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Table 6 Studies related to HRH intervention: combined interventions

From: Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low- and middle-income countries

Study HRH management system   Others
  Training Policy Management Incentive Supervision Partnership Personnel system Intervention to evaluation duration  
Kayongo [50] Peru (before/after)          
Implementation Training sessions for 15 days with on-call duty after an analysis of the causes of maternal death, the treatment, and prevention of postpartum hemorrhage received special emphasis in the trainings.   Development of a more efficient mechanism for recordkeeping and data collection.   Quality of care was enhanced through the use of criterion-based audits. External supportive supervision and on-site quality improvement processes were used to enhance efficient service delivery. The FEMME Project worked with community groups to form local committees. CARE’s most important partners in the FEMME Project have been the IMP in Lima, the Ayacucho DIRESA, and the Regional Hospital.   The intervention started in 2000 and the first evaluation took place in 2001 and then in next three years till 2004. Facility setup, including adequate infrastructure, equipment, and supplies
Placement of trained staff to ensure a wide distribution of technical capability to resolve obstetric emergencies.
Outcomes CFR decreased from 1.7% to .01%, increase in met needs from 30% to 84% in 5 years, and a small increase in cesarean sections from 4% to 6%.
  Quality: 1Y, 2Y, 3Y, 4Y, 5Y, 6Y, 7Y, 8Y, 9N, 10N, 11U, 12Y
Kayongo [51] Rwanda (before/after)          
Implementations CARE conducted several trainings to provide doctors and midwives to manage major obstetric complication. Most significant training course was a 12-module competency-based training.   Staff, including doctors and midwives, were trained and supported to ensure complete recording of case notes and filling out of registers.   Main strategies of the project were to engage the participation of district supervisors as partners for improving and transforming this process. Stakeholders in the MoH, local partners in safe motherhood such as UNFPA, district health officials, and hospital health professionals were involved in various process of the project.   The interventions started in 2001 with first evaluation in 2002 and then consequently in 2003 and 2004. Renovations and provision of essential equipment and supplies
Outcomes Numbers of deliveries increased by almost 25% from 2001 to 2002, and the obstetric complications managed increased by almost the same magnitude (26.5%). Cesarean section increased by 63% during this time. There was a continuous decrease in the case fatality rate over the 4 years of the project from 2.2% in 2001 to 1.8 in 2002 and finally 1.2% in 2004.
  Quality: 1Y, 2Y, 3Y, 4Y, 5Y, 6Y, 7Y, 8Y, 9N, 10N, 11U, 12Y
Jamisse [49] Mozambique (before/after)          
Implementations Technicians trained in surgery and anesthesia, nurses trained as surgical assistants. MNCH nurses and midwives were trained in basic and comprehensive EmOC and management of major obstetric complications.     Supervision of the activities was the responsibility of the Ministry of Health.    Intervention started in 1998 and the first evaluation was done in 1999 and then consequent evaluations for 2 more years. Supplementing equipment and essential supplies at the EmOC units
Radio communication and transport system was established
Outcomes José Macamo Hospital, which dealt with 14% of all deliveries and 2.5% of all C-sections in 1998, was responsible for 32% of all deliveries and 38% of all C-sections in Maputo city in 2001. Mavalane never succeeded in providing comprehensive EmOC 24 h a day. It did succeed, however, in almost doubling the number of deliveries, from 2 500 in 1998 to almost 5 000 in 2001. While in 1998 the Manhica Hospital managed 29% of institutional deliveries and 8.2% of cesarean sections in the district, these percentages increased to 33% and 31.2%, respectively, in 2001. The maternal deaths per total number of deliveries occurring in the district’s institutions were 572/100 000 live births in 1998 and 433/100 000 in 2001. The case fatality rate in basic EmOC units decreased from 4.7 in 2000 to 2.4 in the first 6 months of 2002
  Quality: 1Y, 2U, 3U, 4Y, 5Y, 6U, 7U, 8Y, 9N, 10N, 11U, 12Y
Santos [52] Mozambique (before/after)          
Implementations The 4-week training session for basic EmOC consisted of 1 week of theory and 3 weeks of practical hands-on experience, emergency transport, and referral system. Policy clearly endorsed EmOC The project used the UN process indicators for obstetric services as its monitoring tools   The Medical Director of the Provincial Health Directorate and the Chief Nurse were given the responsibility to coordinate all activities of the project, which included frequent supervisory visits to the facilities. AMDD’s partner in Mozambique was UNFPA. AMDD was supported by the Bill and Melinda Gates Foundation.   Interventions started in 1999, and first evaluation began in 2002 and was continued for 3 years till 2005. Renovation of the hospitals, equipments and emergency drugs and supplies were provided
Outcomes Utilization among women with complications (met need or the proportion of women expected to have complications who are admitted for treatment) increased 3-fold, from 11.3% to 32.8% in all facilities. The aggregate case fatality rate (CFR) was reduced by almost half (2.9% to 1.6%).
Islam [48] Bangladesh (before/after)          
Implementations Training of medical officers was originally designed as a 6-month course but was later extended to 1 year. Training of nurses was extended from 6 weeks to 4 months. Laboratory technicians participated in a 2-week training course.   A checklist was developed for monitoring visits to training facilities to capture information such as trainees’ performance, lecture classes, opportunities for skills practice, training facility caseload, number of other trainees in the department, training problems, and general observations recorded in reports. Trainees were provided with a monthly scholarship, book grant, travel allowance, and training materials. Training activities were coordinated locally by the Training Coordination Committee at each medical college hospital. UNFPA and UNICEF Manager of the Directorate General of Health Services selected the medical officers for training, while nurses and laboratory technicians were selected from the facilities. Intervention started in 2003 and evaluation was done in 2004. Supply of necessary equipment and logistics. Renovations of the facilities
Outcomes In 2004, 105 of the 120 sub-district hospitals had become functional for EmOC, 70 with comprehensive EmOC, and 35 with basic EmOC, while 53 of 59 of the district hospitals were providing comprehensive EmOC compared to 35 in 1999.
  Quality: 1Y, 2Y, 3Y, 4Y, 5Y, 6Y, 7Y, 8Y, 9N, 10N, 11U, 12Y
Barker [24] Nepal (before/after)          
Implementations Ongoing work to incorporate training for skilled birth attendants into pre-service courses for doctors and nurses SSMP worked with other safe motherhood stakeholders   SSMP supported Maternity Incentives   Civil society, political parties, local media, development program, and health workers. Provided technical and strategic planning support for training   Interventions started in 1997, and evaluations began in 1998 and continued till 2005 every year. Supplies of emergency drugs and equipment
Outcomes Utilization of antenatal care services increased from 39% to 72%, delivery by a trained health worker from 9% to 19%, institutional delivery from 8% to 18%, and cesarean sections from 1% to 2.7%. CFR decreased from 0.5% to 0.4%.