Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partners
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BioMed Central
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Leveraging human capital to reduce maternal mortality in India: enhanced public health system or public-private partnership? Karl Krupp1 and Purnima Madhivanan*1,2 Address: 1Public Health Research Institute, Yadavgiri, Mysore, India and 2San Francisco Department of Public Health, San Francisco, CA, USA Email: Karl Krupp - [email protected]; Purnima Madhivanan* - [email protected] * Corresponding author
Published: 27 February 2009 Human Resources for Health 2009, 7:18
doi:10.1186/1478-4491-7-18
Received: 11 November 2008 Accepted: 27 February 2009
This article is available from: http://www.human-resources-health.com/content/7/1/18 © 2009 Krupp and Madhivanan; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Developing countries are currently struggling to achieve the Millennium Development Goal Five of reducing maternal mortality by three quarters between 1990 and 2015. Many health systems are facing acute shortages of health workers needed to provide improved prenatal care, skilled birth attendance and emergency obstetric services – interventions crucial to reducing maternal death. The World Health Organization estimates a current deficit of almost 2.4 million doctors, nurses and midwives. Complicating matters further, health workforces are typically concentrated in large cities, while maternal mortality is generally higher in rural areas. Additionally, health care systems are faced with shortages of specialists such as anaesthesiologists, surgeons and obstetricians; a maldistribution of health care infrastructure; and imbalances between the public and private health care sectors. Increasingly, policy-makers have been turning to human resource strategies to cope with staff shortages. These include enhancement of existing work roles; substitution of one type of worker for another; delegation of functions up or down the traditional role ladder; innovation in designing new jobs;transfer or relocation of particular roles or services from one health care sector to another. Innovations have been funded through state investment, public-private partnerships and collaborations with nongovernmental organizations and quasi-governmental organizations such as the World Bank. This paper focuses on how two large health systems in India – Gujarat and Tamil Nadu – have successfully applied human resources strategies in uniquely different contexts to the challenges of achieving Millennium Development Goal Five.
Review Recently the association between human resources (HR) and population health has received considerable attention. There is growing evidence that HR inputs are an important determinant of broader population-based outcomes such as maternal mortality [1]. The issue is of crucial importance to developing countries fac
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