Policy brief Rehabilitating the workforce: the key to scaling up MCNCH There are countries where the main problem is an oversupply of staff provide back-up maternal and newborn care with a profile that is ill-adapted to the needs. In others- in fact in most b the deployment of the equivalent of 100,000 full-time multipurpose of the countries with high levels of maternal and child ill-health-there is professionals backed up by millions of community health workers, in a dearth of qualified professionals. These countries face huge shortages addition to more specialised referral level personnel to scale up child and imbalances in the distribution of health workers as a result of insuf. healthcare activities. with less reliance on community health workers ficient production, downsizing and caps on recruitment under structural the number of multipurpose professionals to be deployed would be much adjustment and fiscal stabilization policies, with frozen salaries and with larger losses to the private sector, migration and HIV/AIDS. The situation may be These are human resources needed to make up for the shortfalls in ss critical for child care but in many places large parts of the workforce dealing with the workload for maternal, newborn and child health only maternal and newborn care. There is often an absolute lack of qualified compartments of the health systems are as necessary in many other staff on the labour market, whilst governments experience major difficul- The workforce crisis seriously hampers the correct functioning of ties in recruiting, deploying and retaining them services even where staff has been deployed. The inadequacy of remu- Filling the supply gap will remain a major challenge for years to come. neration has led many professionals to develop individual coping strat- The World Health Report 2005 provides benchmarks for the numbers of egies to make ends meet, resorting to dual employment or exploiting human resources needed for MNCH services. Scaling up towards these their clients. This clearly affects productivity and quality of care. It also enchmarks in the seventy-five countries that currently face the biggest jeopardises the essential relation of trust between users and providers of challenges will require, in the next ten years: care and contributes to the exclusion of large numbers of mothers and e the production of at least 334,000 additional midwives(or children from the quality care to which they are entitled. This devalues professionals with midwifery skills); the legitimacy and credibility of the entire health sector, with both health the upgrading of 140,000 existing professionals providing first-level workers and their clients becoming increasingly dissatisfied. Particularly maternal and newborn care for maternal and child health, which is widely recognised as a core public e the upgrading of 27, 000 doctors and technicians to learn the skills to responsibility, this constitutes a growing political liability igure 2 The human resource gap for maternal and newborn health in Benin, Burkina Faso, Mali and Niger □ Other doctors with Burkina Faso Shortage: 2900] Niger Shorta9:31l口 Midwives Shortage. 2433 Other prof with midy Shortage:690 %o of human resource need met SourceAdaptedfromTheUnmetoBstetricNeedNetwork(http://www.itgbe/uonrPolicy brief Rehabilitating the workforce: the key to scaling up MCNCH There are countries where the main problem is an oversupply of staff with a profile that is ill-adapted to the needs. In others – in fact in most of the countries with high levels of maternal and child ill-health – there is a dearth of qualified professionals. These countries face huge shortages and imbalances in the distribution of health workers as a result of insuf- ficient production, downsizing and caps on recruitment under structural adjustment and fiscal stabilization policies, with frozen salaries and with losses to the private sector, migration and HIV/AIDS. The situation may be less critical for child care, but in many places large parts of the workforce do not reach the competency threshold required for effective and safe maternal and newborn care. There is often an absolute lack of qualified staff on the labour market, whilst governments experience major difficul￾ties in recruiting, deploying and retaining them. Filling the supply gap will remain a major challenge for years to come. The World Health Report 2005 provides benchmarks for the numbers of human resources needed for MNCH services. Scaling up towards these benchmarks in the seventy-five countries that currently face the biggest challenges will require, in the next ten years: ► the production of at least 334,000 additional midwives (or professionals with midwifery skills); ► the upgrading of 140,000 existing professionals providing first-level maternal and newborn care; ► the upgrading of 27,000 doctors and technicians to learn the skills to provide back-up maternal and newborn care; ► the deployment of the equivalent of 100,000 full-time multipurpose professionals backed up by millions of community health workers, in addition to more specialised referral level personnel to scale up child healthcare activities. With less reliance on community health workers the number of multipurpose professionals to be deployed would be much larger. These are human resources needed to make up for the shortfalls in dealing with the workload for maternal, newborn and child health only. However, corrections for shortages are as necessary in many other compartments of the health system. The workforce crisis seriously hampers the correct functioning of services even where staff has been deployed. The inadequacy of remu￾neration has led many professionals to develop individual coping strat￾egies to make ends meet, resorting to dual employment or exploiting their clients. This clearly affects productivity and quality of care. It also jeopardises the essential relation of trust between users and providers of care and contributes to the exclusion of large numbers of mothers and children from the quality care to which they are entitled. This devalues the legitimacy and credibility of the entire health sector, with both health workers and their clients becoming increasingly dissatisfied. Particularly for maternal and child health, which is widely recognised as a core public responsibility, this constitutes a growing political liability. Figure 2 The human resource gap for maternal and newborn health in Benin, Burkina Faso, Mali and Niger 2_rehabilitating workforce.indd 2 2005-03-24 18:49:50