COMMUNITY MIDWIVES IN YEMEN: THE CHALLENGES IN A FRAGILE SITUATION Gamal Badr Al-Aghbari Yemen 53rd Master of Public Health/International Course in Health Development 19 September 2016 - 8 September, 2017 KIT (ROYAL TROPICAL INSTITUTE) Health Education/ Vrije Universiteit Amsterdam Community midwives in Yemen: the challenges in a fragile situation A thesis submitted in partial fulfilment of the requirement for the degree of Master of Public Health By: Gamal Badr Al-Aghbari - Yemen Declaration: Where other people’s work has been used (either from a printed source, internet or any other source) this has been carefully acknowledged and referenced in accor- dance with departmental requirements. The thesis Community midwives in Yemen: the challenges in a fragile situation is my own work. Signature: 53rd Master of Public Health/International Course in Health Development (MPH/ICHD) 19 September 2016 - 8 September, 2017 KIT (Royal Tropical Institute)/ Vrije Universiteit Amsterdam Amsterdam, The Netherlands September 2017 Organised by: KIT (Royal Tropical Institute) Health Unit Amsterdam, The Netherlands In co-operation with: Vrije Universiteit Amsterdam/ Free University of Amsterdam (VU) Amsterdam, The Netherland Table of Contents Table of Contents ...................................................................................................................... i List of Figures ............................................................................................................................ iv List of Tables .............................................................................................................................. v Acknowledgments.................................................................................................................... vi List of Abbreviations .............................................................................................................. vii Glossary ..................................................................................................................................... viii Abstract ....................................................................................................................................... ix Introduction ................................................................................................................................ x Chapter 1: Country Background .................................................................................. 1 1.1 Geography: ......................................................................................................................................... 1 1.2 Political situation and humanitarian crisis: ........................................................................................ 1 1.3 Socio-demographic context: .............................................................................................................. 2 1.4 Education: .......................................................................................................................................... 2 1.5 Economic status: ................................................................................................................................ 2 1.6 Socio-culture and gender: .................................................................................................................. 3 1.7 Health System: ................................................................................................................................... 3 1.7.1 Health financing ..................................................................................................................................... 4 1.8 Community midwives in Yemen: ....................................................................................................... 4 1.9 Health Status: ..................................................................................................................................... 5 Chapter 2: Problem statement, Justification and Methodology ............... 7 2.1 Problem statement: ........................................................................................................................... 7 2.2 Justification: ....................................................................................................................................... 8 2.3 Study objectives ................................................................................................................................. 8 2.3.1 General Objective: ............................................................................................................................ 8 2.3.2 Specific objectives: .......................................................................................................................... 8 2.4 Methodology: ..................................................................................................................................... 9 2.4.1 Methods of data collection: ........................................................................................................... 9 2.4.2 Inclusion criteria: ............................................................................................................................ 11 2.4.3 Conceptual work: ............................................................................................................................ 11 2.4.4 Study Limitation: ............................................................................................................................ 12 i Chapter 3: Findings ........................................................................................................... 13 Section 1. Availability of CMWs, CMWs financing, Legal framework, MoPHP capability, Health policy and HRH policy, Coordination and Monitoring. ..................................................................................... 13 3.1.1 Availability of CMW in Yemen: ..................................................................................................... 13 3.1.1.a Number: ....................................................................................................................................... 13 3.1.1.b Distribution: ................................................................................................................................. 14 3.1.1.c Coverage: ..................................................................................................................................... 15 3.1.2 Ministry of Health capability: ........................................................................................................ 15 3.1.3 Legal framework: .......................................................................................................................... 16 3.1.4 Finance .......................................................................................................................................... 17 3.1.5 Health Policy and HRH policy and plan ......................................................................................... 18 3.1.6 Coordination: ................................................................................................................................ 19 3.1.7 Monitoring: ................................................................................................................................... 20 Section 2: Production, deployment, retention and HR system responding to the health needs .......... 22 3.2.1 Production: .................................................................................................................................... 22 3.2.2 Deployment: ................................................................................................................................. 23 3.2.2.a Recruitment ................................................................................................................................. 23 3.2.2.b Selection........................................................................................................................................ 24 3.2.2.c Public .............................................................................................................................................. 24 3.2.2.d Private ............................................................................................................................................ 26 3.2.3 Retention: ..................................................................................................................................... 26 3.2.3.a HR management ........................................................................................................................ 27 3.2.3.b Career path/ continuous education .................................................................................... 27 3.2.4 HR system responding to the health needs: ................................................................................. 28 Section 3. Review of other similar context policies, regulations and interventions ............................. 29 3.3.1 Human resource availability: ........................................................................................................ 29 3.3.2 MOH capability: ............................................................................................................................ 29 3.3.3 Legal framework: .........................................................................................................................