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in PMR could partly be explained by the proportion of developed and developing countries in these world regions. The PMR in developing Countries was estimated to be titles higher than that, in developed cou

1.000). and Southeast Asia 07 per 1,000). Within the Asia-Oceania -C%,ion. there are only Five places that have a PNIR below 10 Per 1.000.- Australia. Hon g Kong, J apan. New Zealand and Singapore. However. the

ina with over twenty million .11inkliti

nt. Philippines. and'I'llailand 120 25 pet' 1,(XIO). Excluding Autralia, New Zealand. and Singapore, Malaysia has tile best PIVIR in Southeast Asia (20 per 1.000).

ed in lh i: analysis are no[ identical to those used in the PMR report: sub-Salvlvan Africa (32.2 per 1.000). south Asia (31.9 per 1.000). cast Asia (2.31.2 per 1.000). west Asia (18.9 per 1.000). North Africa (IN 6 per J.00

s (33 Per 1.000) ;nut developed countries (4 per 1,000) has been reported. Consequently. 99"'. of neona tal deaths were estimated

to occur in developing Court-tics. The NMR and p ercentage of global neonatal d eat

ubs in the top 10 countries aCCOL111111IL' for two-thirds of the world's neonatal deaths were as follows: India (43 Per 1.004 China (21 per 1.0)0). Pakistan ( 57 per I-000). Nigeria 01 per 1.000). Ethiopia ( 51 per LOW). Ban?gla! , Jcsh

MR of hxiuvc 20 per 10)(1. where tetanus and dia rrileal illnesses were almost Weser a cause of neonatal death. The r isk of neona tal d eath in hig h-NNIR countri es compared to that in low-NMR Countries was c-slitnawd to be 11-G

4/

a: Japan (US S17(10). Australia (US S1600 ). New Zealand (US S139 0). South Korea (US 5860). and Sin gapore (US S75 0). Ill contrast. countries with ill ,, highest PMR were among II:Ciox%e,t ranking I'm

o reside in relatively affluent urban areas. Conversely, only 20".;, of healthcare resources are available to 80')/,. 0I'the population Who rCSid-,' ill impo veris hed rural area s. E in e merg ing ec onomies wh erethe socioecon

3 Promotion of Global Perinatal Health

;laid, 51'yo occ urred in th e lou r Coun tries of I ndia. ('hits, Pakistan. and Banl-ladi-sh.

Neonatal Deaths

of inn-apart um complications leading to asphyxia; con?llibulill, to the fact that three-quartets of all ne

Problems and Obstacles

Table 28.1 Ratios of health workers to populations and selected licaiiii indicators, selected countries, 2000-2005

Country

AfghanistanZambiaEthiopiaBoliviaSweden

Population 2004 (000)28,574

11,47975,600

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516

cipant delii11#419?5

4 6 6 6 i

60 of 'iffivityJ14 '1.,*I f.

K 10 91n ~lW14Nw j Vity

S k i l l e d j ~ ,

- -,

i Red Barth

skills(lovex0

-

i h r Mc c e s s a i ) ~ ~ 4

*

r n . ~ 6 ~ . ~ # - ~ ia.

gnose , manag, 4 9

4; ~ A l q , tgr~.

the nf,t6 manage noring Minimum, pefsqn mus" _ I,;"" attends

y (first-line) obste -

pr e' all skilled a ii

tetric care. a 1!

7p~ should

d should,have the capacity to

,refer women to a hiMidwife

: A midwife is a person wlio,, having been regularly,;4,

program, duly recognized in the country in which it is lcocqtq( prose c

ourse of studies in midwifery and has acquired thoKmtonal and/or legally licensed to practice midwifery (InternatiO9.

28 Planning, Development, and Maintenance of the MCH Workforce

Health Worker Density

(per 1.00(l population)

Physicians0.190.120.031.22

3.28Midwives

0.010.270.010.01

0.70

Nurses0.221.740.233.19

10.24Life expectancy at birth (years) - male,,

4240

4963

78Life expectancy at birth (years) - females

4240

5166

83Adult mortality rate - males aged I5-60

509683

451248

8,Adult mortality rate - females ;Lgcd 15 60

448656

389184

51!matt mortality rate

257182

16669

4

Sources: Management Sciences for Health and Health and Development Service (2003); WHO 0006a)

100

A

70

60

50

40

30

20

11m ro,ofor h-M

10

--a

DcCon

10 to o

Density (per too 000)

Fig. 28.1 Immunization coverage and density of health workers. Source: joint Learning I nitiative (2004)

of services in the urba n a reas, a nd r eduction in t he qu ality of services due to the overburdening of health-care workers. Table 28.1 presents data bn health worker density, life expectancy, and i

ls, including two indica tors re lated to the Mi l lenn ium

is necessary to provide 80% of women with a skilled attendant at birth (Joint Learning In itiative 2004). Studies have also examined the effect of reductions in health sector human resources on matern

United States and Canada there is evidence to suggestt that reductions in nurse staffing levels in hospitals led to a decrease in qual ity of care and to an incre ase in mortality and complications for certain

as a .direct and positive effect oil the morbidity and mor?tality of mothers. infants. and children. When income, education. and poverty levels are controlled for.it10% increase in the number of healt

ven higher. given that ill presence of a health worker will more directh affec the types of morbiditic3 that lead to maternal dead than those tha t lead to init'ant or under-5 death (Joint Learning Initia

bstantial shortage globall, in the number o f he alth work ers able to p rovid , MCH services. This sht . tage is especially acute it Africa (Fig. 28.3). it is estimated that in the next It years, an additional 3

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524 J.M. Smith and A. Hyre28 Planning, Development, and Maintenance of the MCH Workforce 525

develop clinical skills, and the ability to coordinate and manage the development of clinical skills in both simulated and real health facility environments.

c models and

are super?vised and allowed to practice the skills in the curricu?lum. If ;I midwifery curriculum includes the care of pati ents in both inpa tient and outpa tient environ?ments, suitable practice sites for both

the course. This information is used as a basis for determining whether participants can receive a cer?tificate of competency and thus guides post-train?ing follow-up. It is also used for assessing the design of t

gh changes in on-the-job perfor?mance, and the results are used to reassess the quality of training courses and the extent to which trainees were able to transfer new skills, to the workplace.

atistics and quality in dicators an d helps determin e the ap propriateness of using training as the intervention to address service provision gaps.

arrheal diseases among infants and children, reductions in infant and maternal mortality, etc. Training impact is more difficult to measure since improvements in population health outcomes cann

eds of the community they are meant to serve. Deployment may be through voluntary choices of the gradua tes/traine es: th rough enticements such as salary differentials. priority for professional adva

ion of students prior to enrollment. If students are selected from the ma jor urban centers in a country. it is challengi ng and often unlikel y tha t the se stu?dents will be successfully deployed to rural healt

ernment service and are meant to be deployed to government facilities. Deployment of graduates into government service is facilitated by careful recruitment of students from priority areas whe

of primary health-care coordinators and national immuniza?tion program managers were in the form of "sur?prise visits. - usually for punitive reasons (e.g., to identify those who had not re

much more realistic assessment of quality of care and offers the supervisor the chance to make specific recommen?dations and give constructive feedback (Garrison

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