Table 5 Studies related to HRH intervention: policy

Efendi [12] Indonesia program evaluation (before/after)

Doctors and dentists were assigned as temporary staff on contract basis for a certain time period under “Contracted staff” or Pegawai Tidak Tetap (PTT) policy. Similarly, in the Village Midwife Program scheme, midwives were assigned to rural areas. In addition to the PTT scheme, the Special Assignment Program for Strategic Health Workers was implemented which included nurses, sanitarians, nutritionists, and other health cadres as well.

1991

Remote and very remote areas (division based on geographical position, access to transportation and the social economy)

Both these programs made a significant contribution to improving the availability of health workers in remote areas. As a result, in 2010, only 17% of the 9 000 very remote health centers were without a doctor, compared with 30% of 8 000 health centers in 2006.

1Y, 2U, 3Y, 4Y, 5Y, 6U, 7N, 8Y, 9U, 10N, 11N, 12Y

Akashi [45] Cambodia prospective (before/after)

User fees introduced at a public hospital, the National Maternal and Child Health Center (NMCHC) of Cambodia

1997

MOH started discussions to improve health care financing and introduce user contributions in 1995 and initiated a user-fee pilot program in selected national health facilities in 1997.

After the introduction of user fees, revenue was retained by the hospital to improve the quality of hospital services. Consequently, the patient satisfaction rate showed 92.7%, and the number of outpatients doubled. The average monthly number of delivery of babies increased from 319 to 585 in the third year after the user-fee introduction, and the bed occupancy rate also increased from 50.6% to 69.7%. As patient utilization increased, hospital revenue increased. The generatedrevenue was used to accelerate quality improvement, to provide staff with additional fee incentives to compensate their low government salaries, and to expand hospital services.

1Y, 2U, 3Y, 4Y, 5Y, 6U, 7Y, 8Y, 9N, 10N, 11N, 12Y

Koblinsky [46] Bangladesh prospective (before/after)

In 1994, the EmOC approach dominated with assistance from the UNICEF, UNFPA, and the AMDD program in the renovation and up gradation of existing facilities and training of facility staff. With the development of the National Maternal Health Strategy in 2001, the approach broadened, building on the rights’ approach for safer motherhood and was incorporated into the ongoing Health and Population Sector Programme (HPSP) and subsequently into the Health, Nutrition and Population Sector Programme (HNPSP)

1994 and 2001 and first evaluation took place in 1995

EmOC at the facility level

Since 1990, the MMR in Bangladesh has declined from 514 in 1986–1990 to 400 in 2003—22% in the 11 intervening years.

1Y, 2U, 3Y, 4Y, 5Y, 6U, 7Y, 8U, 9N, 10N, 11U, 12Y

CSBAs providing safe delivery care at home.

Deaths from induced abortion have declined when the 1995–2005 level is compared with the pre-intervention levels of 1976–1980.

During 2000–2004, MMR was 322; only 13% of delivering-women used professional care for birthing, and 9% of births were in facilities. By 2007, 18% were delivering with professional care and 15% were in facilities.

For cesarean section in rural areas, the rate increased from 0.9% to 1.7% from 1995–1996 to 2000–2004 and then to 5.4% in 2005–2007, while in urban areas, the corresponding rates doubled—from 5.6% to 11.4% and then increased to 16.2% in 2005–2007.

The increase in the use of antenatal care has shown promise—from 27% in 1991–1994 to 60% in 2005–2007.

Rath [47] Nepal prospective (before/after)

The Nepal National Safer Motherhood Project was a collaborative intervention between the Nepal Ministry of Health and Population and the UK Department for International Development (DFID), managed by Options Consultancy Services.

1997–2004, evaluation was done yearly

In phase 1, the Project focused mainly on improving midwifery and emergency obstetric services in selected health facilities in 3 districts and then in phase 2, to 6 districts. Two main components were developed: (i) management of service provision for women of reproductive age, including improvements to the physical infrastructure of hospitals, equipment and supplies, and training of personnel and (ii) increasing access to midwifery and obstetric services by improving the social context to enable women to utilize services.

Availability of birthing facilities

1Y, 2U, 3Y, 4Y, 5Y, 6U, 7Y, 8Y, 9N, 10N, 11U, 12Y

Met need for emergency obstetric care was <5% in the phase 1 districts in 1997. The average annual increase in met need has been 1.3% per year over the intervention period, bringing it to the 2004 level of 14% in public sector facilities in project-supported districts. In a further 4 districts supported by UNICEF, met need increased from 1.9% to 16.9% between 2000 to 2004.

Availability of a skilled birth attendant near the home

The 2001 Demographic and Health Survey (DHS) found that only 3.1% of deliveries of the approximately 900 000 births per annum were attended by an auxiliary nurse midwife or nurse. This had increased to 8.3% in the 2006 DHS.

Free or reduced costs for services and transport

Communities valued these funds and that they increased confidence in being able to cope with emergencies.