Human resources for health, service coverage and maternal and perinatal outcomes in Benin, Malawi, Tanzania and Uganda

A well-performing and competent health workforce (HWF) is at the core of health systems yet many countries are facing a human resources for health (HRH) crisis. A prerequisite for achieving universal health coverage, including fulfilling the Sustainable Development Goals related to women and newborns, is an adequate supply of health workers able to provide quality of care at all levels of the health system. Thus, we evaluated how HRH policies and strategies influenced trends of maternal and newborn workforce densities and assessed the association between HWF densities, service coverage and health outcomes in Benin, Malawi, Tanzania and Uganda. We applied the READ framework (Ready your materials; Extract data; Analyse data and Distil findings) for our HRH policy and strategy document analysis and conducted a comparative analysis including three HWF densities (medical doctors, nursing and midwifery personnel) two health services, and five health outcome variables. Twenty HRH policies and strategies were included in the analysis published from 2010 to 2021. The scope of the HRH policies and strategies were described in four dimensions; availability, accessibility, acceptability and quality. We found that all policies and strategies addressed aspects related to availability and accessibility as well as the need for HRH quality improvements whereas acceptability was poorly represented. The comparative analysis revealed that service coverage and health outcomes appear to be insensitive to the fluctuations in HWF densities and related HRH policies as very little or no reduction was seen in outcomes from 2010 to 2020. There is a need to tackle the availability, accessibility, acceptability and quality of the HWF. Evidence needs to be translated into policy and practice otherwise the HWF in these countries will continue to struggle, affecting progress and realizing womens and newborns human rights to health.