Safe Motherhood in Nepal

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New Strategy for Human Resources to Support Safe Motherhood

A study carried out under the DfID Health Sector Reform Support Programme (HSR-SP) by Riitta-Liisa Kolehmainen-Aitken and Ishwar Shrestha (RTI International, 2009, Human Resource Strategy Options for Safe Delivery. Research Triangle Park, NC, USA hsrsp.org/pdf/HR_Strategy_Options_for_Safe_Delivery_DOWNLOAD_FINAL.pdfreviewed staffing in a selection of district hospitals, Primary Health Care Centres (PHCC) and health posts in 15 districts of Nepal. Findings highlighted critical shortages, such as lack of staff nurses in PHCCs and health posts; unfilled posts and incomplete safe delivery teams in district hospitals; and lack of Auxiliary Nurse Midwives (ANM) in health posts.

The report made recommendations for seven strategic approaches to address these issues and improve the availability and quality of safe delivery services. SSMP/ Options and HSR-SP have worked with the Ministry of Health and Population, using these recommendations as a basis for developing a draft Human Resource Management Strategy for meeting staffing needs for safe delivery. The draft strategy particularly focuses on peripheral services in outlying areas, which are those most likely to be used by poor and marginalised women and where the staff shortages are greatest. The seven key strategies are to:

i. Improve planning and management; linking human resource planning with infrastructure and equipment planning and decentralising recruitment of critical staff
ii. Increase numbers of nurses and ANMs in PHCCs and health posts
iii. Improve supervision of safe delivery staff in PHCCs and health posts through public health nurses
iv. Improve quality and quantity of safe delivery staff in district hospitals; posting teams, improving career paths for MDGPs and providing incentives for anaesthetics assistants
v. Improve safe delivery staffing at first-referral hospitals; with increased MD level training opportunities
vi. Develop critical skills of safe delivery staff; maximising in-service SBA and anaesthetics assistance training, providing caesarean section training for MBBS doctors, developing a professional midwife cadre 
vii. Increase staff retention in health facilities; addressing living conditions and support.