title: Systematic review on human resources for health interventions to improve maternal health outcomes: evidence from low- and middle-income countries.
abstract: There is a broad consensus and evidence that shows qualified, accessible, and responsive human resources for health (HRH) can make a major impact on the health of the populations. At the same time, there is widespread recognition that HRH crises particularly in low- and middle-income countries (LMICs) impede the achievement of better health outcomes/targets. In order to achieve the Sustainable Development Goals (SDGs), equitable access to a skilled and motivated health worker within a performing health system is need to be ensured. This review contributes to the vast pool of literature towards the assessment of HRH for maternal health and is focused on interventions delivered by skilled birth attendants (SBAs). Studies were included if (a) any HRH interventions in management system, policy, finance, education, partnership, and leadership were implemented; (b) these were related to SBA; (c) reported outcomes related to maternal health; (d) the studies were conducted in LMICs; and (e) studies were in English. Studies were excluded if traditional birth attendants and/or community health workers were trained. The review identified 25 studies which revealed reasons for poor maternal health outcomes in LMICs despite the efforts and policies implemented throughout these years. This review suggested an urgent and immediate need for formative evidence-based research on effective HRH interventions for improved maternal health outcomes. Other initiatives such as education and empowerment of women, alleviating poverty, establishing gender equality, and provision of infrastructure, equipment, drugs, and supplies are all integral components that are required to achieve SDGs by reducing maternal mortality and improving maternal health.
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.|Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: Zohra S
authors.initials: ZS
authors.lastname: Lassi
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Nabiha B
authors.initials: NB
authors.lastname: Musavi
authors.affiliation: Department of Maternal Newborn Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
authors.forename: Blerta
authors.initials: B
authors.lastname: Maliqi
authors.affiliation: Division of Women and Child Health, Aga Khan University, Karachi, Pakistan.
authors.forename: Nadia
authors.initials: N
authors.lastname: Mansoor
authors.affiliation: Partnership for Maternal Newborn & Child Health, Geneva, Switzerland.
authors.forename: Andres
authors.initials: A
authors.lastname: de Francisco
authors.affiliation: Partnership for Maternal Newborn & Child Health, Geneva, Switzerland.
authors.forename: Kadidiatou
authors.initials: K
authors.lastname: Toure
authors.affiliation: Center of Excellence in Women and Child Health, Aga Khan University, Karachi, Pakistan. zulfiqar.bhutta@sickkids.ca.|Centre for Global Child Health, The Hospital for Sick children, Toronto, Canada. zulfiqar.bhutta@sickkids.ca.
authors.forename: Zulfiqar A
authors.initials: ZA
authors.lastname: Bhutta
mesh_terms: D003150:Community Health Workers; D003906:Developing Countries; D005260:Female; D006295:Health Resources; D006297:Health Services Accessibility; D006801:Humans; D000068097:Maternal Health; D008427:Maternal Health Services / Q000592:standards; D008880:Midwifery; D011247:Pregnancy; D013192:Staff Development; D000078329:Workforce
keywords: Human resources for health; Low- and middle-income countries; Maternal mortality; Skilled birth attendant