Training and deploying human resources for health for maternal, newborn, and child health in rural Africa: an in-depth policy analysis

Introduction: The majority of African countries lack sufficient human resources for health (HRH) to deliver basic maternal, newborn, child health (MNCH) care, particularly in rural areas. To inform planning for the scarce HRH available, specifically as it pertains to the Millennium Development Goals and the post-2015 agenda, a rapid systematic review of evidence on training and deployment policies for doctors, nurses and midwives for MNCH in rural Africa was undertaken. Methods: Documents for synthesis and analysis were obtained through a scoping review of 14 peer-reviewed electronic databases and systematic searches of international organization and government websites. In-depth policy analyses were then conducted for sub-set of 8 countries: Ethiopia, Ghana, Mali, Mozambique, Niger, Tanzania, Uganda and Zambia. Results: A paucity of evidence on such policies exists. Beyond policy names and contextual information, little material on actual policy development, implementation, or impact was available. However, multiple cross-cutting political and socio-economic issues affecting the policy process were identified. Conclusion: This lack of evidence hinders objective assessment of policies and the development and management of health care systems, which require clear linkages between evidence, policy, and service provision. Further research into the identified contextual factors and issues of planning-implementation gaps, transparency, limited evidence, research bias, and resource management, among others, is critical to strengthening Africa’s rural health systems through the increased presence of adequately trained HRH for MNCH.