Evaluation de la disponibilité des personnels qualifiés en santé maternelle et néonatale à Madagascar

Several factors contribute to this state of health, including the lack of qualified health workers. Given that previous interventions aimed at achieving Millennium Development Goals 4 and 5 have been unsuccessful, it is essential to assess the availability of qualified health workers to provide maternal and neonatal health services in public health facilities. A cross-sectional survey was conducted in 52 public health facilities across 15 of Madagascar's 22 regions, using and adapting the Service Availability and Readiness Assessment (SARA) tool from the World Health Organization. Data was collected on tablets using CommCare ODK software and analyzed by level of health facility using SPSS20.0. The results show that there is no general practitioner in 14% of reference hospitals and 22% of primary health centers. The median number of obstetrician-gynecologists in hospitals capable of performing caesarean sections is 1. Only 20% of the 15 regions surveyed have a high proportion (>80%) of qualified personnel in maternal and neonatal health in public health facilities. The evaluation of human resources contributing to the health system is rarely conducted globally, particularly in developing countries. However, human resources for health are a key determinant of the health system. In the last decade, it has become clear that the shortage of health workers in countries with low health indicators hinders their ability to combat diseases and provide life-saving interventions. The global shortage of health workers is estimated to be around 4.3 million, with the most affected countries being those with high disease burdens. According to the World Health Organization, the current health workforce in the most affected countries in sub-Saharan Africa would need to be increased by 140% to achieve the Millennium Development Goals. This study aimed to evaluate the status of service offers in maternal and neonatal health in public health facilities. Through this study, the objective is to evaluate the availability of qualified health workers, i.e., those with recent updates on their knowledge and technical skills, to provide maternal and neonatal health services in public health facilities of 15 regions in Madagascar. The literature review highlights the vulnerability of Madagascar's health system to achieve maternal mortality reduction goals, and the active contribution of health workers in the public and private sectors is a strategy to increase the chances of achieving the Millennium Development Goals. The evaluation of the availability of qualified health workers is essential to identify effective strategies for reducing maternal and neonatal mortality. The study's findings have implications for policy and program development, highlighting the need to strengthen human resource capacity and availability to provide maternal and neonatal health services in public health facilities.