Human resources for maternal health: multi-purpose or specialists?
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BioMed Central
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Human resources for maternal health: multi-purpose or specialists? Vincent Fauveau*†1, Della R Sherratt†2 and Luc de Bernis†3 Address: 1Technical Services Division, UNFPA (Geneva Office), 11 Chemin des Anemones, 1219 Chatelaine, Switzerland, 2Wotton under Edge, UK and 3Africa Division, UNFPA, Addis Ababa, Ethiopia Email: Vincent Fauveau* - [email protected]; Della R Sherratt - [email protected]; Luc de Bernis - [email protected] * Corresponding author †Equal contributors
Published: 30 September 2008 Human Resources for Health 2008, 6:21
doi:10.1186/1478-4491-6-21
Received: 14 January 2008 Accepted: 30 September 2008
This article is available from: http://www.human-resources-health.com/content/6/1/21 © 2008 Fauveau et al; 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 A crucial question in the aim to attain MDG5 is whether it can be achieved faster with the scaling up of multi-purpose health workers operating in the community or with the scaling up of professional skilled birth attendants working in health facilities. Most advisers concerned with maternal mortality reduction concur to promote births in facilities with professional attendants as the ultimate strategy. The evidence, however, is scarce on what it takes to progress in this path, and on the 'interim solutions' for situations where the majority of women still deliver at home. These questions are particularly relevant as we have reached the twentieth anniversary of the safe motherhood initiative without much progress made. In this paper we review the current situation of human resources for maternal health as well as the problems that they face. We propose seven key areas of work that must be addressed when planning for scaling up human resources for maternal health in light of MDG5, and finally we indicate some advances recently made in selected countries and the lessons learned from these experiences. Whilst the focus of this paper is on maternal health, it is acknowledged that the interventions to reduce maternal mortality will also contribute to significantly reducing newborn mortality. Addressing each of the seven key areas of work – recommended by the first International Forum on 'Midwifery in the Community', Tunis, December 2006 – is essential for the success of any MDG5 programme. We hypothesize that a great deal of the stagnation of maternal health programmes has been the result of confusion and careless choices in scaling up between a limited number of truly skilled birth attendants and large quantities of multi-purpose workers with short training, fewer skills, limited authority and no career pathways. We conclude from the lessons learnt that no significant progress in maternal mortality reduction can be achieved without a strong polit
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