3 Promotion of Global Perinatal Health

4/

;laid, 51' y o occurred in the lour Countries of India. ('hits, Pakistan. and Banl-ladi-sh. of inn-apart um complications leadin g to asphyxia; con?llibulill, to the fact that three-quartets of all neo

Neonatal Deaths

Problems and Obstacles

hina with over twenty million .11inkliti

nt. Phili p pines. and'I'llailand 120 25 pet' 1,(XIO). Excludin g Autralia, New Zealand. and Sin gapore, Malaysia has tile best PIVIR in Southeast Asia (20 per 1.000).

(33 Per 1.000) ;nut be explained by the proportion has been reported. Consequently. 99" ' . of neonatal regions. The PMR in to occur in Countries was estimated to be titles higher than that, neonatal death ss in PMR could pa rtly developed countries (4 per 1,000)of developed and developing countries in these world deaths were estimated developingdeveloping Court-tics. The NMR and percentage of globalin developed cou

rubs 0 0 )the n d S o ut h e a s t A s i a 0 7 p e r 1 ,0 0 0two-thirds of theAsia-Oceania -C% , ion. were as follows: India places that have a PNIR below 1.0)0). 1.000.- Austra lia . H on g Kong, Japan. New Zealand and 1 per LOW).However.,Jcsh 1 . 0 in . a top 10 countries aCCOL111111IL' for ) . Within the world's neonatal deaths there are only Five (43 Per 1.004 China (21 per 10 Per Pakistan ( 5 7 per I-000). Nigeria 01 per 1.000). Ethiopia ( 5 Singapore. Ban? gla! the a: Japan (US S17(10). Australia (US S1600). New Zealand (US S1390). South Korea (US 5860). and Sin g apore (US S750). Ill contrast. countries with ill , , hi g hest PMR were among II:C iox%e,t ranking I'm

NMR in lh i: a n a ly siperr e no[ identicaltetanus and diarrileal PMR report: sub-Sal v l v a n Africa (32.2 per 1.000). south risk of neonatal death cast Asia ( 2 . 3 1.2 per 1.000). west to that in low-NMR Countries was c-slitnawd 6 per 11-Gi sed of hxiuvc 20 s a 10)(1. where to those used in the illnesses were almost Weser a cause of neonatal death. The Asia (31.9 per 1.000). in high-NNIR countries compared Asia (18.9 per 1.000). North Africa (IN to be J.000

o reside in relativel y affluent urban areas. Conversely, onl y 20".;, of healthcare resources are available to 80')/,. 0I'the population Who rCSid-,' i ll imp o ver is hed r ur a l a r ea s. Ei n eme rg ing economies where t h e socioecono

Table 28.1 Ratios of health workers to populations and selected licaiiii indicators, selected countries, 2000-2005

Country

Afghanistan Zambia Ethiopia Bolivia Sweden Population 2004 (000) 28,574 11,479 75,600

Health Worker Density (per 1.00(l population)

516

28 Planning, Development, and Maintenance of the MCH Workforce

Physicians 0.19 0.12 0.03 1.22 Midwives 0.01 0.27 0.01 0.01 Nurses 0.22 1.74 0.23 3.19 4 6 6 6 i Life expectancy at birth (years) - male,,
70

100

3.28

0.70 A

10.24

cipant deli
i11#

60 of 'iffivityJ14 '1.,* I f.

Sources: Management Sciences for Health and Health and Development Service (2003); WHO40 0006a)
49 63 78 Life expectancy at birth (years) - females
60

42

419?5
S i i h r n

K10

91

~lW14Nwj Vity

j
-, ~ # r M ~

ia gnose , manag 4 "" stt da n e . cy (first-line) obste ther e ' all skilled a ii nf,t6 manage noring Minimum, -p,
0 c c e s s a i ) ~ ~ 4 .~6 ~ . 4 9 ; ~ A l q , tgr~.

skills(lovex *-

Red Barth

42 40 51 66

pefsqn mus"

I,;

83 Adult mortality rate - males aged I5-60 50 509 683 451 248 8, Adult mortality rate - females ;Lgcd 15 60
40

stetric care.

1!

Midwife: A the capacity to refer women to a hi nd should, havemidwife is a person wlio,, having been regularly,;4, , program, duly recognized in the country in which it is lc cqt prose course of studies in midwifery and has acquired thoKm tonal and/or legally licensed to practice midwifery (InternatiO9.
o q(

7p~ should

448 656 389 184 51

!matt mortality rate

30

257 182 166 69

too

10 Density (per too 000) Fig.

28.1

Immunization coverage and density of health workers. Source: joint Learning Initiative (2004)
20

11m

ro,o 10 for h-M

n is necessary in the urban areas, and with a skilled attendant at of services Learning Initiative 2004). Studies have also examined the effect of reductions in health sector human resources on materna of services to provide 80% of women reduction in the quality birth (Joint due to the overburdening of health-care workers. Table 28.1 presents data bn health worker density, life expectancy, and in --a g United her. given that ill presence of a health worker will more directh affec the types of morbiditic3 led lead to maternal dead than those DcCon an to init'a in mortality and complications for certain even hig States and Canada there is evidence to sug estt that reductions in nurse staffing levels in hospitalsthat to a decrease in quality of care and toleadincrease nt or under-5 death (Joint Learning Initiat that als, including t w o i n d i c a t o r s r e l a t e d t o t h e M i l l e n n i u m has a .direct and positive effect oil number of health mor?tality of mothers. infants. and children.. tage is income, education. and poverty levels areestimated that itin theincrease in the an additional 33 ubstantial shortage globall, in the the morbidity and workers able to provid, MCH services. This sht When especially acute it Africa (Fig. 28.3). it is controlled for. 10% next It years, number of healt

524

J.M. Smith and A. Hyre

28 Planning, Development, and Maintenance of the MCH Workforce

525

y develop clinical skills, and the ability to coordinate and manage the development of clinical skills in both simulated and real health facility environments.

n the course. This information is used as a basis for determining whether participants can receive a cer?tificate of competency and thus guides post-train?ing follow-up. It is also used for assessing the design of th

ugh changes in on-the-job perfor?mance, and the results are used to reassess the quality of training courses and the extent to which trainees were able to transfer new skills, to the workplace.

tatistics and ic models and quality enrollment. If students are selected from the major urban using training as the is challenging address service provision gaps. tion of students prior toindicators and helps determine the appropriateness of centers in a country. itintervention to and often unlikely that these stu?dents will be successfully deployed to rural health s of primary health-care coordinators and national immuniza?tion program managers were in the form of "sur?prise visits.- usually for punitive reasons (e.g., to identify those who had not rep arrheal diseases among infants and children, reductions in infant and maternal mortality, etc. Training impact patients in both inpatient since improvements in population health outcomes canno s are super?vised and allowed to practice the skills in the curricu?lum. If ;I midwifery curriculum includes the care ofis more difficult to measureand outpatient environ?ments, suitable practice sites for both

?ernment service and are meant to be deployed to government facilities. Deployment of graduates into government service is facilitated by careful recruitment of students from priority areas wher a much more realistic assessment of quality of care and offers the supervisor the chance to make specific recommen?dations and give constructive feedback (Garrison

eeds of the community they are meant to serve. Deployment may be through voluntary choices of the graduates/trainees: through enticements such as salary differentials. priority for professional advan