Human resources for maternal and newborn health in Benin, Malawi, Tanzania and Uganda: a policy process-tracing analysis

Background Central to the achievement of the Agenda for Sustainable Development and universal health coverage is an adequate, equitably distributed and fully supported health workforce. An adequate supply of health workers who possess the needed competencies and professional attitudes can deliver evidence-based, high-quality care across all levels of the health system, thereby contributing to better health outcomes. Methods This study analysed how the elements of the availability, accessibility, acceptability and quality framework have been integrated and used in human resource for health (HRH) policies and strategies related to the midwifery health workforce since 2010 in Benin, Malawi, Tanzania and Uganda. We applied the READ framework for our HRH policy and strategy policy tracing analysis. The stages of READ framework are: i) Ready your materials, ii) Extract data, iii) Analyse data and iv) Distil your findings Results Twenty HRH policies and strategies were included in the analysis. We found that all policies and strategies addressed aspects linked to availability and accessibility as well as the need for HRH quality improvements whereas acceptability was poorly represented. None of the policies and strategies mentioned the Sustainable Development Goals (SDG) target 3.c “substantially increase health financing and the recruitment, development, training and retention of the health workforce in developing countries, especially in least developed countries and small island developing States” and indicator 3.c.1 “health workforce density and distribution. Indicating a profound disconnect between reflecting the impact of national HRH interventions against the global accountability to the SDGs policy development framework. Conclusion Efforts and investments are needed to tackle the gaps and inequalities in the availability, accessibility, acceptability and quality of the midwifery workforce. Newer modalities of investments in their quality of pre-service training, remain imperative to accelerate the transition towards universal access to quality and more acceptable and accessible maternal and newborn health care services and consequently improved health outcomes.