Obstacles and Enablers to the Professional Development of Skilled Birth Attendants: a Case Study of the Shoklo Malaria Research Unit on the Thailand-Myanmar Border

• Main Author: Chamberland, Caroline
• Other Authors: Bourgeault, Ivy Lynn
• Language: en
• Published: Université d'Ottawa / University of Ottawa 2016
• Subjects: Human Resources for Health; Health Systems; Skilled Birth Attendance; Maternal Health; Professional Development; Protracted Displacement; Recruitment; Retention
• Online Access: http://hdl.handle.net/10393/35100; http://dx.doi.org/10.20381/ruor-5397

Although Skilled Birth Attendance has been universally acknowledged as essential to progress in the field of maternal health (WHO, 2004), Human Resources for Health (HRH) deficits are currently impeding the sustainability of essential maternal health interventions on a global scale. Over the past 30 years, the Shoklo Malaria Research Unit (SMRU), along with other agencies such as non-governmental organizations and community-based organizations, have developed a self-contained health system, which provides health services, including maternity care, to migrants and refugees at the Thailand-Myanmar Border. The staff necessary to the provision of care in SMRU’s clinics are mostly recruited from within the migrant and refugee populations, and trained internally by SMRU. In the last decade, SMRU has experienced high-turnover rates and shortages of Skilled Birth Attendants (SBA). Consequently, their current maternity workforce is characterized by an acute shortage of SBAs who have attained senior status, and a higher concentration of SBAs at the assistant and junior levels. As a response to these HRH challenges, this case study aimed to conduct a multi-level analysis of obstacles and enablers to professional development amongst Skilled Birth Attendants working for SMRU. This single descriptive case study with embedded units of analysis, which incorporated non-participant observation, a template-based personnel file review, individual interviews, and focus groups at two of SMRU’s Birthing Units, represented a unique opportunity to observe and analyze the multiple influences that interact at various levels of a relatively self-contained health system. By highlighting the obstacles and enablers present within the system, this study purposed to identify means by which to empower lower level SBAs, support their professional development, and create a more sustainable maternity workforce. The study found that SMRU has been successful in providing its SBAs with the appropriate midwifery skills to fulfill a limited scope of practice, and in fostering strong intra-professional relationships that allow the SBAs to motivate and mentor each other. Achieving workforce sustainability with a model of care that implements task-shifting requires a balance of appropriate and constructive consultation structures without enabling the stagnation of SBAs’ skills and confidence. This study also reveals the importance of context and culture to a health system’s capacity to optimally plan and implement its HRH functions. Finally, in the case of SMRU, persistent recruitment and retention concerns underscore that workforce sustainability cannot be achieved through professional development alone. Therefore, this study reveals a need for further inquiry into the complexities of maternal health workforce planning in contexts of protracted displacement, and the challenges associated with developing appropriate supervisory structures for lower level health professionals.