In September 2010 the United Nations Secretary-General launched the Global Strategy for Women’s and Children’s Health. As part of their broader responses, the UN health agencies - “H4+” (UNAIDS, UNFPA, UNICEF, World Bank, WHO) - collectively proposed to support a group of countries with some of the highest numbers of maternal and newborn mortality to strengthen evidence-based policy and its implementation. Eight countries (Afghanistan, Bangladesh, Democratic Republic of Congo, Ethiopia, India, Mozambique, Nigeria and the United Republic of Tanzania), representing nearly 60% of the global maternal and newborn deaths, have welcomed the response of the H4+. Ministers of Health, leaders of UN agencies, representatives of the UN Secretary-General’s MDG Advocates Group, civil society, private sector, partner governments and health professionals subsequently gathered at the Greentree Foundation in September 2011 to elaborate the priorities and calendar for the H4+ support. Participants concluded that the H4+ would initiate, alongside the government and development partners, national assessments of the midwifery workforce in all eight countries (including all cadres engaged, e.g. midwives, nurses, doctors, obstetricians and community health workers): as part of the H4+ High Burden Countries Initiative (HBCI). The national assessments are consistent with an ‘Operational Guidance and Assessment Framework’ (finalized in April 2012) and tailored to the context and individual needs of the countries. Modeled projections of midwifery service needs, workforce demand and supply will inform costed scenarios and policy options. These will be developed and agreed in consultation with key stakeholders. This presentation provides a short overview of progress as at October 2012.

1. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Planning
to
address
the
challenge
of
human
resources
for
reproduc4ve,
maternal
and
newborn
health:
the
“High
Burden
Countries
Ini4a4ve”
FIGO
Congress
2012.
Rome.
Wednesday
10th
October,
2012
Progress,
preliminary
findings
and
discussion
points
Jim
Campbell
Director,
ICS
Integrare,
Barcelona,
Spain
enquiries@integrare.es
`

2. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Overview
1. Progress
across
countries
2. Preliminary
findings
(examples)
– Assessing
“need”
– Assessing
current
HRH
supply
– Modelling
future
HRH
supply
The
10
countries
with
the
greatest
number
of
maternal
deaths
per
year
India
56000
3. Discussion
points
(AAAQ)
Nigeria
40000
DemocraNc
Republic
of
the
Congo
15000
60%
Pakistan
Of
all
12000
maternal
deaths
Sudan
10000
Indonesia
9600
Ethiopia
9000
United
Republic
of
Tanzania
8500
Bangladesh
7200
Afghanistan
6400
`

3. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Progress
to
date
J
F
M A
M J
J
A
S
O
N
D
Afghanistan
Bangladesh
DR
Congo
Ethiopia
India
Mozambique
Nigeria
Tanzania
NaNonal
assessment
reports
Available
at:
www.integrare.es
`

4. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Assessing
need
–
pregnancies
per
year
Afghanistan
Ethiopia
Tanzania
`

5. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Assessing
supply:
Health
labour
market
analysis
Public
Private
Other
Health
sector
‘supply’
Exits
Employed
Unemployed
‘parNcipaNon’
‘potenNal
Qualified
healthcare
workers
supply’
Healthcare
educaNon
and
training
High
School
graduates
(male/female)
`

6. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Assessing
supply:
who
plays
what
role
in
the
midwifery
workforce?
`

7. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Assessing
supply:
Educa4on
pathways,
provider
and
costs?
How
many
are
currently
prac%sing?
`

8. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Assessing
supply:
urban/rural
distribu4on
-­‐
equitable?
`

9. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Modelling
future
supply:
how
many
(more)
are
needed?
Projected
GAP
NEED
OR
Exit
Projected
Need
Entry
+
?
service
Projected
coverage
STOCK
target
STOCK
Current
Year
‘x’
Year
‘x’
`

10. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Modelling
future
supply:
if
we
use
Tanahashi?
Service
Delivery
Goal
Target
populaNon
who
do
not
contact
EffecNve
Coverage
services
Process
of
service
provision
People
who
receive
effec7ve
care
Contact
Coverage
People
who
use
the
service
Acceptability
Coverage
People
willing
to
use
the
service
Accessibility
Coverage
People
who
can
use
service
Availability
Coverage
People
for
whom
service
is
available
Target
PopulaNon
`

11. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Modelling
future
supply:
to
provide
effec4ve,
equitable
coverage?
`

12. `
H4+
‘High
Burden
Countries
Ini4a4ve’:
Midwifery
Workforce
Assessments
Discussion
points:
AVAILABILITY
Benchmarks?
• PopulaNon
or
births
for
EmONC?
• Normal
births
v
complicaNons?
(85/15)
• Midwives
/
ObGyn
per
births?
Pre-­‐service
educaNon
(public/private)
Labour
market
analysis;
skill-­‐mix
ACCESSIBILITY
Deployment
(rural/remote)
RetenNon
24/7
ACCEPTABILITY
Respecpul
care;
ethnicity;
gender;
language
CONTACT
“if
you
build
it
they
will
come”
QUALITY
EducaNon,
RegulaNon,
AssociaNon
In-­‐service
training
SupporNve
supervision
Policy
discourse:
evidence,
ac4on,
results,
resources
`