Human resources for maternal health: multi-purpose or specialist?

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This pertinent question formed the title to an article in Human Resources for Health by midwife consultant Della Sherratt and Vincent Fauveau and Luc de Bemis of UNFPA. Can the aim to attain MDG5 be achieved faster with the scaling up of multipurpose health workers operating in the community or with the scaling up of professional skilled birth attendants working in health facilities?

The authors propose addressing seven key areas when planning human resources for maternal health: those recommended by the ICM/UNFPA first International Forum on Midwifery in the Community, Tunis, December 2006:

1. Policy, legal and regulatory frameworks

2. Ensuring equity to reach all

3. Recruitment and education (pre- and in-service), accreditation

4. Empowerment, supervision, support

5. Enabling environment, systems, community aspects

6. Tracking progress, monitoring and evaluation, numbers and quality

7. Stewardship, resource mobilisation

They introduce a fundamental contrast between 'community midwives', considered unable to fulfil core life-saving functions and 'midwives in the community', who are midwives first, with all the skills in the definition.

Fauveau et al conclude that no significant reduction in maternal mortality can be achieved...