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.
Highlights
Each year, roughly 27 million women give birth in India [2]
In order to deal with staff shortages, the state has successfully used a variety of human resources (HR) strategies, including enhancement of the non-specialist physician and nursing roles, innovations such as the creation of Comprehensive Emergency Obstetric Newborn Care Centres (CEmONC) in 51 government hospitals [58], and the relocation of some health system functions to the private sector
It is telling that Gujarat and Tamil Nadu – the states which are among the most aggressive in experimenting with HR strategies – are among the top performers in reducing maternal and neonatal mortality in India
Summary
Roughly 27 million women give birth in India [2]. Of these, about 136 000 die as a direct result of their pregnancy and delivery [3]. In order to deal with staff shortages, the state has successfully used a variety of HR strategies, including enhancement of the non-specialist physician and nursing roles, innovations such as the creation of Comprehensive Emergency Obstetric Newborn Care Centres (CEmONC) in 51 government hospitals [58], and the relocation of some health system functions to the private sector. As part of these efforts, there is a compelling need for additional research into the contribution of human resource strategies in reducing maternal death in Tamil Nadu
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