TABLE.

Mapped Human Resources for Health-Related Challenges With Review Sources

HRH ChallengeExamplesCountrySource TypeSource
1. Lack of data on HRHScarce HRH data as a barrier to HRH planningNigeriaPRAdegoke et al.35
Few workforce indicators for midwiferyMongoliaPRKildea et al.36
2. Poor HW preservice education/insufficient newborn contentLack of qualified instructors and clinical preceptors for midwivesDemocratic Republic of the CongoPRBogren et al.37
Basic neonatal component in nursing preservice insufficientGhanaPRElikplim Pomevor and Adomah-Afari38
Bachelor's-level nurse curriculum and performance poor compared to other providers (including diploma nurses)EthiopiaReportGetachew et al.32
HWs receive limited preservice instruction on neonatal care in their basic trainingKenyaPRAluvaala et al.10
NB care not a core competency in general nursing educationIndiaPRCampbell-Yeo et al.39
3. Lack of access for HWs to evidence-based practice guidelines and protocols, CE, and CPDNonavailability of ENC and NR guidelines/protocolsEthiopiaPRHaile-Mariam et al.41
Lack of guidelines/posted protocols NRMalawiPRBream et al.42
Few protocols for care of sick neonates availableGhanaPRElikplim Pomevor and Adomah-Afari38
Helping Babies Breathe guidelines in 25% of health facilitiesMalawiPRKozuki et al.43
Nonavailability of NB protocolsTanzaniaPRNyamtema et al.47
Poor dissemination of practice protocols to NICU nursesThailandPRJirapaet et al.44
Little in-service training on NB, NR, and small and sick newborn careGhanaPRElikplim Pomevor and Adomah-Afari38
IndiaPRMalhotra et al.40
75% of health centers studied had no trained clinician in basic emergency obstetric and newborn careMalawiPRKozuki et al.43
Variable CE opportunities for neonatal nursesIndiaPRCampbell-Yeo et al.39
Limited access to CE for nurses and midwivesDR CongoPRBolan et al.66
Lack of policy on CE/renewal of skillsMalawiPRBream et al.42
Little CE for HWs on managing NR or newborn emergenciesThe GambiaPRCole-Ceesay et al.45
No CE for midwivesMongoliaPRKildea et al.36
Lack of coordination of CPD of HWs, in past CPD not mandatory for MWs and absence of quality control over CPDLiberiaPRMichel-Schuldt et al.46
4. Insufficient and inequitable distribution of HWs, heavy workloadInsufficient HWs in generalNigeriaPRAdegoke et al.35
MalawiPRBream et al.42
TanzaniaPRNyamtema et al.47
Lack of HWs in primary health care/district hospitalsNepalPRAllen and Jeffrey54
Insufficient NICU staffThailandPRJirapaet et al.44
Lack of specialized nursing staff for neonatal care and sick newbornsSE Asia (4 countries)PRMartinez et al.29
Solomon IslandsPRTosif et al.55
IndiaPRNeogi et al.31
Acute nursing shortage in newborn unitsKenyaPRNzinga et al.48
KenyaPRAluvaala et al.10
Shortage of HWs with neonatal trainingRwandaPRNtigurirwa et al.49
Low number of HWs compounded by uneven distribution.IndonesiaReportNational Research Council33
Poor distribution in rural/remote areasNepalPRAllen and Jeffrey54
NigeriaPRAdegoke et al.35
IndiaPRFischer et al.50
Heavy workload for existing staffIndiaPRAmin et al.51
CambodiaPRIth et al.52
IndiaPRMorgan et al.58
Gap filling with lower-level staffTanzaniaPRPrytherch et al.53
5. Poor retention, rotation out, absenteeismPoor retention of HWs due to (examples)

  • - Deaths of HWs from HIV

  • - Rural-urban migration

  • - External brain drain

  • - Attrition to private sector and non-governmental organizations

TanzaniaPRNyamtema et al.47
RwandaPRNtigurirwa et al.49
IndiaPRNeogi et al.11
GambiaPRCole-Ceesay et al.45
AbsenteeismIndiaPRNeogi et al.11
TanzaniaPRNyamtema et al.47
TanzaniaPRPrytherch et al.53
Rotation /transfer of neonatal nurses

  • - To other units

  • - To other facilities

IndiaPRDewez et al.57
GhanaPRElikplim Pomevor and Adomah-Afari38
RwandaPRNtigurirwa et al.49
6. Poor work environment including: low salary; bad housing; lack of supplies, medications, equipment, electricity, and water; and poor safety and infrastructureLow salary and irregular paymentNigeriaPRAdegoke et al.35
CambodiaPRIth et al.52
TanzaniaPRPrytherch et al.53
Poor accommodationsGambiaPRCole-Ceesay et al.45
Lack of safety on the job

  • - Lack of protective equipment

  • - Fear theft, assaults, gender-based violence, assault by families

NigeriaPRAdegoke et al.35
GambiaPRCole-Ceesay et al.45
IndiaPRMorgan et al.58
TanzaniaPRPrytherch et al.53
Lack of equipment, essential drugs, suppliesNigeriaPRAdegoke et al.35
Southeast Asia (4 countries)PRMartinez et al.29
EthiopiaPRHaile-Mariam et al.41
IndiaPRMorgan et al.58
Lack of tech support, delays in repairSolomon IslandsPRTosif et al.55
Ward setup as barrier to careIndiaPRNeogi et al.56
MalawiPRBream et al.42
7. Limited and poor supervisionLimited capacity for routine supervisionLao PDRPRHoriuchi et al.59
No on-site mentors or technical support for MWs with limited skillsNigeriaPRAdegoke et al.35
Lack of clinical supervision in NICUThailandPRJirapaet et al.12
Supervision punitive, no feedback given, lack of confidentialityTanzaniaPRPrytherch et al.53
Problems remain unsolved after supervisory visitsLao PDRPRHoriuchi et al.59
8. Low morale, poor motivation and attitude, dissatisfactionPoor conditions, salaries, lack of incentivesGambiaPRCole-Ceesay et al.45
Lack of career ladder and promotion opportunities for HWsNigeriaPRAdegoke et al.35
MongoliaPRKildea et al.36
TanzaniaPRPrytherch et al.53
Burnout and stress, overwhelmed by workload and patient numbersIndiaPRAmin et al.51
IndiaPRDewez et al.57
Powerless over work environment, lack of control over transfersTanzaniaPRPrytherch et al.53
IndiaPRDewez et al.57
Low morale from high mortality of patients and inability to provide good care due to poor conditionsGambiaPRCole-Ceesay et al.45
IndiaPRDewez et al.57
TanzaniaPRPrytherch et al.53
9. Weaknesses of policy, regulations, management, leadership, governance, and fundingLack of policy and regulatory frameworks for neonatal care and clinical protocolsGhanaPRElikplim Pomevor and Adomah-Afari38
CambodiaPRIth et al.52
Limited scope of practice for MWs, not in line with international scope of practiceMongoliaPRKildea et al.36
No nationally accepted competency standards for MWs and nursesMongoliaPRKildea et al.36
IndonesiaReportNational Research Council33
Lack of parity between public and faith-based workers' salariesTanzaniaPRPrytherch et al.53
Absence of staffing norms by facility levelGhanaReportMinistry of Health Ghana30
Nonrecognition by management of need for ICU-like ratios in neonatal care unitsIndiaPRDewez et al.57
Lack of support by hospital management team, facility leadership, or authoritiesIndiaPRDewez et al.57
IndiaPRFischer et al.50
Lack of job descriptions, neonatal guidelines, or orientation in newborn unitsKenyaPRNzinga et al.48
TanzaniaPRPrytherch et al.53
IndiaPRCampbell-Yeo et al.39
Low productivity by HWsTanzaniaPRNyamtema et al.47
Unsupportive management, inflexible work schedulesTanzaniaPRPrytherch et al.53
HR deficiencies at management level resulting in inefficient management, particularly related to budgetingLao PDRPRSychareun et al.60
Nonprioritization of newborn health by policy makers in pastGhanaReportMinistry of Health Ghana30
Weak professional associations that do not improve conditions of HWsTanzaniaPRPrytherch et al.53
Inadequate funding in national budgets for neonatal care (public sector)UgandaPRMbonye et al.34
TanzaniaPRNyamtema et al.47
GambiaPRCole-Ceesay et al.45
10. Structural and contextual barriersLack of recognition of newborn specialty care requirementsIndiaPRCampbell-Yeo et al.39
Lack of community perception of neonatal disease burdenNepalPRAllen and Jeffrey54
Neglect of female newbornsIndiaPRMorgan et al.58
Child-bearing women lack power to determine care-seeking behavior in emergenciesNepalPRBrunson61

  • Abbreviations: CE, continuing education; CPD, continuing professional development; ENC, essential newborn care; HRH, human resources for health; HW, health worker; ICU, intensive care unit; MW, midwife; NB, newborn; NICU, neonatal intensive care unit; NR, neonatal resuscitation; PR, peer-reviewed.