The “Health 4+” (H4+) agencies (UNAIDS, UNFPA, UNICEF, UN Women, WHO and the World Bank) are working together in support of the United Nations Secretary-General’s Every Woman, Every Child campaign.

This includes the H4+ High Burden Countries Initiative (HBCI) that is supporting in-depth national assessments of midwifery in 8 high-burden countries (Afghanistan, Bangladesh, DRC, Ethiopia, India, Mozambique, Nigeria and Tanzania). ICS Integrare has been engaged by UNFPA to provide the Secretariat for the work of the H4+ and a Technical Working Group for the HBCI.

The National Assessments follow on from the data captured in the State of the World’s Midwifery reports 2011 and 2014 to identify gaps in service availability, quality and accessibility and support national authorities to develop costed implementation strategies. The process draws on existing tools/indicators and is complementary of country activities. A Handbook developed by ICS Integrare for the H4+ describes the framework of the assessments and process to be followed.

H4+ Handbook: Conducting a Sexual, Reproductive, Maternal, Newborn and Adolescent Health Workforce Assessment

This Handbook describes the framework and process for conducting national assessments of the sexual, reproductive, maternal, newborn and adolescent health (SRMNAH) workforce. It has been developed and revised after extensive implementation experience in HBCI countries such as Afghanistan, Bangladesh, Tanzania and Ethiopia.

The Handbook provides a step-by-step guide on data collection, synthesis and analysis that can be used by researchers, national health departments, professional associations, and other interested stakeholders. It is organized into easy-to-use modules that include key questions, data collection tools and instruments, and suggested national and international sources of data.


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Handbook tools and resources

Training capacity questionnaire
Clinical walkthrough tool
Informant interview: health workers
Informant interview: managers
Last 10 patients tool
Module 8. Effective coverage: urban vs. rural
Annex: Technical consensus statement
Pregnancies in 73 Countdown countries: 2012-2030
SoWMy 2014 Questionnaire


HBCI Mozambique SRMNAH workforce assessment

The national assessment of the SRMNAH workforce in Mozambique aims to provide the Ministry of Health (MISAU) with a comprehensive analysis of the context, population health needs and labour market of the SRMNAH workforce, in order to identify costed policy options that can accelerate progress towards achieving universal access to sexual, reproductive, maternal and newborn health services.

Phase 1 of the Assessment was completed in 2013 with the finalization of a Desk Review report. In 2014, a primary data collection study was completed by national partners. In August 2015, ICS Integrare research associates conducted an in-country stakeholder workshop to inform the modeling and analysis for phase 3 of the assessment. Policy options for costing and modeling were selected during this workshop. The final assessment report is currently being prepared and will be finalized by December 2015.

Mozambique: Midwifery Workforce Assessment. Document review. June 2013

Mozambique: Midwifery Workforce Assessment. Document review (Synthesis report). July 2013

HBCI Bangladesh RMNH workforce assessment

The Ministry of Health and Family Welfare (MOHFW) led the national assessment in Bangladesh, with a Steering Group including the H4+, the Bangladesh Nursing Council, the Bangladesh Midwifery Association, the Obstetrical and Gynaecological Society of Bangladesh and Jhpiego.

The national assessment commenced in March 2012, identifying and commissioning primary data requirements and the analysis of existing data specific to the health labour market, the reproductive, maternal and newborn health (RMNH ) workforce and the delivery of MNH services. Research, Training and Management (RTM) International was the country partner supporting the data collection, analysis and reporting for the assessment.

The final assessment report was launched on 5th May 2014, on the International Day of the Midwife. At the launch, the Joint Secretary, Human Resource Management, MoHFW, Dr. Md. Shajedul Hasan, handed over the Reproductive Maternal and Newborn Health (RMNH) Workforce Assessment report to the Honorable State Minister, MoHFW, Mr. Zahid Maleque in the presence of representatives of WHO and UNFPA.

Bangladesh RMNH Workforce Assessment

HBCI Tanzania midwifery workforce assessment

At the invitation of the Ministry of Health and Social Welfare (MOHSW) and led by representatives of the Human Resource Development Division and the Reproductive and Child Health (RCH) Section, a national assessment of the midwifery workforce is being undertaken in Tanzania.

The Core Group, including Jhpiego and the United Nations H4+ agencies, is supporting the Ministry in this effort. The national assessment commenced in April 2012 with a desk review that collated and analysed existing data and identified gaps that would require additional national data and primary data collection specific to the health labour market, the midwifery workforce and maternal and newborn health (MNH). A first draft of the assessment report was completed in July 2014.


HBCI Afghanistan midwifery workforce assessment

The Ministry of Public Health (MoPH), led by the Directorate for Reproductive Health and the Directorate General for Human Resources, is coordinating the national assessment, with support from the Afghanistan Midwives Association, the Afghan Society of Obstetricians and Gynaecologists, Jhpiego and the United Nations H4+ agencies.

Activities commenced in May 2012, identifying and commissioning primary data requirements and analysing existing data specific to the health labour market, the midwifery workforce and maternal and newborn health (MNH).

Preliminary findings were discussed with government and development partners in September 2012 and resulted in a Technical Consensus Statement presented to the Deputy Minister of Health.

The preliminary draft of the workforce assessment report was completed in May 2013.

Progress Update – September 2012
Technical Consensus Statement – September 2012
Stakeholder Consultation – Kabul, 10-11 September, 2012
Presentations – Kabul, May , 2012
Secondary Data Review – May 2012.
Presentation by Ms. Sabera Turkmani at the Global Health Maternal Conference in Arusha, Tanzania, January 16, 2013.
HBCI Primary Data Report – Afghanistan’s Midwifery Workforce Assessment: Rapid assessment in priority areas, April, 2013.

HBCI Ethiopia MNH workforce assessment

An Ethiopian Core Group was constituted under the leadership of the Directorate of Human Resources of the Federal Ministry of Health (FMoH), comprising representatives of the H4+ agencies, Jhpiego, the Ethiopian Society of Obstetricians & Gynaecologists and the Ethiopian Midwives Association.

An initial stakeholders meeting was organized in Addis Ababa in February 2012, where around 20 in-country governmental and non-governmental organizations, UN agencies and donors shared their knowledge of the current situation of the maternal and newborn health (MNH) workforce. The Core Group and the Secretariat assigned two in-country research agencies to collect primary data on the ground and review secondary data from published and unpublished sources.

The final assessment report was completed in September 2013.

Ethiopia: MNH Workforce Assessment. September 2013.