Human resources for maternal, newborn and child health: from measurement and planning to performance for improved health outcomes

<p>Abstract</p> <p>Background</p> <p>There is increasing attention, globally and in countries, to monitoring and addressing the health systems and human resources inputs, processes and outputs that impede or facilitate progress towards achieving the Millennium Development Goals for maternal and child health. We reviewed the situation of human resources for health (HRH) in 68 low- and middle-income countries that together account for over 95% of all maternal and child deaths.</p> <p>Methods</p> <p>We collected and analysed cross-nationally comparable data on HRH availability, distribution, roles and functions from new and existing sources, and information from country reviews of HRH interventions that are associated with positive impacts on health services delivery and population health outcomes.</p> <p>Results</p> <p>Findings from 68 countries demonstrate availability of doctors, nurses and midwives is positively correlated with coverage of skilled birth attendance. Most (78%) of the target countries face acute shortages of highly skilled health personnel, and large variations persist within and across countries in workforce distribution, skills mix and skills utilization. Too few countries appropriately plan for, authorize and support nurses, midwives and community health workers to deliver essential maternal, newborn and child health-care interventions that could save lives.</p> <p>Conclusions</p> <p>Despite certain limitations of the data and findings, we identify some key areas where governments, international partners and other stakeholders can target efforts to ensure a sufficient, equitably distributed and efficiently utilized health workforce to achieve MDGs 4 and 5.</p

Geographical classifications to guide rural health policy in Australia

The Australian Government's recent decision to replace the Rural Remote and Metropolitan Area (RRMA) classification with the Australian Standard Geographical Classification - Remoteness Areas (ASGC-RA) system highlights the ongoing significance of geographical classifications for rural health policy, particularly in relation to improving the rural health workforce supply. None of the existing classifications, including the government's preferred choice, were designed specifically to guide health resource allocation, and all exhibit strong weaknesses when applied as such. Continuing reliance on these classifications as policy tools will continue to result in inappropriate health program resource distribution. Purely 'geographical' classifications alone cannot capture all relevant aspects of rural health service provision within a single measure. Moreover, because many subjective decisions (such as the choice of algorithm and breakdown of groupings) influence a classification's impact and acceptance from its users, policy-makers need to specify explicitly the purpose and role of their different programs as the basis for developing and implementing appropriate decision tools such as 'rural-urban' classifications. Failure to do so will continue to limit the effectiveness that current rural health support and incentive programs can have in achieving their objective of improving the provision of health care services to rural populations though affirmative action programs

Service Users’ Perceptions of an Outreach Wellbeing Service:A Social Enterprise for Promoting Mental Health

Inadequate provision and limited access to mental healthcare has been highlighted with the need to offer more contemporary ways to provide clinically effective interventions. This study aimed to present an insight into service users’ perceptions of an outreach Wellbeing Service (WBS), providing psychological therapy in social settings. Descriptive and thematic analysis was undertaken of 50 returned surveys. Comparison of initial and final mental health measures demonstrated a significant improvement in all outcomes with 96% of participants reporting being helped by attending. Participants were assisted to rebuild social connections in a safe and supportive environment and were facilitated to become more self-determining as their resourcefulness to self-manage was cultivated. Situated within different settings within the community, the WBS offers a workable example of a novel approach to supporting and promoting citizens to become more resilient and lead a more fulfilling and independent life in the community

The Victoria Climbié case: social work education for practice in children and families' work before and since

Based on their research into the Victoria Climbié Inquiry, the authors outline an analysis they undertook of literature which had made substantial comment on either the inquiry itself and/or the subsequent inquiry report. An overview of 18 publications is provided, with four categories of themes emerging. These themes are outlined and then connected with concerns the authors of the current paper identified in journal papers written 10 years or more ago. It is argued that the gap between recognition that society needs competent, well-trained and skilled social work and other professionals to safeguard the lives of children and families and understanding of what education, training and employment support mechanisms are necessary in order for workers to become and remain well-trained, skilled and effective, remains as wide as ever. The paper concludes with an outline of teaching approaches the current authors have adopted in pursuit of the kinds of learning opportunities they believe need to be put in place to improve professional practice in children and families' work. These include creative use of child abuse inquiry reports themselves, role plays and simulations and workshops designed to enhance critical reflection skills

International social workers in England: Factors influencing supply and demand

Recent years have seen considerable increases in the number of internationally-qualified social workers in England. This article presents trends in the international labour mobility of social workers migrating to work in England alongside information on the supply of UK-trained social workers. It concludes that demographic changes and policy imperatives have accentuated structural issues making it difficult to ensure an adequate supply in the number of domestically-trained social workers. We suggest that more cross-national research is needed to achieve a better understanding of the factors influencing social workers' decisions to work in international settings and the extent to which this reflects permanent or temporary migration between countries

An enquiry into students' motivations to train as social workers in England

NoIn 2003, the British Government introduced a bursary to support and attract more recruits to social work. This study is based on 497 questionnaires completed by prospective students to one social work undergraduate programme over a four-year period, from 2002 to 2006. The first aim of this study was to find out the extent of participants' knowledge of the social work bursary, in order to determine whether this had been a successful strategy to attract greater numbers of people to train as social workers. The second aim was to identify the factors that attracted them to train as social workers. Only 52% of the respondents had been aware of the bursary and, significantly, only 3% indicated that this had definitely influenced their choice of career. Prospective students' knowledge of the bursary has not increased since its introduction and the findings suggest that other factors act as primary incentives and motivate students to apply for social work. It is important to consider the factors that motivate students to train as social workers in order to better inform recruitment policies and ensure that the profession attracts people who are representative of the diverse population of England

Safeguarding children: challenges to the effective operation of core groups

Founded on an evaluative review of core group practice in a northern metropolitan borough of England, this paper highlights the tensions and difficulties that might inhibit the quality of post-registration services to children and their families. Insights from the empirical data as well as theoretical literature have been explored in the light of current and developing policies. This exploration is focused on inter-agency coordination; inter-professional relationships; and partnership with parents and children. The recruitment and retention of social workers, the potential contribution of Children's Trusts, as well as unconscious processes relating to child abuse and child protection, are all given consideration