Human Resources

The human resource crisis in emergency obstetric and newborn care

In nearly all low-income countries, health systems lack adequate resources to respond to the health needs of their populations, including life-threatening complications during pregnancy and childbirth.

In low-income countries, only 46 percent of pregnant women give birth with a skilled attendant present. And, the birth attendants who are present are not always sufficiently trained to handle life-threatening complications.

At the epicenter of this challenge stands the issue of human resources for health (HRH): the number of health workers, distribution, motivation, retention, skill mix, morale, professional norms, and, ultimately, the quality of care that they deliver to the population. Sub-Saharan Africa, where the human resource shortage is most dire, has 25 percent of the global burden of disease but only 3 percent of the world’s health workers. Women living in rural areas are most vulnerable as they are more often left without access to life-saving care.

Posting & Transfer

Well-functioning government health services are necessary to achieving universal health coverage in low and middle income countries (LMIC). However, the lack of a skilled and knowledgeable health workforce in many LMICs leaves those in need without appropriate and timely care. Posting and transfer (P&T), the practice by which health workers at all levels are assigned posts and transfers, plays a critical role in the distribution of health professionals in the public sector.

Poor P&T practices are driven by multiple factors, including corruption and patronage, dissatisfaction with health worker performance, health worker preference for urban postings, and inefficient human resource management. Despite the widespread recognition of these challenges by global health advocates and policy-makers, little discussion or formal research of P&T has taken place. To address this glaring gap, AMDD and its partners have begun to research the consequences of poor P&T practices and explore policy options to address this issue. 

AMDD’s contributions to posting and transfer

  • The Health Governance Hub of the Public Health Foundation of India (PHFI), with AMDD support, organized a global consultative meeting on “Posting and Transfer Practices in the Health Sector” in New Delhi, India in April 2013. Participants included researchers and experts from India, Indonesia, Ghana, Australia, UK and USA, in addition to senior Indian health administrators, civil society organizations and donor agencies. Significant ideas generated at the meeting included the necessity of broadening the scope of understanding postings and transfers from a narrow frame of corruption to a much broader frame of human resources for health. Read the final report of the meeting here.

  • In October 2013, AMDD published a foundational open access literature review entitled "Unmasking the open secret of posting and transfer practices in the health sector" in Health Policy and Planning. The review looks at practices that can be described as “mission inconsistent” meaning that they operate in ways that do not maximize health outcomes, and that are inconsistent with prevalent professional norms. The article also proposes research principles to guide future research on P&T.

  • Stemming from the literature review and the Delhi meeting, AMDD and PHFI co-convened a three day meeting at the Bellagio Center in Bellagio, Italy in February 2014. Researchers and policy makers from India, the Middle East, West Africa, North America, and Latin America were invited to deliberate on the issues of P&T, and to consider the potential for a joint research and advocacy platform for P&T. As discussed by the participants, P&T is a complex issue that is shaped by human resources for health constraints, maldistribution of the health workforce, lack of transparency in hiring and posting, and context-specific social and political dynamics. Two researchers who attended the meeting are conducting country level case studies on posting and transfer in their country, contributing to an emerging understanding of how P&T operates globally. See the final report of the meeting here and short blog post summarizing key takeaways here.

  • On September 30, 2014, AMDD and PHFI held an open satellite meeting on posting and transfer at the Global Symposium on Health Systems Research. A colleague wrote a brief blog summarizing the event here.

  • Posting and transfer (P&T) was highlighted as a challenge to equitable and transparent health employment and health systems functioning in a policy brief submitted by AMDD and the Public Health Foundation of India (PHFI) to the UN Secretary General’s High-Level Commission on Health Employment and Economic Growth’s Expert Group.  The Commission’s purpose was to propose intersectoral actions to guide and stimulate the creation of health and social sector jobs to advance inclusive economic growth. The P&T policy brief is publically available on the Commission’s website. In addition, the Expert Group included a discussion of P&T on page 46 of its final report, published in September 2016.  

  • AMDD is reviewing literature and data to understand the implications of posting and transfer for emergency obstetric and neonatal care, particularly on how poor P&T practices can undermine EmONC coverage in LMICs.