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Case studies and best practice

Accompanying the report of the Task Force on Scaling up Education and Training of Health workers --Scaling Up, Saving Lives-- are a series of country case studies, commissioned as part of the Task Force work. Currently available are five published country case studies: from Bangladesh, Ethiopia, Ghana, India and Malawi. These case studies describe successful scale up models which are central in bringing about improvements in the health status of their populations.


Bangladesh Trains Health Workers to Reduce Maternal Mortality, 2008 (GHWA). Medical doctors and nurses in Bangladesh are concentrated in urban secondary and tertiary hospitals, while 70% of the population lives in rural areas. This situation has created a major challenge for the national health system, particularly for reducing the high maternal mortality rate, with fewer than 20% of births being attended by a skilled birth attendant. To address this issue, the Prime Minister signed the Declaration of Safe Motherhood in 1997.


Ethiopia's human resources for health program, 2008 (GHWA). Ethiopia suffers from an acute shortage of health workers at every level, and rural areas, in which 85% of the population live, have been particularly chronically under-served. The Ministry of Health calculated that 60-80% of the country’s annual mortality rate is due to preventable communicable diseases such as malaria, pneumonia and TB. HIV and AIDS are also growing concerns. They therefore chose to begin by focussing on community level provision, initiating the Health Extension Programme in 2004.


Ghana: Implementing a national human resources for health plan, 2008 (GHWA). Ghana has recognised the need to address its serious health workforce shortage, and consequent issues with health service delivery. A new human resources strategic plan has been developed to guide scale-up from 2007 to 2011. This fits into the broader health sector plan, which prioritises general health system development, promotion of healthy lifestyles and environment, improving healthy reproduction and nutrition services and governance and financing . It is also consistent with the President’s vision to bring the country to middle-income status by 2015 – a goal that requires a healthy population.


Malawi's emergency human resources programme, 2008 (GHWA). Human resource shortages in Malawi’s health sector are among the severest in sub-Saharan Africa, even though political commitment to address the crisis has been strong since the late 1990s. Limited financial support of the country’s 1999-2004 human resource development plan prompted the Ministry of Health to focus specifically on pre-service education with an emergency training plan beginning in 2002.


Pakistan's lady health worker programme, 2008 (GHWA). Pakistan’s health sector is characterised by urban-rural disparities and an imbalance in the health workforce, with insufficient numbers of health managers, nurses, paramedics and skilled birth attendants. Through the Prime Minister’s Programme for Family Planning and Primary Care, the government created the Lady Health Worker cadre in 1994. The aim was to provide essential primary health services in the community and fulfil the unmet health needs in rural and urban slum areas.