Progress on HRH: Acceptability
Dr Veena Dhawan stands outside Save the Children’s Mobile Health Unit of in Jahangir Puri, New Delhi, India.
Credit: Prashanth Vishwanathan/Save the Children
The acceptability dimension of human resources for health (HRH) introduces the dynamic of how users perceive health workers and the services they provide. Policymakers cannot assume that individuals will take-up services unless they deem them to be appropriate. Poor quality of care, or perceptions that care will be of poor quality, or provided in an inappropriate way, deters people from using services even if they are available.
The White Ribbon Alliance has launched a campaign for respectful maternity care and is calling for an end to the ill treatment and disrespect that many women experience during pregnancy.
Acceptability is enhanced when users of services have access to a health workforce that meets their expectations in terms of its gender and age composition, its skills mix, its cultural and linguistic make-up and, above all, its attitudes and behaviour and perceived competencies and quality of care (respect, no discrimination, good communication and empathy). Adolescent and youth health services, for example, need to be provided in a friendly way, so that they are accessible to and acceptable by young people.
The creation or expansion of community health workers and other cadres of frontline health workers who are deployed close to communities, can be an effective and efficient way to make services more accessible and acceptable s Since they are often from the communities they serve, these health workers are more likely to accepted and be sensitive to cultural, religious and other social issues.
The gender of health workers can be a critical factor for user demand and satisfaction, particularly among populations where being served by someone of the other sex is not culturally accepted. The gender of health providers is particularly relevant for increasing the uptake of reproductive health services.
Using the gender distribution of physicians and the ratio of nurses to physicians as proxies for acceptability, the Global Health Workforce Alliance report found a wide variation in health workforce configurations. In India, for example, 83% of physicians are men.
In higher-income countries women now form a majority in educational institutions and are gradually becoming a majority of physicians. However, attracting more women medical students is not a guarantee that access to women doctors will improve in the same proportion, as the new graduates do not always enter the labour market or may seek more flexible working patterns in their career paths
To ensure that all communities benefit from increased access to health workers, policymakers must ensure that they are building a workforce that reflects the composition and needs of the whole population, including the most vulnerable and marginalised groups.