Improving the MNH workforce: The basis for quality care

Background

This is the third article in Evidence for Action’s second series from 2015 published in the International Journal of Gynecology and Obstetrics (IJGO). focussing on different  evidence available on quality of care for mothers and newborns. This article examines improvements in quality of care through a better healthcare workforce.

Authors’ discussion

Ambitious goals are been outlined to end preventable maternal and newborn deaths:

• A global target of 70 maternal death per 100,000 live births by 2030.
• A target for every country of 12 newborn deaths per 1,000 live births by 2030.

The authors argue that these targets will not be reached without accelerated progress in quality of care and that the health workforce is the basis of quality. As described in Hulton and colleague’s article in this same issue, quality of care has many dimensions, which involve the health workforce, such as having skilled and motivated human resources, who provide respectful care and follow good clinical practice. Nevertheless, the authors highlight that quality of care is not always being provided:

• A survey by WHO found that in hospitals with high numbers of maternal deaths, a large percentage of women were receiving the recommended interventions, suggesting major issues in quality of, and not merely access to, care provided.
• In countries with the highest burden of maternal and child deaths, only 10% of midwives available are truly skilled to attend to births.

The lack of quality of care provided is compounded by shortages in health workers:

• 39 countries in Africa have a critical shortage in health workers.
• 10 million more health workers need to be trained and working in low- and middle- income countries by 2030. 

The authors highlight that Improvements in providing a strong workforce are hampered by the fact that the planning required to do so is not on the policy agenda.

Conclusions and recommendations

The authors conclude that the Global Strategy on Human Resources for Health: Workforce 2030 and the Sustainable Development Goals provide an opportunity to strengthen accountability frameworks for the health workforce.

The authors recommended the inclusion of a measurable target in the SDGs on delivering quality maternal and newborn healthcare with a strong workforce. This will build accountability mechanisms and encourage action, collaboration and policy developments. An essential step is to strengthen data collection systems so they collect data not only on the availability of healthcare workers but also on geographical distribution, employment status, gender, wages, quality and performance.