Inclusion of human resources in maternal health policy processes: Lessons for strategic human resource planning

Background: Strategic human resource (HR) planning is key to solving the global health workforce crisis, but this needs to be integrated with health service planning. This study looked at HR planning in the context of policy development and implementation in the area of maternal health. Methods: Case studies of maternal health policies on skilled birth attendance, adolescent reproductive health, abortion and domestic violence were conducted in Vietnam, India and China. Data collection methods included over 110 semi-structured interviews, reviews of over 500 documents, several stakeholder participatory workshops and focus group discussions. A framework approach was used in the data analysis, followed by comparative analysis of the findings from study countries. Analysis included the complex interplay of key influences of health policy processes including human resources. Results: Skilled birth attendance is essentially about staffing health services, so unsurprisingly HR requirements were integrated in the policy planning process in all countries. In general, however, HR only began to be addressed when problems of policy implementation were identified. Then addressing HR was easier where, as with adolescent reproductive health policy in China and Vietnam, specific implementation guidelines had been developed. One reason for the absence of HR planning at the policy development stage is the lack of involvement of stakeholders who represent the HR needs of the health system. In fact the HR departments of ministries of health played no strategic role in policy development. Conclusions: Greater effort is needed at the policy development stage to identify HR requirements to minimise problems at the implementation stage. HR experts in the systems need to take a more proactive and strategic role to ensure that HR planning is integrated with health service planning. In turn this will lead to more successful execution of maternal health and other health policies.