Abstract

A well-performing and competent health workforce (HWF) is at the core of health systems yet many countries are facing a human resources for health (HRH) crisis. A prerequisite for achieving universal health coverage, including fulfilling the Sustainable Development Goals related to women and newborns, is an adequate supply of health workers able to provide quality of care at all levels of the health system. Thus, we evaluated how HRH policies and strategies influenced trends of maternal and newborn workforce densities and assessed the association between HWF densities, service coverage and health outcomes in Benin, Malawi, Tanzania and Uganda. We applied the READ framework (Ready your materials; Extract data; Analyse data and Distil findings) for our HRH policy and strategy document analysis and conducted a comparative analysis including three HWF densities (medical doctors, nursing and midwifery personnel) two health services, and five health outcome variables. Twenty HRH policies and strategies were included in the analysis published from 2010 to 2021. The scope of the HRH policies and strategies were described in four dimensions; availability, accessibility, acceptability and quality. We found that all policies and strategies addressed aspects related to availability and accessibility as well as the need for HRH quality improvements whereas acceptability was poorly represented. The comparative analysis revealed that service coverage and health outcomes appear to be insensitive to the fluctuations in HWF densities and related HRH policies as very little or no reduction was seen in outcomes from 2010 to 2020. There is a need to tackle the availability, accessibility, acceptability and quality of the HWF. Evidence needs to be translated into policy and practice otherwise the HWF in these countries will continue to struggle, affecting progress and realizing womens’ and newborn’s human rights to health.

Competing Interest Statement

The authors have declared no competing interest.

Funding Statement

The authors received no specific funding for this work.

Author Declarations

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

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I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

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I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Data availability statement

All original data are publicly available.

List of abbreviationsAAAQAvailability, Accessibility, Acceptability and QualityANC4+antenatal care of four or more visitsCrIcredible intervalLBWlow birthweightGHOGlobal Health ObservatoryMMRmaternal mortality ratioMNHmaternal and newborn healthHRHhuman resources for healthHWFhealth workforceNHWANational Health Workforce AccountNMRneonatal mortality ratePTBpreterm birthREADReady your materials, Extract data, Analyse data and Distil your findingsSBRstillbirthSDGSustainable Development GoalsSRMNCAHsexual, reproductive, maternal, newborn, child and adolescent healthSSASub-Saharan AfricaUHCuniversal health coverageUNICEFUnited Nations Children’s FundWHOWorld Health Organization