be successfully recruited and retained. The authors also note that such policies only work if health system objectives are aligned with appropriate institutional and incentive structures.

Jokhio AH, Winter HR, Cheng KK. An Intervention Involving Traditional Birth Attendants and Perinatal and Maternal Mortality in Pakistan. New England Journal of Medicine 2005 May 19;352(20):2091-9.

Abstract: BACKGROUND: There are approximately 4 million neonatal deaths and half a million maternal deaths worldwide each year. There is limited evidence from clinical trials to guide the development of effective maternity services in developing countries. METHODS: We performed a cluster-randomized, controlled trial involving seven subdistricts (talukas) of a rural district in Pakistan. In three talukas randomly assigned to the intervention group, traditional birth attendants were trained and issued disposable delivery kits; Lady Health Workers linked traditional birth attendants with established services and documented processes and outcomes; and obstetrical teams provided outreach clinics for antenatal care. Women in the four control talukas received usual care. The primary outcome measures were perinatal and maternal mortality. RESULTS: Of the estimated number of eligible women in the seven talukas, 10,114 (84.3 percent) were recruited in the three intervention talukas, and 9443 (78.7 percent) in the four control talukas. In the intervention group, 9184 women (90.8 percent) received antenatal care by trained traditional birth attendants, 1634 women (16.2 percent) were seen antenatally at least once by the obstetrical teams, and 8172 safe-delivery kits were used. As compared with the control talukas, the intervention talukas had a cluster-adjusted odds ratio for perinatal death of 0.70 (95 percent confidence interval, 0.59 to 0.82) and for maternal mortality of 0.74 (95 percent confidence interval, 0.45 to 1.23). CONCLUSIONS: Training traditional birth attendants and integrating them into an improved health care system were achievable and effective in reducing perinatal mortality. This model could result in large improvements in perinatal and maternal health in developing countries.

Ministry of Health Government of Pakistan. National Health Policy 2001 The Way Forward: Agenda for Health Sector Reform.  2001 Dec.

Notes: This document presents MOH Pakistan's 2001 policy for health sector reform. The document defines 10 specific areas as needing reforms:  the widespread prevalence of communicable diseases; inadequacies in primary/secondary health care services; remote professional and managerial deficiencies in district health system; greater gender equity in the health sector; nutrition gaps in the population; urban bias in the health sector implementation modalities; introduction of regulation in the private medical sector; the creation of mass awareness in public health matters; effect improvements in the drug sector with a view to ensuring the availability, affordability and quality of drugs in the country; and capacity building for health policy monitoring in the ministry of health.

Ministry of Health Government of Pakistan. Pakistan: National Maternal and Child Health Policy and Strategic Framework (2005-2015).  2005 Apr.

Notes: This is a draft document prepared for review by policymakers in health sector to provide a basis for further provincial consultations and development of National Maternal and Child Health Program. A comprehensive National MCH strategic framework has been developed by Ministry of Health in consultation with Departments of Health and other stakeholders with an objective to improve the accessibility of high quality and effective MCH services for all, particularly the poor and the disadvantaged. Public Health Forum held in Islamabad on April 1-2, 2005, in which this document was endorsed. Key areas of reform identified include: developing a unified policy on maternal and child health, implemented through an integrated national MCH program; training of LHVs and community skilled birth attendants to ensure that each birth is attended by skilled health personnel, ensuring comprehensive family planning services across all health care infrastructure; ensuring easy and organized access to high quality 24/7 basic and comprehensive EmONC for all; ensuring implementation of integrated management of childhood illness and child survival interventions through skill building of health care providers; expansion of Lady Health Workers; culturally appropriate interventions; and the development of social safety nets for the poor.

Ministry of Health Government of Pakistan, International Council of Nurses, International Confederation of Midwives, World Health Organization. Islamabad Declaration on Strengthening Nursing and Midwifery. 4-6 March 2007.  2007.

Notes: This is a declaration made by the Federal Minister of Health for Pakistan in response to the World Health Assembly May 2006 Resolution WHA59.27 which reaffirmed the valuable role of nursing and midwifery professions to health systems and the health of the people they serve. The declaration is founded on the belief that effective nursing and midwifery services are critical to achieving the MDGs, to improving primary health care programmes and to the strengthening of health systems. This declaration calls for the scaling up of nursing and midwifery capacity, high level political leadership, a multi-sectoral approach, significant financial investment in education and employment expansion, and that each country must establish policies and practices to ensure self-sufficiency in workforce production.

Ministry of Health Government of Pakistan. National Health Policy 2009.  2009 Jul.

Notes: Draft of MOH Pakistan's National Health Policy 2009. The vision of this policy is to improve the health and quality of life of all Pakistanis, particularly women and children, through access to essential health services. The goal of this policy as stated is to remove barriers to essential health services. The document outlines 6 key policy objectives to reach this goal: provide and deliver a basic package of quality Essential Health Care Services; develop and manage competent and committed health care providers; generate reliable health information to manage and evaluate health services; adopt appropriate health technology to deliver quality services; finance the costs of providing basic health care to all Pakistanis; and to reform the health administration to make it accountable to the public. This policy further states that it recognizes the varied needs of different provinces, therefore this policy is designed to contribute to advancing and strengthening the provincial health strategies.

Oulton J, Hickey B. Review of the Nursing Crisis in Bangladesh, India, Nepal and Pakistan - Draft for Internal Review. Barcelona, Spain: Instituto de Cooperación Social, INTEGRARE; 2009 Feb.

Notes: This document is a report produced by Integrare and commissioned by DFID, Regional Team for South Asia. This report outlines shared concerns relating to the nursing crisis in the four countries: quality assurance in education and practice; working conditions; faculty numbers and competence, teaching resources and student clinical experiences; and absenteeism, deployment policy, and planning skills. The document states that all four countries show weaknesses of varying degrees in planning, administration, education, practice, leadership, policy, and regulation.

Pakistan. Assessment of the Quality of Training of Community Midwives in Pakistan. 2010.  

Notes: This document presents conclusions of a community midwife training programme in Pakistan. CMW training commenced in 2007/2008 in Pakistan and has made good progress in terms of numbers enrolled and trained. Results of theoretical knowledge testing of CMWs are encouraging and show commitment of CMW training schools and MNCH Programs, federal and provincial. However, poor aptitude in critical thinking and analytical skills and major weaknesses in management of maternal and neonatal complications especially their early identification and timely referral means that the majority of graduating CMWs lack competence to practice domiciliary midwifery independently. Broad limitations in all aspects of clinical learning opportunity, hospital as well as community, results from: shortfalls in enforcement of PC1 criteria; failure to translate PNC curriculum into an objective-based structured teaching training program; and lack of coordination among various stakeholders of the CMW training programme including; CMW school, training health institution, District Health system, LHW programme, community and CMWs families. Source not provided.

Pakistan Nursing Council (Community Midwifery Curriculum). List of Skills to be Imparted to a Midwife.

Notes: This document as part of the Community Midwifery Curriculum lists skills needed to be a midwife. Skills listed include: antenatal care; normal deliveries; management of post-partum hemorrhage; immediate care of newborn and resuscitation; and postpartum care.

Papua New Guinea

National Department of Health Papua New Guinea. Ministerial Taskforce on Maternal Health in Papua New Guinea.  2009 May.

Notes: This is a report from the Ministry of Health, Papua New Guinea on the current situation of the impact maternal death has on the country. This report states that there is a crisis in maternal health in Papua New Guinea and presents 7 key recommendations to guide the response to this crisis and to build a stronger health system which that better meets the needs of our mothers. These recommendations are: securing investments between major government, private sector and development partners; ensuring universal free primary education for girls; recognising that MMR is the most sensitive indicator of quality and level of functioning of a health service and that a dysfunctional health system in PNG has been a major contribution to the high levels of maternal morbidity and mortality; strengthening the quality of voluntary family planning services, ensuring supervised delivery by a trained health care provider; ensuring that every woman has access to comprehensive obstetric care; and ensuring every woman has access to quality emergency obstetric care if required at first referral level.

Rwanda

Haji M, Durairaj V, Zurn P, Stormont L, Mapunda M. Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce Through Decentralized Health Financing Systems. Bulletin of the World Health Organization 2010 May;88(5):397-9.

This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector, better use of existing financial resources, and creation of financial incentives for health workers. The paper also considers the conditions under which decentralized health financing systems can lead to improved health workforce retention using examples from several countries including Brazil, China, Costa Rica, Guyana, India, Kenya, Pakistan, the Philippines, Romania, Rwanda, Thailand, Uganda, Tanzania, and Zambia. The document concludes that it is evident that providing the ministry of health with autonomy, by delinking the health workforce from the civil workforce and providing strategic performance incentives, are means by which health workers can be successfully recruited and retained. The authors also note that such policies only work if health system objectives are aligned with appropriate institutional and incentive structures.

Harvey SA, Ayabaca P, Bucagu M, Djibrina S, Edson WN, Gbangbade S, et al. Skilled Birth Attendant Competence: An Initial Assessment in Four Countries, and Implications for the Safe Motherhood Movement. International Journal Of Gynecology And Obstetrics 2004 Nov;87(2):203-10.

Abstract: OBJECTIVES: Percentage of deliveries assisted by a skilled birth attendant (SBA) has become a proxy indicator for reducing maternal mortality in developing countries, but there is little data on SBA competence. Our objective was to evaluate the competence of health professionals who typically attend hospital and clinic-based births in Benin, Ecuador, Jamaica, and Rwanda. METHODS: We measured competence against World Health Organization's (WHO) Integrated Management of Pregnancy and Childbirth guidelines. To evaluate knowledge, we used a 49-question multiple-choice test covering seven clinical areas. To evaluate skill, we had participants perform five different procedures on anatomical models. The 166 participants came from facilities at all levels of care in their respective countries. RESULTS: On average, providers answered 55.8% of the knowledge questions correctly and performed 48.2% of the skills steps correctly. Scores differed somewhat by country, provider type, and subtopic. CONCLUSION: A wide gap exists between current evidence-based standards and current levels of provider competence.

Harvey SA, Blandon YC, McCaw-Binns A, Sandino I, Urbina L, Rodriguez C, et al. Are Skilled Birth Attendants Really Skilled? A Measurement Method, Some Disturbing Results and a Potential Way Forward. Bulletin of the World Health Organization 2007 Oct;85(10):783-90.

Abstract: OBJECTIVE: Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide -- the fifth Millennium Development Goal. Though WHO tracks the proportion of women delivered by SBAs, we know little about their competence to manage common life-threatening obstetric complications. We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement. METHODS: The WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines served as our competency standard. Evaluation included a written knowledge test, partograph (used to record all observations of a woman in labour) case studies and assessment of procedures demonstrated on anatomical models at five skills stations. We tested a purposive sample of 166 SBAs in Benin, Ecuador, Jamaica and Rwanda (Phase I). These initial results were used to refine the instruments, which were then used to evaluate 1358 SBAs throughout Nicaragua (Phase II). FINDINGS: On average, Phase I participants were correct for 56% of the knowledge questions and 48% of the skills steps. Phase II participants were correct for 62% of the knowledge questions. Their average skills scores by area were: active management of the third stage of labour -- 46%; manual removal of placenta -- 52%; bimanual uterine compression -- 46%; immediate newborn care -- 71%; and neonatal resuscitation -- 55%. CONCLUSION: There is a wide gap between current evidence-based standards and provider competence to manage selected obstetric and neonatal complications. We discuss the significance of that gap, suggest approaches to close it and describe briefly current efforts to do so in Ecuador, Nicaragua and Niger.

Institut National des Statistiques Ministère des Finances et de la Planification Economique, Ministère de la Santé Rwanda. République du Rwanda: Enquête sur la prestation des services de soins de santé 2007 Prestations des Soins Obstétricaux et Néonatals d'Urgence (SONU).  2008 Nov.

Notes: This document presents the results of the 2007 health service performance survey conducted in Rwanda, with specific emphasis on emergency obstetric care. This is the second survey of its kind conducted in Rwanda. This survey provides detailed findings relating to the quality, availability and use of maternal health services in the country, including available facilities, medications and equipment as well as issues pertaining to skilled personnel.

Ministry of Health Government of Rwanda. Human Resources for Health Strategic Plan 2006-2010.  2006 Apr.

Notes: This report documents the Health Sector Strategic Plan adopted by Rwanda. This plan identifies human resources as the major challenge if quality of care and the achievement of the MDGs are to be attained. This document introduces the plan, presents an overview of the health care system organization and structure, an analysis of the current health workforce and on training programs and training issues. This plan looks to improve policy, regulation and planning of HRH, improve management and performance, stabilize the labour market, create capacity such as strengthening education, training and research, and to monitor and evaluate progress.

Rwanda. Map of Health Facilities.

Notes: This is a map of health facilities in Rwanda. Types of facilities include health centers, dispensaries, district hospitals, military hospitals, national referral hospitals, prison dispensaries, and health posts. Source not provided.

Senegal

De Brouwere V, Dieng T, Diadhiou M, Witter S, Denerville E. Task Shifting for Emergency Obstetric Surgery in District Hospitals in Senegal. Reproductive Health Matters 2009 May;17(33):32-44.

Abstract: Due to a long-term shortage of obstetricians, the Ministry of Health of Senegal and Dakar University Obstetric Department agreed in 1998 to train district teams consisting of an anaesthetist, general practitioner and surgical assistant in emergency obstetric surgery. An evaluation of the policy was carried out in three districts in 2006, covering trends in rates of major obstetric interventions, outcomes in newborns and mothers, and the views of key informants, community members and final year medical students. From 2001 to 2006, 11 surgical teams were trained but only six were functioning in 2006. The current rate of training is not rapid enough to cover all districts by 2015. An increase in the rate of interventions was noted as soon as a team had been put in place, but unmet need persisted. Central decision-makers considered the policy more viable than training gynaecologists for district hospitals, but resistance from senior academic clinicians, a perceived lack of career progression among the doctors trained, and lack of programme coordination were obstacles. Practitioners felt the work was valuable, but complained of low additional pay and not being replaced during training. Communities appreciated that the services saved lives and money, but called for improved information and greater continuity of care.

Dumont A, de Bernis L, Bouillin D, Gueye A, Dompnier JP, Bouvier-Colle MH. Morbidité Maternelle et Qualification du Personnel de Santé : Comparaison de Deux Populations Différentes au Sénégal. Journal de Gynécologie, Obstétrique et Biologie de la Reproduction 2002;31:70-9.

Notes: This document is a journal article comparing maternal mortality and the qualifications of health personnel in two populations of Senegal (St-Louis and Kaolack). The objectives of the study conducted was to compare and contrast the situation of these two populations in relation to the offering of health services, and construct health indicators which could be adapted on the basis of the comparisons made. The study aimed to determine the extent to which maternal health outcomes are dependent on the level of qualifications of the nursing and medical staff. Results found that maternal mortality was higher in the Kaolack area where women gave birth mainly in district health care centers most often attended by traditional birth attendants, than in St-Louis where women giving birth in health facilities were principally referred to the regional hospital and were generally assisted by midwives.

Dumont A, Tourigny C, Fournier P. Improving Obstetric Care in Low-Resource Settings: Implementation of Facility-Based Maternal Death Reviews in Five Pilot Hospitals in Senegal. Human Resources for Health 2009;7:61.

Abstract: BACKGROUND: In sub-Saharan Africa, maternal and perinatal mortality and morbidity are major problems. Service availability and quality of care in health facilities are heterogeneous and most often inadequate. In resource-poor settings, the facility-based maternal death review or audit is one of the most promising strategies to improve health service performance. We aim to explore and describe health workers' perceptions of facility-based maternal death reviews and to identify barriers to and facilitators of the implementation of this approach in pilot health facilities of Senegal. METHODS: This study was conducted in five reference hospitals in Senegal with different characteristics. Data were collected from focus group discussions, participant observations of audit meetings, audit documents and interviews with the staff of the maternity unit. Data were analysed by means of both quantitative and qualitative approaches. RESULTS: Health professionals and service administrators were receptive and adhered relatively well to the process and the results of the audits, although some considered the situation destabilizing or even threatening. The main barriers to the implementation of maternal deaths reviews were: (1) bad quality of information in medical files; (2) non-participation of the head of department in the audit meetings; (3) lack of feedback to the staff who did not attend the audit meetings. The main facilitators were: (1) high level of professional qualifications or experience of the data collector; (2) involvement of the head of the maternity unit, acting as a moderator during the audit meetings; (3) participation of managers in the audit session to plan appropriate and realistic actions to prevent other maternal deaths. CONCLUSION: The identification of the barriers to and the facilitators of the implementation of maternal death reviews is an essential step for the future adaptation of this method in countries with few resources. We recommend for future implementation of this method a prior enhancement of the perinatal information system and initial training of the members of the audit committee--particularly the data collector and the head of the maternity unit. Local leadership is essential to promote, initiate and monitor the audit process in the health facilities.

Kone KG. Analyse de la Situation des Services de Soins, du Personnel Infirmier et du Personnel Obstétrical dans le Système de Santé au Sénégal par Rapport aux Dispositions de la Convention n° 149 et de la Recommandation n° 157 de l'OIT.  International Labour Organization; 2009 Nov.

Notes: This document is an ILO report describing the situation of health services and nursing and obstetric personnel working in Senegal in the context of ILO Convention 149 and ILO Recommendation 157. Findings from the study indicate that there is no specific health policy for nurses in Senegal.

Ministère de la Santé et de la Prévention République du Sénégal, Agence Nationale de la Statistique et de la Démographie. Comptes Nationaux de la Santé 2005.  2005.

Notes: This is a MOH Senegal National Health Report for 2005. This document presents figures for reproductive health in the country, in particular in the context of expenditures and finance. This report addresses issues such as private and public finance in the health sector, and allocation of funds.

Ministère de la Santé et de la Prévention République du Sénégal, Service National de l'Information Sanitaire. Carte Sanitaire du Senegal.  2008.

Notes: Final Version. This MOH Senegal document maps out health services and distributions. It provides figures relating to human resources, demography, health districts, infrastructure, and an inventory of equipment.

Ministère de la Santé et de la Prévention République du Sénégal, Service National de l'Information Sanitaire. Annuaire Statistique 2009.  2009.

Notes: This document in an annual statistical report produced by MOH Senegal and the National Health Information Services. This report presents figures relating to geography and demography, socio-economic context, health systems, health resources, human resources, distribution of health districts and epidemiology such as HIV/AIDS, morbidity and mortality, mental health and others.

Ministère de la Santé et de la Prévention République du Sénégal. Plan National de Developpement Sanitaire PNDS 2009-2018.  2009 Jan.

Notes: Final version. This document outlines Senegal's National Health Development Plan. Covering the period 2009-2018, this plan is intended as a strategy document to reduce poverty and reach the MDGs. This plan calls for the working together of all health related sectors: health professionals, civil society, private, local and other development stakeholders. This strategy takes a multisectoral approach in order to strengthen Senegal's health system and improve access and quality of health care. Areas in need of strengthening include: health promotion, human resources development, information and referral systems, and health infrastructure.

Ministère de la Santé et de la Prévention République du Sénégal. Programme de Formation de l'Infirmier au Sénégal.  2010 Mar.

Notes: This document presents the national Nurse Training Programme as defined by MOH Senegal. The objectives of this are to produce competent and capable nurses to improve individual, family and community health. This document outlines the modules and curriculum of nurse training in Senegal.

Ministère de la Santé et de la Prévention République du Sénégal. Programme de Formation de l'Assistant Infirmier au Sénégal.  2010 Mar.

Notes: This document presents the MOH Senegal Programme for Assistant (Auxiliary) Nurse Training. The document outlines the requirements for auxiliary nurse candidates and is intended to increase professional competencies so as to improve individual, family and community health. The document presents an outline of training modules and curriculum for assistant/auxiliary nurses in Senegal.

Ministère de la Santé et de la Prévention République du Sénégal. Analyse: Arrêté Portant Validation des Programmes de Formation de la Sage-Femme d'Etat, de l'Infirmier d'Etat et de l'Assistant Infirmier.  2010 Aug 6. Report No.: 05045.

Notes: This MOH Senegal document presents a short overview of laws relating to health worker training programmes in Senegal, specifically state midwives, state nurses, and assistant/auxiliary nurses. This policy document consists of three clauses. 1. state training programmes fall under the jurisdiction of the MOH,  2, private training programmes have to conform to these laws, and 3, each respective government officer (human resources, MOH) will be in charge of ensuring these laws are being conformed to.

Ministère de la Santé et de la Prévention République du Sénégal. Programme de Formation de la Sage-Femme au Sénégal.  2010 Mar.

Notes: This document presents the national Midwife Training Programme as defined by MOH Senegal. The objectives of this are to produce competent and capable midwives to improve individual, family and community health. This document outlines the modules and curriculum of midwifery training in Senegal as well as the necessary qualifications to partake in these programmes.

Plan-Cadre des Nations Unies pour l'Assistance au Développement (UNDAF). Sénégal 2007-2011. Dakar: Système des Nations Unies au Sénégal; 2007.

Notes: This document presents the United Nations Development Assistance Framework for Senegal. The UNDAF is a framework for the Senegal Country Team and describes priorities specific to the region. The initiatives outlined address poverty reduction, social services, and promotion of governance as three key areas.

USAID. Atteindre les OMDs. La Contribution de la Planification Familiale: Sénégal.  2009 Jul.

Notes: This document is a 2 page country brief for Senegal as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute.The briefing provides information on the contribution of family planning toward achieving the MDGs in Senegal. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 6 to 1.

Zurn P, Codjia L, Sall FL. La Fidélisation des Personnels de Santé dans les Zones Difficiles au Sénégal. Geneva: World Health Organization; 2010.

Notes: This is a report produced by WHO in collaboration with the Ministry of Health, Prevention and Hygiene in Senegal. This document reports findings from a study conducted examining the loyalties of health personnel working in difficult environments. The intent of this study is to examine motives of these workers with the broader goal to contribute to strategies aimed at increasing the workforce in difficult areas. This report analyzes the geographic distribution of health personnel and potential factors that contribute to the unequal distribution, specifically in rural, isolated or generally unfavorable regions. Findings indicate a variety of attributing factors to the unequal distribution, including professional factors, family obligations, and feelings of isolation while working in these areas.

South Africa

Cow S, Marcus J, Adams C. Midwife-Led Units in Community Settings, Cape Peninsula South Africa. 6-6-2010.

Notes: This is a powerpoint presentation about community midwifery in South Africa. It provides a general background of the situation and outlines specific challenges to being a midwife in this context. It also presents an outline of midwifery training programmes and clinical status leading to professional practice. Authors of this document are from University of Cape Town and Mowbray Maternity Hospital, South Africa.

Daniels K, Lewin S, Policy Group. The Growth of a Culture of Evidence-Based Obstetrics in South Africa: A Qualitative Case Study. Reproductive Health 2011 Mar 28;8(1):5.

Abstract: BACKGROUND: While the past two decades have seen a shift towards evidence-based obstetrics and midwifery, the process through which a culture of evidence-based practice develops and is sustained within particular fields of clinical practice has not been well documented, particularly in LMICs (low- and middle-income countries). Forming part of a broader qualitative study of evidence-based policy making, this paper describes the development of a culture of evidence-based practice amongst maternal health policy makers and senior academic obstetricians in South Africa METHODS: A qualitative case-study approach was used. This included a literature review, a policy document review, a timeline of key events and the collection and analysis of 15 interviews with policy makers and academic clinicians involved in these policy processes and sampled using a purposive approach. The data was analysed thematically. RESULTS: The concept of evidence-based medicine became embedded in South African academic obstetrics at a very early stage in relation to the development of the concept internationally. The diffusion of this concept into local academic obstetrics was facilitated by contact and exchange between local academic obstetricians, opinion leaders in international research and structures promoting evidence-based practice. Furthermore the growing acceptance of the concept was stimulated locally through the use of existing professional networks and meetings to share ideas and the contribution of local researchers to building the evidence base for obstetrics both locally and internationally. As a testimony to the extent of the diffusion of evidence-based medicine, South Africa has strongly evidence-based policies for maternal health. CONCLUSION: This case study shows that the combined efforts of local and international researchers can create a culture of evidence-based medicine within one country. It also shows that doing so required time and perseverance from international researchers combined with a readiness by local researchers to receive and actively promote the practice.

Medical Research Council of South Africa. Intrapartum Care in South Africa - Review and Guidelines.  MRC; 2005.

Notes: This report is the result of a meeting held by MRC Maternal and Infant Health Care Strategies Research Unit involving both health workers and administrators from the provincial Departments of Health. The aim of the meeting was to review the current relevant research on intrapartum care and define what is known, what knowledge is lacking and how labour should be managed in maternity units in South Africa. This report presents the review of the past and current status of intrapartum care in South Africa, a review of the normal labour in African women and how it differs from other races, a comprehensive intrapartum care guideline which contains the motivation for each step and a review of the current strategies being used to improve intrapartum care. Some proposed strategies for improving the quality of intrapartum care include comprehensive training, auditing of units on day to day management of labour, and identifying individuals who would be especially adept at driving implementation.

Wall SN, Lee AC, Carlo W, Goldenberg R, Niermeyer S, Darmstadt GL, et al. Reducing Intrapartum-Related Neonatal Deaths in Low- and Middle-Income Countries - What Works? Seminars in Perinatology 2010 Dec;34(6):395-407.

Abstract: Each year, 814,000 neonatal deaths and 1.02 million stillbirths result from intrapartum-related causes, such as intrauterine hypoxia. Almost all of these deaths are in low- and middle-income countries, where women frequently lack access to quality perinatal care and may delay care-seeking. Approximately 60 million annual births occur outside of health facilities, and most of these childbirths are without a skilled birth attendant. Conditions that increase the risk of intrauterine hypoxia--such as pre-eclampsia/eclampsia, obstructed labor, and low birth weight--are often more prevalent in low resource settings. Intrapartum-related neonatal deaths can be averted by a range of interventions that prevent intrapartum complications (eg, prevention and management of pre-eclampsia), detect and manage intrapartum problems (eg, monitoring progress of labor with access to emergency obstetrical care), and identify and assist the nonbreathing newborn (eg, stimulation and bag-mask ventilation). Simple, affordable, and effective approaches are available for low-resource settings, including community-based strategies to increase skilled birth attendance, partograph use by frontline health workers linked to emergency obstetrical care services, task shifting to increase access to Cesarean delivery, and simplified neonatal resuscitation training (Helping Babies Breathe(SM)). Coverage of effective interventions is low, however, and many opportunities are missed to provide quality care within existing health systems. In sub-Saharan Africa, recent health services assessments found only 15% of hospitals equipped to provide basic neonatal resuscitation. In the short term, intrapartum-related neonatal deaths can be substantially reduced by improving the quality of services for all childbirths that occur in health facilities, identifying and addressing the missed opportunities to provide effective interventions to those who seek facility-based care. For example, providing neonatal resuscitation for 90% of deliveries currently taking place in health facilities would save more than 93,000 newborn lives each year. Longer-term strategies must address the gaps in coverage of institutional delivery, skilled birth attendance, and quality by strengthening health systems, increasing demand for care, and improving community-based services. Both short- and long-term strategies to reduce intrapartum-related mortality should focus on reducing inequities in coverage and quality of obstetrical and perinatal care.

World Health Organization, Department of Reproductive Health and Research. Preventing Unsafe Abortion - Mid-Level Health-Care Providers are a Safe Alternative to Doctors for First-Trimester Abortions in Developing Countries. 2 p. Geneva: World Health Organization; 2008 Feb.

Notes: This is a document produced by WHO and HRP -Special Programme of Research, Development and Research Training in Human Reproduction (UNDP, UNFPA, WHO, World Bank. This study is a comparative assessment of the safety of first-trimester abortion by type of provider in developing countries. The study was conducted to compare the safety of first-trimester abortion with manual vacuum aspiration performed by nurses, midwives, mid-level healthcare providers and doctors in South Africa and Viet Nam. This study finds that abortions performed by government trained and accredited nurses, midwives and midlevel healthcare providers in these countries were comparable in terms of safety and acceptability to those performed by doctors. The report concludes that countries seeking to expand safe abortion services can consider an approach similar to that taken by the results of this study.

Sudan

Ali AA, Rayis DA, Mamoun M, Adam I. Use of Family Planning Methods in Kassala, Eastern Sudan. BMC Research Notes 2011 Feb 28;4(1):43.

Abstract: Investigating use and determinants of family planning methods may be instructive in the design of interventions to improve reproductive health services. FINDINGS: Across sectional community- based study was conducted during the period February- April 2010 to investigate the use of family planning in Kassala, eastern Sudan. Structured questionnaires were used to gather socio-demographic data and use of family planning. The mean +/- SD of the age and parity of 613 enrolled women was 31.1+/-7 years and 3.4+/- 1.9, respectively. Only 44.0% of these women had previously or currently used one or more of the family planning methods. Combined pills (46.7%) and progesterone injection (17.8%) were the predominant method used by the investigated women. While age, residence were not associated with the use of family planning, parity (> five), couple education ([greater than or equal to] secondary level) were significantly associated with the use of family planning. Husband objection and religious beliefs were the main reasons of non- use of family planning. CONCLUSION: Education, encouragement of health education programs and involvement of the religious persons might promote family planning in eastern Sudan.

Babiker ARM. National EmOC Needs Assessment. Republic of Sudan: Federal Ministry of Health; 2005.

Notes: This is a general needs assessment conducted for the Federal Ministry of Health, Republic of Sudan, to evaluate the capability of EmOC health facilities. This report assesses the availability of trained care providers, adequate equipment and supplies and classifies the hospitals as comprehensive, basic, or suboptimal EmOC providers. The report provides recommendations to ensure improved quality of care and availability of resources such as: the creation of a well equipped and properly staffed information unit, secure links and communication throughout the system, ambulance availability, expansion of obstetric training for female doctors, and special courses on EmOC for medical officers and students.

Eltigani Elfadil Mahmoud L. Turning a Corner on the Road to Maternal Health: A New Vision for Midwifery in Sudan. Federal Ministry of Health Republic of Sudan, editor.

Notes: This document is a powerpoint presentation by the National Reproductive Health Director, Federal Ministry of Health, Sudan. It presents an overview of the situation in Sudan relating to maternal and neonatal health, and discusses challenges which need to be addressed such as: village midwives versus SBAs, poor conditions of schools, donor dependence of schools, and no standardization of curricula. The author presents a framework for scaling up midwifery which includes issues relating to supervision, training and education, funding, monitoring and evaluation, and access and equity.

Evans G, Lema ME. Road Map for Community Midwifery in Southern Sudan.  2010 Jun.

Notes: This report is produced jointly by the Ministry of Health - Government of Southern Sudan (MOH-GOSS) and the Liverpool Associates in Tropical Health. This report follows the Community Midwifery programme recommendation to propose a road map with short and longer term actions to improve access of mothers to skilled attendance during labour and delivery. This road map presents recommendations that focus on improving the quality of community midwives by regulating training and practice, providing internships and linking recent graduates to available jobs, improving the availability of community midwives by addressing pay and classification issues, increasing demand for midwifery services by educating communities, and preparing highly educated and skilled nursing and midwifery human resources for the increasingly complex future of health care of Southern Sudan.

Evans G, Rehnström U. Assessment of the Community Midwifery Programme in Southern Sudan.  2010 Feb.

Notes: This report is produced jointly by the Ministry of Health-Government of Southern Sudan (MOH-GOSS) and Liverpool Associates in Tropical Health (LATH). This document is an assessment of the Community Midwifery training programme introduced by MOH-GOSS in 2006. The programme is intended to make skilled maternity care accessible, acceptable, affordable, sustainable and cost-effective. The assessment reviews the capacity of midwifery training institutions and the current knowledge, skills, confidence and practices of community midwives. The findings state that the curriculum was felt to be adequate, provided it was fully implemented and the students received ample practice in deliveries but that there is considerable variance in the quality of clinical tutoring, standards and quality of care are lacking and also a variance in the performance and clinical capacities of community midwife graduates.

Federal Ministry of Health Republic of Sudan, UNFPA. Reproductive Health Services Map in Sudan. 2005 Jul.

Notes: This is a joint UNFPA, Sudan Ministry of Health document mapping reproductive health services throughout the country. This document details the organizational structure at state and locality levels, maternal and neonatal health services at rural hospitals, and maternal and neonatal health services at villages. The document does not list conclusions or recommendations.

Federal Ministry of Health Republic of Sudan. The National Strategy for Reproductive Health 2006 - 2010.  2006 Aug.

Notes: This is a strategy document aimed to improve the state of reproductive health in Sudan. The overall objective of the strategy for RH in Sudan is to accelerate progress towards meeting the nationally set and internationally agreed RH targets (esp. MDGs) and ultimately to attain highest achievable standard of RH for all population. This document defines key important issues for effective implementation of the National RH Strategy: sustainable financing mechanism, human resources development, quality in service provision, utilization of the services, improving information system, mobilizing political will, creating supportive and legislative and regulatory mechanisms, and strengthening evaluation and accountability.

Federal Ministry of Health Republic of Sudan, Central Bureau of Statistics. The Sudan Household Health Survey (SHHS). 2007 Apr.

Notes: DRAFT. This is an unfinished draft of the survey which has been conducted as part of the effort to assess the situation of children and women and to monitor progress towards selected MDG indicators. Survey tools are based on the models and standards developed by the global MICS project, and PAPFAM designed to collect information on the situation of children and women in countries around the world. It collects data relating to health and MDG indicators. Results are presented in table format.

Federal Ministry of Health Republic of Sudan. National Reproductive Health Policy.  2010.

Notes: This document outlines Sudan's reproductive health policy. Reproductive and sexual health is a high priority for the government. This document is produced with the aim of improving the health status of the population and to reduce rates of maternal mortality and reaching the MDG 5 goal. This document draws from existing national policies and strategies and national and international commitments. The policy calls for comprehensive reproductive health services, integration of RH services with mainstream primary health care, health workforce development for reproductive health services, equitable financing of reproductive health services, RH technology, and governance and monitoring of reproductive health.

Federal Ministry of Health Republic of Sudan. National Strategy Document for Scaling-up Midwifery in the Republic of Sudan.  2010.

Notes: This is a strategy document calling for the need to scale-up midwifery practices. This document is presented in response to Sudan's high maternal mortality rate which is off track to meeting MDG 5. The ministry of health recognizes the importance of midwifery care the most appropriate and cost-effective health care professional who can provide care in normal pregnancy and childbirth, including risk assessment and recognition of complications. This document sets out various recommendations such as the importance of evidence based advocacy efforts, expanding midwifery coverage and prioritizing underserved communities, and liaising between donors, NGOs and Sudan's National Technical Midwifery Committee.

Federal Ministry of Health Republic of Sudan. Road Map for Reducing Maternal and Newborn Mortality in Sudan (2010 - 2015). Khartoum; 2010 Dec.

Notes: This roadmap is developed in order to move towards the MDG goals and to accelerate the reduction of maternal and newborn mortality. The objectives of this roadmap are to improve policy, utilization and quality of MNH services, ensure access to care, strengthen the capacity of health systems for the planning and management, monitoring and evaluation of MNH programmes, increase the availability and usage of youth friendly reproductive health and HIV prevention services, and to strengthen the capacities of individuals, families and communities for health promotion.

Ministry of Health Government of Southern Sudan, UNFPA. Southern Sudan Maternal, Neonatal and Reproductive Health Strategy - Action Plan 2008-2011 (second draft and revision).  2007 Oct 18.

Notes: DRAFT. This document is a draft and revision following recommendations made of key stakeholders and UNFPA organized workshop. It presents the Government of Southern Sudan's strategy to provide a comprehensive, integrated, equitable and sustainable maternal and reproductive health care (MRH) package. The goal of this strategy is to implement the recommendations of the MRH policy, including reducing maternal and neonatal mortality, increasing the availability and accessibility of resources, and ensuring adequately built, equipped and funded health facilities. The strategy outlines ten action plans in the arenas of: policy implementation, financing and advocacy of the strategy, human resource development, management of MNRH services, monitoring and evaluation of services, reproductive health commodities, access to facilities and health promotion, HIV/AIDS and STI programmes, and GBV and sexual and reproductive health rights programme and research.

Tajikistan

Beer KO. Tajikistan Reproductive Health Commodity Security (RHCS), Contraceptive Logistics Management Information System (CLMIS) Assessment, Social Marketing Assessment. Tajikistan: UNFPA; 2010 Feb. 

Notes: This UNFPA Tajikistan report presents an assessment of the CLMIS system and provides guidance on proper management of forms and application of forecasting mechanisms and software applications. The CLMIS assessment component focuses specifically on the UNFPA reproductive health program, and within that on distribution and logistics issues for contraceptives to public reproductive health (RH) facilities. For the Social Marketing component, the focus is on the four types of contraceptives currently supplied by UNFPA: IUDs, oral contraceptive pills, injectables and condoms.

de Haan O. Bridging the Gap; An Effective Approach to Strengthen the Health System from Two Entries Through Empowering Pregnant Women and Their Families and Health Providers Simultaneously.

Notes: This is a 3 page briefing on a project implemented in central Asia to make high-quality care available to rural women in Tajikistan and Kyrgyzstan. The approach of the project was to reduce maternal and newborn mortality by addressing families directly and educating them through Parents Schools and simultaneously train providers in client-centred services.Findings from the project state that the client education program as offered by the Parents School turns out to be highly effective: knowledge on physiology, danger signs and birth preparedness increased significantly among women and their families and reduced fear and anxiety for the delivery. Providers treat women with more respect, clients are supported to deliver under their own conditions (free positions as alternatives for the Rachmanovsky chair, partner participation) and they are enabled to make an informed choice on family planning after delivery.

de Haan O, Askerov A, Chirkina G, Popovitskaya T, Tohirov R, Sharifova D, et al. Preparedness for Birth in Rural Kyrgyzstan and Tajikistan. Follow-up KAP Study Among Women, Households and Health Professionals.  2010.

Notes: NSPOH, AP3, TFPA. This report, funded by the Dutch Ministry of Foreign Affairs is a part of a larger safe motherhood project aimed to promote sexual and reproductive health and rights in rural areas in Central Asia. This report describes the differences in knowledge, attitudes and practices of various target groups before and after the main project interventions in Kyrgyzstan and Tajikistan. The overall objective of the project was to reduce maternal and infant mortality through making high quality maternal care available to vulnerable rural women. The approach of the project was to reduce maternal and newborn mortality by addressing families directly and educating them through Parents Schools and simultaneously train providers in client-centred services. The case study presented in this report explores the key determinants of motivation and decision-making under both providers and users of health facilities. The study reports that provider-client communication is essential to improving the quality of perinatal health services and that the attitude of providers is the discriminating factor between formal acceptance of changes and the motivation to change practices at the work floor.

de Haan O. From Patient to Client. Patient Education and Counseling 2010 Dec;81(3):442-7.

Abstract: OBJECTIVE: To gain insight in the knowledge, attitude and practices of users and providers of reproductive health services in rural areas of Kyrgyzstan and Tajikistan before and after interventions. METHODS: KAP (Knowledge, Attitude, Practices) studies under 500 respondents. RESULTS: Training that addressed the determinants of behavioural change contributed to the motivation under health care providers to improve performances. The simultaneously implemented education program for users of health services enhanced the preparedness for birth of pregnant women and their family members. Both interventions had positive effects on health outcomes. CONCLUSIONS: Behavioural change, from hierarchic and directive into client-centred and supportive, can be realized in Central Asia by enhancing the decision-making capacities of providers. A client-centred attitude of health care providers is the key condition for sustainable improvement of service delivery. Improving client-provider communication is a cost-effective way to enhance the quality of care in low resource settings, such as in Central Asia. PRACTICE IMPLICATIONS: The providers can be best trained in a practical setting, when trainees are enabled to practice with real patients, under guidance of a highly skilled professional. Psychological components such as addressing emotions and exploring the values and beliefs of providers should be incorporated in separate training modules.

Resolution No. 348 On Approval of the Strategic Plan for Reproductive Health of the Republic of Tajikistan by 2014, Government of the Republic of Tajikistan, (2004).

Notes: This document outlines Tajikistan's policy for the improvement of reproductive health. The Government of the Republic of Tajikistan's concern about the persistent consequences of gender disparity, particularly their influence on women's health, and of socio-economic inequality in countries which limit women's opportunities for achievement of health, has provided the basis for the development of the current Strategic Plan on Reproductive Health of the Republic of Tajikistan, which is specific for the country. Through implementation of this plan, the government expects to raise awareness toward the right for independent and informed choice, decrease mortality rates (maternal, infant, perinatal, neonatal), decrease the absolute number of abortions, increase the use of modern contraceptive methods among married couples, increase use of antenatal care services, and increase the percentage of deliveries assisted by trained medical staff.

Rakhimova N. Information on Reproductive Health in Tajikistan.  2010 Jun 4.

Notes: This document presents an analysis of obstacles and challenges to reproductive health in Tajikistan. Tajikistan has high levels of poverty and shows an increased gap between social and economic groups of the population. This document identifies the relationship between poverty, poor health and high rates of maternal mortality. This report suggests that family decision-making plays an important role in addressing issues such as maternal mortality, where the head of household is often responsible for the decision to seek health services. Health reform models include re-structuring the system of health services delivery and quality development of primary health care based on concept of family practice; change of health financing and system of health providers' payment; public participation in decision of health questions; information management base. This document also identifies links with other sectors such as education, infrastructure, transportation, drinking water, and nutrition.

Šiupšinskas G. Training on Effective Perinatal Care for University Teachers (22-26 March 2010). Dushanbe, Tajikistan: UNFPA; 2010.

Notes: This report summarizes the events of a WHO training package on effective perinatal care for university teachers. The author of this document was invited by UNFPA Tajikistan to direct and facilitate this training. The aim of the visit was to coordinate and supervise training for university teachers in obstetrics and neonatology in WHO Euro evidence-based package "Effective Perinatal Care", up to date clinical family-centered and efficient interventions aimed at reduction of maternal and perinatal morbidity and mortality and improvement of quality of perinatal care. Existing barriers and difficulties of implementation of evidence-based perinatal care were identified. The possible solutions were discussed. Based on the results of the course trainees drafted their own plans of action for implementation of proposed strategies. Presented plans revealed insufficient awareness of participants about real clinical problems existing in their institutions, which is consequence of separation of teaching and clinical staff and their responsibilities in the maternities.

Walker G. A Review of the Population and Reproductive Health Situation in the Republic of Tajikistan. Tajikistan: UNFPA; 2008 May.

Notes: This document undertaken for UNFPA is a review of the state of reproductive health in Tajikistan. UNFPA programme guidelines identify the need to periodically undertake a review and analysis of the causes of a country's critical population, and reproductive health issues in order that they can be taken into account when the UNDAF is prepared. This review addresses safe motherhood, family planning and contraceptive security, STIs and HIV/AIDS, adolescent sexual and reproductive health, issues and underlying causes related to reproductive health, gender and disaster occurrence, preparedness and response.

Walker G. Evaluation of the Reproductive Health Component of the Second UNFPA Tajikistan Country Programme 2005-2009. Tajikistan: UNFPA; 2009 Jun.

Notes: This UNFPA document is part of a mandatory periodical review of a country programme. This UNFPA Tajikistan Country Programme (2005-2009) is the Second UNFPA Country Programme for Tajikistan supported by UNFPA.  The goal of the Second UNFPA Country Programme is to "contribute to poverty reduction by focusing on reproductive health/family planning, population and development, and women's empowerment."  Achievements of the RH component of this country programme are most notably those with regard to efforts to improve the quality of maternity care, a functioning contraceptive management logistics information system, and increasing awareness among young people of RH issues including HIV/AIDS. Other activities contributing to improving quality of reproductive care include trainings in integrated comprehensive RH using evidence-based approaches and provision of essential equipment and screening tests necessary for effective care.

Timor-Leste

Grupo das Mulheres Parlamentares de Timor Leste (GMPTL). Report on the National Conference on Reproductive Health, Family Planning and Sex Education.  2010. 

Notes: This document presents the proceedings of East Timor's National Conference on reproductive health. The report presents East Timor's declaration for affirmative action to reduce maternal and child death, birth rate and teenage pregnancy and affirms the right of every Timorese to access sexual, maternal and reproductive health information and services that are affordable, good quality, culturally sensitive and gender responsive. Problems identified during consultations prior to the conference were lack of services, health professionals, transport and infrastructure, as well as lack of education and information on reproductive health.

Timor-Leste. Links to Related Documents.

Notes: This document provides a list of links to documents relating to health in East Timor. Links include: DHS 2009-10, Health Sector Strategic Plan 2008-12, Basic Services for Primary Health Care and Hospitals, Timor-Leste Health Seeking Behaviour, and the National Reproductive Health Strategy 2004-15.

Timor-Leste. Ministry of Health Projects Related to Maternal and Newborn Health.

Notes: This is an excel spreadsheet listing projects relating to maternal and newborn health in East Timor. The table lists the name of the project, donor, implementing agency, expected outcomes and funding and financial data.

Togo

Baeta SM, Kpegba PK, Anthony AK. Évaluation des Soins Obstétricaux et Néonatals d'Urgence au Togo.  2007 Aug.

Notes: This is a joint Ministry of Health and UNFPA report evaluating emergency obstetric and neonatal health care in Togo. This evaluation was conducted by the Togolese Association for Public Health (AUTOSAP) by means of a national survey to determine the availability, quality and utilization of EmONC services in Togo. This study evaluated capacities of health facilities offering EmONC services and the availability of qualified personnel, equipment, supplies and medicines in this context. Findings indicate poor levels of EmONC services and low utilization.

Togo. Togo Country Factsheets.  11.

Notes: These slides present a summary of Togo relating to midwifery and human resources for health. The first slide lists statistics: demographics, education, MDG 5 indicators, midwifery workforce, education, regulation and policies. The following slides detail a general overview of the country in the context of MDG 5 and women and newborn health. The document details the shortage of midwives in the country and states that there are significant variations in the distribution of midwives between urban and rural areas. This document highlights the need to review existing midwifery education modules, develop a monitoring and evaluation system, and organize continuing education schemes to reinforce midwife capacities and competencies. Source not provided.

Togo. Évolution de la Contraception de 1988 à 2006.  2011.

Notes: This document presents a table and a graph detailing the evolution and prevalence of contraceptive use in Togo from 1988 to 2006. The document shows modern contraceptive use has gone up since 1988 and traditional contraceptive methods have gone down. Source not provided.

Togo. Togo Répartition des Ressources Humaines dans le Secteur de la Santé.

Notes: This document presents a brief table of the distribution of human resources for health in Togo: doctors, nurses, and paramedical. Data from the table comes from Données du Ministère de la Santé (DAC/DARH). Source of this document not provided.

Togo. Togo Répartition du Personnel de la Santé de Tous les Secteurs Selon les Catégories Professionnelles et les Région d'Occupation.

Notes: This document presents a more detailed table of the distribution of health personnel in Togo. It lists personnel according to their professional category and region of occupation (general medicine, cardiology etc). Source not provided.

Togo. Togo Répartition de la Population et la Superficie par Région et par Préfecture en 2008. 

Notes: This document contains tables and graphs detailing the evolution of the population and distribution of Togo. Data is taken from the Direction Générale de la Statistique et de la Comptabilité Nationale. Source of document not provided.

Togo. Répartition du Personnel de la Santé de tous les Secteurs selon les Catégories Professionnelles et les Région d'Occupation. 2009. Ref ID: 354

Notes: This document is an excel spreadsheet listing the distribution of medical personnel in Togo according to professional category and region of employment.

Uganda

African Health Workforce Observatory, World Health Organization. Human Resources for Health Country Profile: Uganda.  2009 Oct.

Notes: This is a document produced by the African Health Workforce Observatory with support from the Global Health Workforce Alliance and WHO and presents a country profile outlining the state of the health workforce in Uganda. This document provides a general profile of the country and gives an overview of the country's health system, the state of the health personnel, HRH production and utilization, and governance mechanisms.

Haji M, Durairaj V, Zurn P, Stormont L, Mapunda M. Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce Through Decentralized Health Financing Systems. Bulletin of the World Health Organization 2010 May;88(5):397-9.

This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector, better use of existing financial resources, and creation of financial incentives for health workers. The paper also considers the conditions under which decentralized health financing systems can lead to improved health workforce retention using examples from several countries including Brazil, China, Costa Rica, Guyana, India, Kenya, Pakistan, the Philippines, Romania, Rwanda, Thailand, Uganda, Tanzania, and Zambia. The document concludes that it is evident that providing the ministry of health with autonomy, by delinking the health workforce from the civil workforce and providing strategic performance incentives, are means by which health workers can be successfully recruited and retained. The authors also note that such policies only work if health system objectives are aligned with appropriate institutional and incentive structures.

Maclean GD, Forss K. An Evaluation of the Africa Midwives Research Network. Midwifery 2010 Dec;26(6):e1-e8.

Abstract: OBJECTIVE: to evaluate the strengths and limitations of the Africa Midwives Research Network (AMRN) and provide feedback and direction to the network and the funding body. DESIGN: a qualitative study incorporating visits to three African countries and Sweden, using interviews, non-participant observation, an internet survey and review of records. SETTING: principally Tanzania, Uganda, Zambia and Sweden. FINDINGS: AMRN can be described as a small, dispersed, loosely coupled professional network which has made considerable impact on midwifery practice in the areas of its members. The biennial scientific conferences could be perceived as AMRN's flagship activity and have been notably successful, becoming renowned internationally. Around 1500 midwives have benefited from educational programmes at regional or national level. These include research methodology, evidence-based practice, scientific writing and communication skills. Attention needs to be given to some aspects of governance and organization, as well as to communication strategies including websites and newsletters. Technical support from the Karolinska Institute in Stockholm has provided good collegiate support and proved to be cost effective. KEY CONCLUSIONS: AMRN has shown resilience and continuity since its inception and has made a palpable difference to the quality of midwifery care and the professional development of midwives within the remit of its members. AMRN needs to be consolidated before expanding further. The work of AMRN is particularly pertinent in the context of the millennium development goals.

Ministry of Health Republic of Uganda, World Health Organization. Service Availability Mapping (SAM). Geneva: World Health Organization; 2006.

Notes: This is a joint MOH Uganda and Who document outlining the SAM project in Uganda conducted in 2004. The goal was to collect information on the availability and distribution of key health services by interviewing the district director of health services and his/her team in all 56 districts. SAM provided baseline monitoring information for the scale-up of key HIV/AIDS-related services such as antiretroviral therapy (ART), prevention of mother-to-child transmission (PMTCT) of HIV, and counseling and HIV testing. The project mapped health service availability, health infrastructure, human resources, and social marketing programmes.

Nabudere H, Asiimwe D, Mijumbi R. Task Shifting to Optimise the Roles of Health Workers to Improve the Delivery of Maternal and Child Healthcare.  2010 Jun 22.

Notes: This is a policy brief prepared by the Uganda country node of the Regional East African Community Health (REACH) Policy Initiative. This report is based largely on systematic reviews and details the state of health workforce shortages in Uganda, identifying task shifting as a potential conflict with current health professional regulations and licensure. This report is intended as a summary of the problem and potential options for solving this. It does not offer recommendations.

Spero JC, McQuide PA, Matte R. Tracking and Monitoring the Health Workforce: A New Human Resources Information System (HRIS) in Uganda. Human Resources for Health 2011 Feb 17;9(1):6.

Abstract: BACKGROUND: Health workforce planning is important in ensuring that the recruitment, training and deployment of health workers are conducted in the most efficient way possible. However, in many developing countries, human resources for health data are limited, inconsistent, out-dated, or unavailable. Consequently, policy-makers are unable to use reliable data to make informed decisions about the health workforce. Computerized human resources information systems (HRIS) enable countries to collect, maintain, and analyze health workforce data. METHODS: The purpose of this article is twofold. First, we describe Uganda's transition from a paper filing system to an electronic HRIS capable of providing information about country-specific health workforce questions. We examine the ongoing five-step HRIS strengthening process used to implement an HRIS that tracks health worker data at the Uganda Nurses and Midwives Council (UNMC). Secondly, we describe how HRIS data can be used to address workforce planning questions via an initial analysis of the UNMC training, licensure and registration records from 1970 through May 2009. RESULTS: The data indicate that, for the 25 482 nurses and midwives who entered training before 2006, 72% graduated, 66% obtained a council registration, and 28% obtained a license to practice. Of the 17 405 nurses and midwives who obtained a council registration as of May 2009, 96% are of Ugandan nationality and just 3% received their training outside of the country. Thirteen per cent obtained a registration for more than one type of training. Most (34%) trainings with a council registration are for the enrolled nurse training, followed by enrolled midwife (25%), registered (more advanced) nurse (21%), registered midwife (11%), and more specialized trainings (9%). CONCLUSION: The UNMC database is valuable in monitoring and reviewing information about nurses and midwives. However, information obtained from this system is also important in improving strategic planning for the greater health care system in Uganda. We hope that the use of a real-world example of HRIS strengthening provides guidance for the implementation of similar projects in other countries or contexts.

Uganda. Uganda Facility Inventory.  2010.

Notes: This document is a spreadsheet detailing facility inventory in various districts of Uganda. Source not provided.

UNFPA. The State of Midwifery Training, Service and Practice in Uganda: Assessment Report.  2009 Jul 9. 

Notes: This needs assessment study is one of the key interventions of a project initiated by Uganda to scale-up midwifery capacities and building the profile of midwifery in the country. This project stems from a joint initiative launched by UNFPA and ICM aimed to build national capacity in low-resource countries to increase skilled attendance at all births . The study identifies gaps and needs in midwifery training, practice and regulation as bases for developing interventions to integrate the full continuum of maternal health care in the national health system. The study shows that there is a shortage of skilled midwives and poor employment opportunities and recommends that the government should set up a framework for employment to strengthen midwifery services nationwide.

UNFPA. Midwifery Programme, Annual Report 2009 (Uganda). Uganda: UNFPA; 2009.

Notes: This document is a UNFPA annual report for Uganda. This document presents a report on a year-long project to increase access to and utilization of quality maternal health services in order to reduce maternal mortality. The report finds that there is growing realization at the Ministry of Health and by professional bodies that the comprehensive nurse training has not been able to contribute much to the reduction of maternal mortality and therefore, there is an urgent need for reintroduction of vertical midwifery training in Public training schools. The curriculum for the Comprehensive Nurse programme also needs to be reviewed to make it suitable for training not only nurses, but midwives as well. Recommendations cited are to mobilize additional resources and prioritize implementation of the Midwifery Improvement Plan.

USAID. Achieving the MDGs. The Contribution of Family Planning: Uganda.  2009 Jul.

Notes: This document is a 2 page country brief for Uganda as part of the USAID Health Policy Initiative project, task order 1. This portion of the policy project is implemented by Futures Group International in collaboration with the Center for Development and Population Activities, the White Ribbon Alliance, and Futures Institute. The briefing provides information on the contribution of family planning toward achieving the MDGs in Uganda. The brief highlights that although family planning is not one of the MDGs, increased family planning use could contribute to meeting the targets, and that cost savings in meeting the selected MDGs by satisfying unmet need outweigh additional costs of family planning by a factor of 2 to 1.

United Republic of Tanzania

Canadian International Development Agency, Ministry of Health and Social Welfare United Republic of Tanzania. Proposal for a Tanzania Health Workforce Initiative (Draft 3).  2009 Jan 8. 

Notes: This draft document is a joint CIDA and MOH Tanzania proposal for a health workforce initiative. The initiative proposed in this document is based on a series of detailed discussions that have taken place across a wide variety of human resources for health (HRH) stakeholders, including government, donor partners and non-state actors. Following from these discussions, the Health Workforce Initiative has been designed to twin the Government of Tanzania's key priorities of HRH and public-private partnerships (PPP). It will, on the one hand, support eligible private sector training institutions (including Tutor Training Institutions), to enable them to scale up the production of mid-level health workers and trainers, and on the other hand, support eligible research institutions in undertaking priority HRH operations research and studies, with a view to informing evidence-based planning and decision making in HRH. The implementation mechanism adopted for this initiative is largely a responsive one. The sub-projects to be supported under this initiative will be based on proposals submitted by partner institutions in line with tender calls.

Commission on Information and Accountability for Women's and Children's Health: Working Group on Accountability for Resources. Co-Chairs Summary Statement: H.E. Mr Jakaya Mirisho Kikwete, President, United Republic of Tanzania & Prime Minister Stephen Harper, Canada.  2011.

Notes: See 238 and 239 for additional reports on this meeting. This document presents a summary statement by the co-chairs on the Commission on Information and Accountability for Women's and Children's Health. The Commission on Information and Accountability for Women's and Children's Health, called at the request of the UN Secretary-General, met in Geneva on January 26, 2011, to take the next step in this unparalleled opportunity to make a difference in the lives of women and children. Co-chaired by President Jakaya Kikwete of United Republic of Tanzania and Prime Minister Stephen Harper of Canada, the Commission agreed to establish a framework to monitor global commitments for maternal, newborn and child health and ensure committed resources save as many lives as possible. The meeting discussed issues relating to improving accountability for results and resources.

Family Care International. Saving Women's Lives: The Skilled Care Initiative.  2000. 

Notes: This document is a two page brief providing an overview of Family Care International's Skilled Care Initiative. The initiative, launched in 2000, is a multi-faceted, five-year project to increase the number of women who receive skilled care before, during, and after childbirth. The project is being implemented in four rural, underserved districts in Burkina Faso, Kenya, and Tanzania. It also includes advocacy and information-sharing in the Latin America and Caribbean (LAC) region, and with global partners. The initiative focuses specifically on "skilled care" as a strategy for reducing maternal mortality and morbidity. The initiative emphasizes the critical importance of the environment where the provider works, such as the need for supportive policies, equipment, efficient communication systems and infrastructure. The project works in collaboration with government agencies and aims to offer project activities that are sustainable and replicable.

Haji M, Durairaj V, Zurn P, Stormont L, Mapunda M. Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce Through Decentralized Health Financing Systems. Bulletin of the World Health Organization 2010 May;88(5):397-9.

This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector, better use of existing financial resources, and creation of financial incentives for health workers. The paper also considers the conditions under which decentralized health financing systems can lead to improved health workforce retention using examples from several countries including Brazil, China, Costa Rica, Guyana, India, Kenya, Pakistan, the Philippines, Romania, Rwanda, Thailand, Uganda, Tanzania, and Zambia. The document concludes that it is evident that providing the ministry of health with autonomy, by delinking the health workforce from the civil workforce and providing strategic performance incentives, are means by which health workers can be successfully recruited and retained. The authors also note that such policies only work if health system objectives are aligned with appropriate institutional and incentive structures.

Kruk ME, Paczkowski M, Mbaruku G, de Pinho H, and Galea S. Women's Preferences for Place of Delivery in Rural Tanzania: A Population-Based Discrete Choice Experiment. American Journal of Public Health, September 2009, Vol 99, No. 9: 1666-1672.

Maclean GD, Forss K. An Evaluation of the Africa Midwives Research Network. Midwifery 2010 Dec;26(6):e1-e8.

Abstract: OBJECTIVE: to evaluate the strengths and limitations of the Africa Midwives Research Network (AMRN) and provide feedback and direction to the network and the funding body. DESIGN: a qualitative study incorporating visits to three African countries and Sweden, using interviews, non-participant observation, an internet survey and review of records. SETTING: principally Tanzania, Uganda, Zambia and Sweden. FINDINGS: AMRN can be described as a small, dispersed, loosely coupled professional network which has made considerable impact on midwifery practice in the areas of its members. The biennial scientific conferences could be perceived as AMRN's flagship activity and have been notably successful, becoming renowned internationally. Around 1500 midwives have benefited from educational programmes at regional or national level. These include research methodology, evidence-based practice, scientific writing and communication skills. Attention needs to be given to some aspects of governance and organization, as well as to communication strategies including websites and newsletters. Technical support from the Karolinska Institute in Stockholm has provided good collegiate support and proved to be cost effective. KEY CONCLUSIONS: AMRN has shown resilience and continuity since its inception and has made a palpable difference to the quality of midwifery care and the professional development of midwives within the remit of its members. AMRN needs to be consolidated before expanding further. The work of AMRN is particularly pertinent in the context of the millennium development goals.

Mbaruku G, Bergstrom S. Reducing Maternal Mortality in Kigoma, Tanzania. Health Policy and Planning 1995 Mar;10(1):71-8.

Abstract: An intervention programme aiming at a reduction of maternal deaths in the Regional Hospital, Kigoma, Tanzania, is analyzed. A retrospective study was carried out from 1984-86 to constitute a background for an intervention programme in 1987-91. The retrospective study revealed gross under-registration of data and clarified a number of potentially useful issues regarding avoidable maternal mortality. An intervention programme comprising 22 items was launched and the maternal mortality ratio was carefully followed in 1987-91. The intervention programme paid attention to professional responsibilities with regular audit-oriented meeting, utilization of local material resources, schedules for regular maintenance of equipment, maintenance of working skills by regular on-the-job training of staff, norms for patient management, provision of blood, norms for referral of severely ill patients, use of antibiotics, regular staff evaluation, public complaints about patient management, travel distance of all essential staff to the hospital, supply of essential drugs, the need of a small infusion production unit, the creation of culture facilities for improved quality of microbiology findings, and to efforts to stimulate local fund-raising. The results indicate that the maternal mortality ratio fell from 933 to 186 per 100,000 live births over the period 1984-91. Thus it is underscored that the problem of maternal mortality can be successfully approached by a low-cost intervention programme aiming at identifying issues of avoidability and focusing upon locally available problem solutions.

Ministry of Health and Social Welfare Tanzania. The Approved Organisation Structure of the MInistry of Health and Social Welfare.  13-1-2009.

Notes: This document is an organogram of the approved organizational structure of Tanzania's Ministry of Social Health and Welfare.

Ministry of Health and Social Welfare Tanzania Mainland, Ministry of Health and Social Welfare Zanzibar, World Health Organization. Tanzania Service Availability Mapping 2005-2006. Geneva: World Health Organization; 2007. 

Notes: This is a joint MOH Tanzania and WHO document mapping the services available in the country. This document presents the results of the 2005-2006 mapping survey (SAM). SAM is a rapid assessment tool that generates information on the availability of specific health services, health infrastructure and human resources for each district. The objectives of this survey are to provide planners and decision makers with information on the distribution of services, provide baseline monitoring information, and to assess whether the facility SAM can become a useful and feasible planning and monitoring tool at the district level. Services investigated include: laboratory services, blood transfusion services, medical equipment, injection and sterilization practices, HIV/AIDS, malaria, and safe motherhood.

Ministry of Health and Social Welfare United Republic of Tanzania. Primary Health Services Development Programme (PHSDP) 2007-2017.  2007 May. 

Notes: This document presents a situation analysis of the health sector in Tanzania. The health sector is understaffed and operating at less than the international standards. Despite the good network of primary health facilities, accessibility to health care is still inadequate due to many reasons. In some areas the accessibility to health facilities is more than 10 kilometers and where accessibility is less than 5 kilometers to health facilities the availability of health care is inequitable, with human resource operating at 32% of the required skilled workforce, insufficient medical equipment, and shortage of medicines, supplies and laboratory reagents. The PHSDP has been put in place to accelerate the provision of primary health care services. The main areas of focus are on strengthening health systems, rehabilitation, human resource development, the referral system, increase health sector financing and improve the provision of medicines, equipment and supplies.

Ministry of Health and Social Welfare United Republic of Tanzania. Human Resource for Health Strategic Plan 2008-2013.  2008 Jan.

Notes: This document presents MOH Tanzania's HRH strategic plan. This Human Resources for Health Strategic Plan has been developed with a view to creating an enabling environment to promote participation of key Human Resource for Health and Social Welfare stakeholders in addressing human resource crisis in the health sector. Specific focus is on planning and policy development capacity; leadership and stewardship; education, training and development; workforce management and utilization; partnership; research and development; and financing. Effective implementation of this plan, will lead to increased human resource capacity necessary for the achievement of quality health and social welfare services at all levels.

Ministry of Health and Social Welfare United Republic of Tanzania. The National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn and Child Deaths in Tanzania 2008-2015.  2008 Apr.

Notes: This MOH Tanzania document presents a roadmap to reduce mortality relating to MDGs 4 and 5. The National Road Map Strategic Plan stipulates various strategies to guide all stakeholders for Maternal, Newborn and Child Health (MNCH), including the Government, development partners, non-governmental organizations, civil society organizations, private health sector, faith-based organizations and communities, in working together towards attainment of the Millennium Development Goals (MDGs) as well as other regional and national commitments and targets related to maternal, newborn and child health interventions. This document is intended as a guide to ensure improved coordination of interventions and delivery of services across the continuum of care as well as across operational levels of the system so that national level policy will reach community and regional levels.

Ministry of Health and Social Welfare United Republic of Tanzania. Health Sector Strategic Plan III July 2009-June 2015, "Partnership for Delivering the MDGs". 2009. 

Notes: This document presented by MOH Tanzania is the third health sector strategic plan addressing the MDGs. This HSSP III is intended as a guiding reference document, for the preparation of the five-year Regional Strategic Plans, as well as, hospital and Council Health Strategic Plans. It will also guide the formulation of specific plans and programmes, including annual plans, at all levels. This document addresses issues of equity, gender, quality and governance and explains governance arrangements of the health sector such as the monitoring and evaluation of this strategic plan. Strategies covered include district health services, referral hospital services, central level support, HRH, health care financing, PPP, MNCH, prevention and control of diseases, and monitoring and evaluation.

Tanzania. Report on the Dissemination Workshop for Studies on Health Worker Retention in Tanzania.  2008. 

Notes: The workshop held on 19th June, 2008, was organized by the National Institute for Medical Research (NIMR) in collaboration with Capacity Project and Ministry of Health and Social Welfare (MOHSW). It was attended by participants from NIMR, MOHSW including the Director for human resources development, Dr Gilbert Mliga, Presidents Office Public Services Management, District Executive Directors of selected councils and donors (USAID, Irish Aid and WHO). The aim of the workshop was to disseminate results from human resources for health (HRH) studies done by NIMR, in collaboration with the Capacity Project and MOHSW, and seek participants' inputs to guide the MOHSW to formulate appropriate strategies to improve the retention of health workers.

Tanzania Nurses and Midwives Council. Number of Male and Female Nurses in Specified Region.  2010 May 10.

Notes: This is a table that lists the numbers of nurses per region in Tanzania. It provides numbers on male and female nurses and whether they are enrolled or registered.

USAID. Tanzania: Population, Reproductive Health and Development.  2006 Dec. 

Notes: This document is a USAID funded report produced in collaboration with the Population Planning Section of the Tanzania Ministry of Planning, Economy and Empowerment. The report is designed as a guide to contribute to the design and implementation of strategies relating to population issues and their role in the social and economic development of the nation. It presents an overview of current population trends in Tanzania and how such trends might affect the long term development of the country. Given the rapid growth rate in the country, policy initiatives that take into account family planning and contraceptive security are noted as relevant factors for development initiatives and are discussed in this report.

Viet Nam

Larrinaga M. Addressing Maternal Health in H'Mong Communities in Viet Nam. UNFPA News: Feature Story . 18-8-2009. 5-2-2011.

Notes: This is a UNFPA feature news story on maternal health in Vietnam. The story presents an overview of birth and midwifery practice and awareness campaigns to reduce rates of maternal mortality. Efforts to ensure skilled birth attendance have contributed to reduction in MMR and the country is on track to meeting MDG 5.

Larrinaga M. Recruiting Ethnic Minority Midwives to Meet Mother' Needs in Remote Areas of Viet Nam. UNFPA News: Feature Story . 28-2-2010. 5-2-2011.

Notes: This is a UNFPA feature news story about ethnic minority midwives in Vietnam. Ethnic minorities in remote areas in Vietnam face particular challenges in regards to maternal health care and tend to face high levels of maternal mortality. The story highlights the importance of cultural sensitivity and recruiting locally to address these issues. In light of this, the UNFPA has implemented an 18 month training programme for the recruitment and training of local women to become midwives. This story discusses this programme.

Viet Nam. Reaching Out to Minorities in Viet Nam with Midwives who Speak their Language. UNFPA News: Feature Story . 17-9-2010. 5-2-2011.

Notes: This is a UNFPA feature story midwives working with ethnic minorities in Vietnam. The story highlights the importance of culturally sensitive practice and the use of local languages. This story reports on the experiences of trainees involved in the UNFPA 18 month MIdwife Training Programme for ethnic minority women.

World Health Organization, Deptartment of Reproductive Health and Research. Preventing Unsafe Abortion - Mid-Level Health-Care Providers are a Safe Alternative to Doctors for First-Trimester Abortions in Developing Countries. 2 p. Geneva: World Health Organization; 2008 Feb.

Notes: This is a document produced by WHO and HRP -Special Programme of Research, Development and Research Training in Human Reproduction (UNDP, UNFPA, WHO, World Bank. This study is a comparative assessment of the safety of first-trimester abortion by type of provider in developing countries. The study was conducted to compare the safety of first-trimester abortion with manual vacuum aspiration performed by nurses, midwives, mid-level healthcare providers and doctors in South Africa and Viet Nam. This study finds that abortions performed by government trained and accredited nurses, midwives and midlevel healthcare providers in these countries were comparable in terms of safety and acceptability to those performed by doctors. The report concludes that countries seeking to expand safe abortion services can consider an approach similar to that taken by the results of this study.

Yemen

Al Salaam A. Yemen List of Essential Medicines.  15-10-2009.

Notes: This is a joint WHO and Yemeni Ministry of Public Health document providing a table of essential medicines in Yemen.

Ghérissi A. Yemen - Health and Population Project (HPP) Acceleration of MDGs 5 and 4 - Preparation Phase Development of a National Midwifery Strategy in Yemen. MoPHP Funded by the World Bank Midwifery Training Program (2010-2015): Draft Mission Report for 20 Days International Consultancy (July-August 2010).  2010 Aug.

Notes: This document is a draft mission report for an international consultancy held in 2010. This document presents a progress report on the Health and Population Project in Yemen. The project, funded by World Bank is to develop a consensual comprehensive National Midwifery Strategy in Yemen for 2010-2015 that should be articulated and integrated in the National Reproductive Health Strategy in the process of being developed for the same period. The report cites the need for the midwifery education programme in Yemen to be reviewed and updated according to a paradigmatic approach that integrates educational, sociocultural and disciplinary paradigms. This report provides an overview of this approach placed in the context of current midwifery training strategies.

Yemen. Yemen: Private Midwives Serve the Hard-to-Reach: A Promising Practice Model. Establishing Private Midwifery Project.

Notes: This document presents an overview of the Private Midwifery Project in Yemen. Women's access to essential health services in Yemen is limited and many rural areas lack health facilities or where health facilities exist, quality of service is often poor. This document addresses the need for well-qualified midwives to improve neonate and child health services coverage in underserved areas. Objectives of the project are to increase women's access to services, increase the percentage of SBA's, and to create work opportunities for trained but unemployed midwives. Activities of the project include community mapping, refresher training courses in safe motherhood and best practices, and business management training skills. Source not provided.

Yemen. List of Medicines.  2010.

Notes: This document is an excel spreadsheet listing medicines according to region in Yemen.

Zambia

Gabrysch S, Cousens S, Cox J, Campbell OM. The Influence of Distance and Level of Care on Delivery Place in Rural Zambia: A Study of Linked National Data in a Geographic Information System. PLoS Medicine 2011;8(1):e1000394.

Abstract: BACKGROUND: Maternal and perinatal mortality could be reduced if all women delivered in settings where skilled attendants could provide emergency obstetric care (EmOC) if complications arise. Research on determinants of skilled attendance at delivery has focussed on household and individual factors, neglecting the influence of the health service environment, in part due to a lack of suitable data. The aim of this study was to quantify the effects of distance to care and level of care on women's use of health facilities for delivery in rural Zambia, and to compare their population impact to that of other important determinants. METHODS AND FINDINGS: Using a geographic information system (GIS), we linked national household data from the Zambian Demographic and Health Survey 2007 with national facility data from the Zambian Health Facility Census 2005 and calculated straight-line distances. Health facilities were classified by whether they provided comprehensive EmOC (CEmOC), basic EmOC (BEmOC), or limited or substandard services. Multivariable multilevel logistic regression analyses were performed to investigate the influence of distance to care and level of care on place of delivery (facility or home) for 3,682 rural births, controlling for a wide range of confounders. Only a third of rural Zambian births occurred at a health facility, and half of all births were to mothers living more than 25 km from a facility of BEmOC standard or better. As distance to the closest health facility doubled, the odds of facility delivery decreased by 29% (95% CI, 14%-40%). Independently, each step increase in level of care led to 26% higher odds of facility delivery (95% CI, 7%-48%). The population impact of poor geographic access to EmOC was at least of similar magnitude as that of low maternal education, household poverty, or lack of female autonomy. CONCLUSIONS: Lack of geographic access to emergency obstetric care is a key factor explaining why most rural deliveries in Zambia still occur at home without skilled care. Addressing geographic and quality barriers is crucial to increase service use and to lower maternal and perinatal mortality. Linking datasets using GIS has great potential for future research and can help overcome the neglect of health system factors in research and policy. Please see later in the article for the Editors' Summary.

Gabrysch S, Zanger P, Seneviratne HR, Mbewe R, Campbell OM. Tracking Progress Towards Safe Motherhood: Meeting the Benchmark yet Missing the goal? An Appeal for Better Use of Health-System Output Indicators with Evidence from Zambia and Sri Lanka. Tropical Medicine and International Health 2011 Feb 14.

Abstract: Objectives: Indicators of health-system outputs, such as Emergency Obstetric Care (EmOC) density, have been proposed for monitoring progress towards reducing maternal mortality, but are currently underused. We seek to promote them by demonstrating their use at subnational level, evaluating whether they differentiate between a high-maternal-mortality country (Zambia) and a low-maternal-mortality country (Sri Lanka) and assessing whether benchmarks are set at the right level. Methods: We compared national and subnational density of health facilities, EmOC facilities and health professionals against current benchmarks for Zambia and Sri Lanka. For Zambia, we also examined geographical accessibility by linking health facility data to population data. Results: Both countries performed similarly in terms of EmOC facility density, implying this indicator, as currently used, fails to discriminate between high- and low-maternal-mortality settings. In Zambia, the WHO benchmarks for doctors/midwives were met overall, but distribution between provinces was highly unequal. Sri Lanka overshot the suggested benchmarks by three times for midwives and over 30 times for doctors. Geographical access in Zambia - which is much less densely populated than Sri Lanka - was poor, less than half the population lived within 15 km of an EmOC facility. Conclusions: Current health-system output indicators and benchmarks on EmOC need revision to enhance discriminatory power and should be adapted for different population densities. Subnational disaggregation and assessing geographical access can identify gaps in EmOC provision and should be routinely considered. Increased use of an improved set of output indicators is crucial for guiding international efforts towards reducing maternal mortality.

Haji M, Durairaj V, Zurn P, Stormont L, Mapunda M. Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce Through Decentralized Health Financing Systems. Bulletin of the World Health Organization 2010 May;88(5):397-9.

This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector, better use of existing financial resources, and creation of financial incentives for health workers. The paper also considers the conditions under which decentralized health financing systems can lead to improved health workforce retention using examples from several countries including Brazil, China, Costa Rica, Guyana, India, Kenya, Pakistan, the Philippines, Romania, Rwanda, Thailand, Uganda, Tanzania, and Zambia. The document concludes that it is evident that providing the ministry of health with autonomy, by delinking the health workforce from the civil workforce and providing strategic performance incentives, are means by which health workers can be successfully recruited and retained. The authors also note that such policies only work if health system objectives are aligned with appropriate institutional and incentive structures.

Maclean GD, Forss K. An Evaluation of the Africa Midwives Research Network. Midwifery 2010 Dec;26(6):e1-e8.

Abstract: OBJECTIVE: to evaluate the strengths and limitations of the Africa Midwives Research Network (AMRN) and provide feedback and direction to the network and the funding body. DESIGN: a qualitative study incorporating visits to three African countries and Sweden, using interviews, non-participant observation, an internet survey and review of records. SETTING: principally Tanzania, Uganda, Zambia and Sweden. FINDINGS: AMRN can be described as a small, dispersed, loosely coupled professional network which has made considerable impact on midwifery practice in the areas of its members. The biennial scientific conferences could be perceived as AMRN's flagship activity and have been notably successful, becoming renowned internationally. Around 1500 midwives have benefited from educational programmes at regional or national level. These include research methodology, evidence-based practice, scientific writing and communication skills. Attention needs to be given to some aspects of governance and organization, as well as to communication strategies including websites and newsletters. Technical support from the Karolinska Institute in Stockholm has provided good collegiate support and proved to be cost effective. KEY CONCLUSIONS: AMRN has shown resilience and continuity since its inception and has made a palpable difference to the quality of midwifery care and the professional development of midwives within the remit of its members. AMRN needs to be consolidated before expanding further. The work of AMRN is particularly pertinent in the context of the millennium development goals.

Ministry of Health The Government of the Republic of Zambia. National Training Operational Plan 2008: Field Assessments, Analysis and Scale-up Plans for Health Training Institutions.  2008.

Notes: This Operational Plan aims to summarize the current situation in health training institutions across the country and set plans for addressing current needs at individual schools. The document provides information for increasing capacity of each school in line with the national scale-up plan for health care workers in Zambia. The training institutions covered in this operational plan are Nursing and Midwifery Schools, Biomedical and Paramedical Colleges, and the University of Zambia School of Medicine. While staffing, infrastructure, and resources varied greatly between training institutes, common themes outlined in the document relating to challenges include: accommodation, faculty recruitment and retention, repairs to basic infrastructure, books, computers and teaching material shortages, and transportation to practice sites.

Mitchell K. EmOC Supply Side Capacity Assessments in Choma, Mongu and Serenje Districts, Zambia.  2010 Jul. Report No.: 399 (10C).

Notes: The Mobilising Access to Maternal Health Services in Zambia (MAMaZ) programme is a three-year programme, funded by the UK Department for International Development (DFID) and implemented by Health Partners International (HPI), in conjunction with the Zambia Ministry of Health (MOH).  The programme aims to identify and address community and household-level barriers that affect timely access to life-saving maternal and newborn health services. Although Choma, Mongu and Serenje districts are designated EmOC districts, a lot of effort is still required in order to ensure that obstetric clients in these districts will receive timely, life-saving obstetric services if they develop obstetric complications. All of the EmOC facilities assessed have significant gaps in staffing and staff capacity, as well as drugs, equipment and supplies for EmOC.  Addressing these gaps and establishing "EmOC referral zones" so that women seen at non-EmOC facilities have access to EmOC services, would improve the quality and availability of EmOC services and would complement the demand that will be created by the MAMaZ programme.

Zimbabwe

Ministry of Health and Child Welfare Republic of Zimbabwe. The National Reproductive Health Policy. 

Notes: This document outlines Zimbabwe's national reproductive health policy. The objective of this policy is to provide comprehensive and good quality services which meet the needs of women, men and children and include reproductive health and safe motherhood interventions. The document presents this as the first integrated reproductive health approach to be formulated into policy and addresses gaps in the range of services available. The report provides a situation analysis such as economic challenges, available resources, and distribution of trained personnel and covers topics relating to reproductive health such as gender equality, STIs and HIV/AIDS, family planning, and cultural issues among others. The framework for implementation covers advocacy, health promotion, capacity building, monitoring and evaluation and quality healthcare delivery.

Ministry of Health and Child Welfare Republic of Zimbabwe. The National Health Strategy for Zimbabwe (2009-2013) - Equity and Quality in Health: A People's Right.

Notes: This strategy document follows Zimbabwe's National Health Strategy, 1997-2007: Working for Quality and Equity in Health. This document highlights poverty as a known negative determinant of health and prioritizes gender sensitive health strategies, educational opportunities particularly for women, and safe water supply and sanitation to influence the health and quality of life of communities. This document addresses determinants of health, specific diseases affecting Zimbabweans, health systems strengthening, and inclusive implementation.

Ministry of Health and Child Welfare Zimbabwe. The Zimbabwe National Maternal and Neonatal Health Road Map 2007-2015.  2008 Nov. 

Notes: This document presents a roadmap for Zimbabwe's Ministry of Health and is supported by UNFPA, UNICEF and WHO. In response to the high maternal and neonatal mortality rates in Africa, the African Union proposed an African Road Map aimed at providing guidance to governments in developing country-specific Road Maps to accelerate the attainment of the Millennium Development Goals related to maternal and newborn health.  The objectives of the Road Map are to provide skilled attendance during pregnancy, childbirth, and the postnatal period at all levels of the health care delivery system; and to strengthen the capacity of individuals, families, communities, civil society organizations and Governments to improve maternal and newborn health. Topics addressed include the maternal and neonatal mortality, policy, health system expenditure and financing, human resources for health and the relationship between the four pillars of safe motherhood and the 3 delays.



Library Sections: Bibliography | Bibliography by Country | Photos

Report Photos

Cover photo 1
(Titi Chairani, Jhpiego, Indonesia)

Cover photo 2
(Ron Haviv, East Timor)

Cover photo 3
(Nasratullah Ansari, Jhpiego, Afghanistan)

Cover photo 4
(Caroline Kilo Bara, UNFPA, Cameroon)

Page ii
(UNFPA photo)

Page iii
Learning to record foetal heartbeat is one of the simplest and most common techniques. When part of a midwife’s competencies, it is a life-saving aid. (Sven Torfinn; Sudan)

Page v
Birth is always an intense moment, both for women and for the maternal health team. It is our collective responsibility to ensure that the quality of care available protects and saves lives. (Lynsey Addario; Afghanistan)

Page vii
Ensuring midwives are in the right place at the right time with the necessary infrastructure, drugs and equipment is a central pillar of the Global Strategy for Women’s and Children’s Health. (WHO/Marie-Agnes Heine; Senegal)

Page 1
Midwives provide woman-centred care that includes a listening ear and reassurance. (WHO/Marie-Agnes Heine; Uganda)

Page 4
High-quality antenatal care can maximize health during pregnancy and includes early detection and treatment or referral of selected complications. (Ellen Krijgh; Viet Nam)

Page 6
Learning with models enables student midwives to attain proficiency in the essential competencies. (Liba Taylor for ICM; India)

Page 9
Not all women are able to access a midwife while pregnant or during labour and birth. For some it entails a long and arduous journey by whatever means possible. (Claire Escoffier; Somalia)

Page 10
Midwives are able to provide health education and services to all in the community, promoting planned pregnancies and positive parenting. (Ahmed Al-Adboei; Yemen)

Page 15
Midwives provide high-quality, culturally sensitive care during labour as one of their core competencies. (William Daniel; Tajikistan)

Page 28
Pregnant women require access to midwifery care at all hours and in all circumstances, including in humanitarian disasters. (William A. Ryan; Pakistan)

Page 31
Midwives are an investment in the health of mothers, their newborns, the community and a nation. (Helen de Pinho; Malawi)

Page 36
Bold action can realize the right of every woman to the best possible health care before and during pregnancy, at birth and immediately after.  (Mandy La Fleur, UNFPA; Guyana)