IFGH 2012: Motivating and Retaining Mid-level Cadres in Obstetric Services

January 30, 2012


Authors:Sidat, M and the HSSE teams in the following organisations:

Centre for Global Health, University of Dublin, Trinity College; Averting Maternal Death and Disability Program (AMDD), Heilbrunn Department of Population and Family Health, Mailman School of Public Health, Columbia University, USA; Realizing Rights: the Ethical Globalization Initiative, USA; Regional Prevention of Maternal Mortality network, Accra, Ghana; Ifakara Health Institute, Mikocheni, Dar Es Salaam, Tanzania; University of Malawi, College of Medicine, Centre for Reproductive Health, Malawi; Department of Community Health, Faculty of Medicine, Eduardo Mondlane University, Mozambique

Option 1– Scientific / Empirical Research Findings Presented as – Oral Poster


The HSSE project aimed to support health system strengthening for equity in Africa by building an evidence base on the role of mid-level providers (MLP) in maternal and neonatal health and promoting greater political leaderships and critical policy action on this issue. One of the key research questions was ‘What are the factors that will optimise and support mid-level provider performance?’


The HSSE project drew on the WHO framework for monitoring health systems to address the six building blocks necessary for a functioning health system. The evidence generated was used to explore gaps and constraints in service delivery, health workforce, information, medical supplies and infrastructure, financing, leadership and governance. Quantitative and qualitative data were collected at multiple levels of the health system in each country. Hospitals and health facilities providing EmOC were included.


Between one-quarter and one-third of staff surveyed had seriously thought about leaving their current positions (Malawi 33%, Mozambique 29%, and Tanzania 27%). A substantial portion of job satisfaction levels could be explained by providers’ perceptions of adequate supervision, support from management, adequate pay for work done, and opportunities for career advancement. Supervision was a strong predictor of job satisfaction, and its absence directly affected stated intention to leave. Management and supervisory support appear to outweigh concerns relating to pay threefold in their contribution to job satisfaction levels.

Discussion/conclusions/ implications:

1. Support initiatives to strengthen human resource management practices, including supportive supervision 2. Develop clear career pathways for NPCs, particularly in Malawi
3. Develop professional representation mechanisms to ensure a voice for MLPs


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