Maternity Benefit Programs: An Investment in Human Resource

Dear Sir, I am writing to express grave concern regarding the current practice of limiting maternity leave to 90 days in private or deemed medical institutions and hospitals, which directly violates the Maternity Benefit (Amendment) Act, 2017. This act mandates 6 months (26 weeks) of paid maternity leave for working women in both public and private sectors. The discrepancy between legal requirements and implementation poses significant risks to maternal and child health outcomes. The Maternity Benefit (Amendment) Act was enacted based on substantial scientific evidence supporting the benefits of extended maternity leave for both mother and child.[1] The current practice in many private and medical institutions is limiting maternity leave to 90 days or paid leaves for only 90 days instead of 180 days or 26 weeks, representing a legal violation and a significant public health concern. THE IMPACT ON MATERNAL HEALTH The inadequate maternity leave period significantly compromises maternal health recovery. Research indicates that women need at least 24 weeks for optimal physical recovery from childbirth.[2] The postpartum period involves significant physiological changes, including: Physical Recovery: The immediate postpartum period requires 6–8 weeks for essential wound healing and uterine involution. However, complete musculoskeletal recovery, particularly after cesarean sections, can take 3–6 months.[3] Mental Health: Studies show that shortened maternity leave is associated with increased rates of postpartum depression and anxiety. Women, who return to work before six months postpartum show a 25% higher risk of developing postpartum depression compared to those who take longer leave.[4] Lactation Establishment: The World Health Organization recommends exclusive breastfeeding for 6 months. Early return to work significantly impacts breastfeeding duration and success rates, with studies showing that women, who return to work before 6 months are 40% more likely to discontinue breastfeeding prematurely.[5] IMPACT ON CHILD HEALTH AND DEVELOPMENT The consequences of abbreviated maternity leave extend beyond maternal health to affect infant development and well-being: Compromised Immune Protection: Shortened breastfeeding duration due to early return to work reduces the transfer of maternal antibodies to infants, leading to increased susceptibility to infections and respiratory illnesses in the first year of life.[6] Developmental Impacts: Research demonstrates that infants whose mothers return to work before 6 months show slightly lower cognitive and socio-emotional development scores in their first year than those whose mothers take longer leave.[7] Attachment and Bonding: The critical period for maternal-infant bonding extends beyond the first three months. Interrupted bonding due to early maternal return to work can affect the child’s emotional security and social development.[8] ECONOMIC AND PROFESSIONAL IMPLICATIONS While private medical institutions might cite financial considerations for limiting maternity leave, this short-sighted approach overlooks several critical factors: Staff Retention: Inadequate maternity benefits often increase female medical professionals’ turnover rates, increasing recruitment and training costs. Productivity and Job Satisfaction: Women who receive adequate maternity leave show higher rates of job satisfaction and workplace commitment upon return, leading to improved productivity and reduced absenteeism. Healthcare Quality: Stressed and inadequately recovered healthcare workers are more prone to medical errors and compromised patient care quality. DISCRIMINATION AGAINST NON-PERMANENT EMPLOYEES The situation is even more dire for non-permanent employees, who are denied their rightful maternity benefits despite working for more than a year, and the employees are always employed on a contractual basis in private and deemed Institutions. This discriminatory practice violates the fundamental right to equality enshrined in our Constitution. Research indicates that temporary workers already face heightened workplace stress, and denying them maternal benefits further compounds their vulnerabilities. To address these concerns, we propose the following measures: Immediate Policy Revision: Private medical institutions must align their maternity leave policies with the national mandate of 6 months of paid leave. Implementation Monitoring: Establishment of a monitoring mechanism to ensure compliance with maternity benefit regulations across all private healthcare institutions. Support Systems: Development of workplace support systems, including Flexible return-to-work options, on-site childcare facilities, Lactation support rooms and breaks, Extended leave options for complicated pregnancies Financial Planning: Institutions should develop sustainable financial models to support extended maternity leave, possibly through insurance schemes or government partnerships. Creation of awareness programs about the importance of adequate maternity leave among institutional leadership. The disparity between legally mandated maternity leave and current practices in private medical institutions represents a significant public health concern that demands immediate attention. As healthcare institutions, these organizations are responsible for modelling best practices in health-protective policies. The current practice violates legal requirements and contradicts evidence-based recommendations for optimal maternal and child health outcomes. The health of our healthcare workers and their children should not be compromised for institutional convenience or financial considerations. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Monto-Carlo method is widely used for project risk analysis. Evaluating the risk in HR (Human Resources) investment project, which is of hi-investment and hi-return, by Monto-carlo method is a new attempt. In this paper, by taking cost, profit and risk in the HR investment as index, emulation model of HR investment and index function of risk evaluation were established. Simulation about the whole investment course was done by computer program using Monto-Carlo method. Case study of HR investment risk evaluation was done later using concrete data.

BackgroundDespite continued investment, Maternal, Newborn and Child Health (MNCH) indicators in low and middle income countries have remained relatively poor. This could, in part, be explained by inadequate resources to adequately address these problems, inappropriate allocation of the available resources, or lack of implementation of the most effective interventions. Systematic priority setting and resource allocation could contribute to alleviating these limitations. There is a paucity of literature that follows through MNCH prioritization processes to implementation, making it difficult for policy makers to understand the impact of their decision-making on population health. The overall objective of this paper was to describe and evaluate priority setting for maternal, newborn and child health interventions in Uganda.MethodsFifty-four key informant interviews and a review of policies and media reports were used to describe priority setting for MNCH in Uganda. Kapiriri and Martin’s conceptual framework was used to evaluate priority setting for MNCH.ResultsThere were three main prioritization exercises for maternal, newborn and child health in Uganda. The processes were participatory and were guided by explicit tools, evidence, and criteria, however, the public and the districts were insufficiently involved in the priority setting process. While there were conducive contextual factors including strong political support, implementation was constrained by the presence of competing actors, with varying priorities, an unequal allocation of resources between child health and maternal health interventions, limited financial and human resources, a weak health system and limited institutional capacity.ConclusionsStronger institutional capacity at the Ministry of Health and equitable engagement of key stakeholders in decision-making processes, especially the public, and implementers, would improve understanding, satisfaction and compliance with the priority setting process. Availability of financial and human resources that are appropriately allocated would facilitate the implementation of well-developed policies.

SummaryBackgroundTracking aid flows helps to hold donors accountable and to compare the allocation of resources in relation to health need. With the use of data reported by donors in 2015, we provided estimates of official development assistance and grants from the Bill & Melinda Gates Foundation (collectively termed ODA+) to reproductive, maternal, newborn, and child health for 2013 and complete trends in reproductive, maternal, newborn, and child health support for the period 2003–13.MethodsWe coded and analysed financial disbursements to reproductive, maternal, newborn, and child health to all recipient countries from all donors reporting to the creditor reporting system database for the year 2013. We also revisited disbursement records for the years 2003–08 and coded disbursements relating to reproductive and sexual health activities resulting in the Countdown dataset for 2003–13. We matched this dataset to the 2015 creditor reporting system dataset and coded any unmatched creditor reporting system records. We analysed trends in ODA+ to reproductive, maternal, newborn, and child health for the period 2003–13, trends in donor contributions, disbursements to recipient countries, and targeting to need.FindingsTotal ODA+ to reproductive, maternal, newborn, and child health reached nearly US$14 billion in 2013, of which 48% supported child health ($6·8 billion), 34% supported reproductive and sexual health ($4·7 billion), and 18% maternal and newborn health ($2·5 billion). ODA+ to reproductive, maternal, newborn, and child health increased by 225% in real terms over the period 2003–13. Child health received the most substantial increase in funding since 2003 (286%), followed by reproductive and sexual health (194%), and maternal and newborn health (164%). In 2013, bilateral donors disbursed 59% of all ODA+ to reproductive, maternal, newborn, and child health, followed by global health initiatives (23%), and multilateral agencies (13%). Targeting of ODA+ to reproductive, maternal, newborn, and child health to countries with the greatest health need seems to have improved over time.InterpretationThe increase in reproductive, maternal, newborn, and child health funding over the period 2003–13 is encouraging. Further increases in funding will be needed to accelerate maternal mortality reduction while keeping a high level of investment in sexual and reproductive health and in child health.FundingSubgrant OPP1058954 from the US Fund for UNICEF under their Countdown to 2015 for Maternal, Newborn and Child Survival Grant from the Bill & Melinda Gates Foundation.

SummaryBackgroundFour methods have previously been used to track aid for reproductive, maternal, newborn, and child health (RMNCH). At a meeting of donors and stakeholders in May, 2018, a single, agreed method was requested to produce accurate, predictable, transparent, and up-to-date estimates that could be used for analyses from both donor and recipient perspectives. Muskoka2 was developed to meet these needs. We describe Muskoka2 and present estimates of levels and trends in aid for RMNCH in 2002–17, with a focus on the latest estimates for 2017.MethodsMuskoka2 is an automated algorithm that generates disaggregated estimates of aid for reproductive health, maternal and newborn health, and child health at the global, donor, and recipient-country levels. We applied Muskoka2 to the Organisation for Economic Co-operation and Development's Creditor Reporting System (CRS) aid activities database to generate estimates of RMNCH disbursements in 2002–17. The percentage of disbursements that benefit RMNCH was determined using CRS purpose codes for all donors except Gavi, the Vaccine Alliance; the UN Population Fund; and UNICEF; for which fixed percentages of aid were considered to benefit RMNCH. We analysed funding by donor for the 20 largest donors, by recipient-country income group, and by recipient for the 16 countries with the greatest RMNCH need, defined as the countries with the worst levels in 2015 on each of seven health indicators.FindingsAfter 3 years of stagnation, reported aid for RMNCH reached $15·9 billion in 2017, the highest amount ever reported. Among donors reporting in both 2016 and 2017, aid increased by 10% ($1·4 billion) to $15·4 billion between 2016 and 2017. Child health received almost half of RMNCH disbursements in 2017 (46%, $7·4 billion), followed by reproductive health (34%, $5·4 billion), and maternal and newborn health (19%, $3·1 billion). The USA ($5·8 billion) and the UK ($1·6 billion) were the largest bilateral donors, disbursing 46% of all RMNCH funding in 2017 (including shares of their core contributions to multilaterals). The Global Fund and Gavi were the largest multilateral donors, disbursing $1·7 billion and $1·5 billion, respectively, for RMNCH from their core budgets. The proportion of aid for RMNCH received by low-income countries increased from 31% in 2002 to 52% in 2017. Nigeria received 7% ($1·1 billion) of all aid for RMNCH in 2017, followed by Ethiopia (6%, $876 million), Kenya (5%, $754 million), and Tanzania (5%, $751 million).InterpretationMuskoka2 retains the speed, transparency, and donor buy-in of the G8's previous Muskoka approach and incorporates eight innovations to improve precision. Although aid for RMNCH increased in 2017, low-income and middle-income countries still experience substantial funding gaps and threats to future funding. Maternal and newborn health receives considerably less funding than reproductive health or child health, which is a persistent issue requiring urgent attention.FundingBill & Melinda Gates Foundation; Partnership for Maternal, Newborn & Child Health.

Waste management systems in low- middle-income countries are strained due to rapid urbanization and population growth. Inefficiencies in formal waste management systems have led to the emergence of the informal waste sector (IWS). Despite benefits like higher collection efficiency and the provision of livelihoods for workers, IWS creates exposure to occupational hazards and social discrimination. Although previous studies have researched the role of IWS workers, their occupational conditions, and barriers to formalization, there is limited research on contextualization of social dynamics in both the informal and formal waste sectors. In this study, we provide for the first time a comparison of the social and institutional hotspots in the formal and informal plastic waste management systems of Chennai, India, through interviews with stakeholders from both sectors. We show that social hotspots can be just as bad in the formal sector for waste collectors, resulting in a preference among the most vulnerable workers to remain informal. This is also in part due to power imbalances in the formal sector, which have worsened since the privatization of the solid waste management system, and in contrast, the autonomy offered by the informal system. At the institutional level, the formal system faces the barriers of lack of transparency, waste generator mistrust on the system, and lack of infrastructure, while the informal system exhibits strong barriers to data collection due to system-hiding and lack of organization. We argue that narratives around formalization must adopt a participatory approach to improve social outcomes for waste workers.

This paper examines the earnings penalties and premiums associated with different types of employment in 73 countries. Workers are divided into four categories: non-professional own-account workers, employers and own-account professionals, informal wage employees, and formal wage employees. Approximately half of the workers in low income countries are non-professional own-account workers, and the majority of the rest are informal employees. Fewer than 10 percent are formal employees, and only 2 percent of workers in low income countries are employers or own-account professionals. As per capita gross domestic product increases across countries, there are large net shifts from non-professional own-account work into formal wage employment. Across all regions and income levels, non-professional own-account workers and informal wage employees face an earnings penalty compared with formal wage employees. But in low income countries, this earnings penalty is small, and non-professional own-account workers earn a positive premium relative to all wage employees. Earnings penalties for non-professional own-account workers tend to increase with gross domestic product and are largest for female workers in high income countries. On average, employers and own-account professionals earn a premium compared to employees, although there are important differences across countries and between men and women. In terms of regional differences, earnings premiums for employers and professionals are largest for men in middle income Latin American countries. On the other hand, women employers and professionals do not earn a statistically significant premium compared to employees in any region of the world. These results are consistent with compensating wage differentials and firm quasi-rents playing important roles in explaining cross-country variation in earnings penalties, and raise questions about the extent to which the unskilled self-employed are rationed out of formal wage work in low income countries.

The Jawaharlal Nehru Medical College (JNMC) Women’s and Children’s Health Research Unit (WCHRU) of the Karnataka Lingayat Education (KLE) Academy of Higher Education and Research Deemed-to-be-University and its collaborators convened the ‘2nd International Conference on Maternal and Newborn Health -Translating Research Evidence to Practice’ to address the common theme of improving maternal and newborn health in low- and middle- income countries (LMIC). This supplement, including 16 manuscripts, reflects much of the research presented at the conference, including analyses of the state of knowledge, as well as completed, ongoing and planned research in these areas conducted by the WCHRU in India together with many collaborators across high-income and LMIC. The first paper reviews maternal, fetal and neonatal mortality in low-income countries, considers their causes, as well as evidence for potential interventions to reduce mortality. A second paper addresses near miss maternal mortality. Several manuscripts address the research conducted by WCHRU and their colleagues in a multi-center research network. One study examines rates of miscarriage and medically terminated pregnancy in India and the risk factors for these occurrences. Another paper addresses stillbirth and its risk factors, both in India as well as in other LMIC. Haemorrhage and preeclampsia/eclampsia, important causes of maternal mortality, stillbirth and neonatal morbidity in LMIC, are addressed in a series of papers summarizing trials of interventions to reduce improve outcomes associated with these conditions. Poor maternal and infant nutritional status, which contribute to adverse outcomes, are addressed through papers which describe a number of important studies that the WCHRU and their colleagues have conducted to attempt to improve nutritional status. Another paper describes a study to investigate causes of stillbirth and deaths among preterm births, which will utilize new techniques to investigate the infectious causes of these deaths. Finally, the supplement addresses the process for dissemination of research results to inform public policy. Together these manuscripts represent a body of research to inform interventions to reduce maternal, fetal and newborn mortality and illustrates what a dedicated research group together with institutional support can accomplish.

Improving the quality of maternal and newborn health (MNH) services is key to reducing adverse MNH outcomes in low-income and middle-income countries (LMICs). The Service Provision Assessment (SPA) and Service...

Solid waste management (SWM) in many low- and middle-income countries is sometimes driven by the informal sector. Unfortunately, contributions of the sector to SWM are not acknowledged in many developing countries. This situation often arises from inadequate awareness and lack of advocacy for these development contributions. This article reports on the impact of a study conducted by final-year geography undergraduates on the informal waste management sector in Nsukka urban area, Nigeria. The purposes of this exercise were to stimulate development intervention on behalf of the sector to improve perceptions, attitudes and performance, to impart a range of development research skills and to expose the students to the business opportunities provided by SWM and recycling. Informal waste sector workers and government officials responsible for SWM were interviewed, and some commercial data on recycling operations were collected. Findings of this study indicate that such advocacy initiatives were effective in increasing students’ awareness of opportunities and interest in working in the informal waste sector to promote better SWM and development in Nigeria. Lessons from this university case study are also drawn for other developing countries struggling to achieve the poverty reduction and job creation Millennium Development Goals (MDGs).

This article has as goal to discuss the importance of Intellectual Capital’s management to obtain positive results from the investments of Human Capital from the sector of Human Resources of institutions of a private administrative nature and check what generates more positive results in Intellectual Capital: the investment in human resources for titration or new ways of management of Intellectual Capital. From the reach of these goals, the problem will be answered: How to obtain more results in terms of Intellectual Capital from the Human Capital? The hypothesis that guides this article are: the management of Intellectual Capital generates results so positive or more than the investments in human resources to obtaining the titration; Intellectual Capital’s management does not generate such positive results as the investments in human resources for titration. Inferences, deductions and inductions were built from a qualitative analysis of data in congruence to the theorized aspects and presented data. The results presented the need of having a management of Intellectual Capital for obtaining satisfactory results from human resources and that only the investment for obtaining titration does not provide the enlargement of Intellectual Capital.

Mental Health Care Reforms in Latin America: Child and Adolescent Mental Health Services in Mexico

BackgroundThis research prioritization aimed to identify major research gaps in maternal, newborn, child and adolescent health (MNCAH) to help mitigate the direct and indirect effects of the COVID-19 pandemic.MethodsWe adapted the Child Health and Nutrition Research Initiative methodology. We defined scope, domains, themes and scoring criteria. We approached diverse global experts via email to submit their research ideas in MNCAH and MNCAH-related cross-cutting/health systems area. We curated the research ideas as research questions (RQs) and sent them to the consenting experts for scoring via the online link. For each RQ, the research priority score (RPS) was calculated as an average of individual criterion scores and ranked based on RPS in each area.ResultsWe identified top-ranked 10 RQs in each maternal, newborn, and child and adolescent health and 5 in the cross-cutting/health systems area. In maternal health, indirect effects on care, measures to improve care, health risks and outcomes, and preventing and managing SARS-CoV-2 infection/COVID-19 disease were priority RQs. In newborn health, clinical characterization and managing SARS-CoV-2 infection/COVID-19 disease, mode of transmission and interventions to prevent transmission were the focus. For child and adolescent health, top-ranked RQs were indirect effects on care, clinical status and outcomes, interventions to protect against SARS-CoV-2 infection/COVID-19 disease, and educational institute-related RQs. The cross-cutting RQs were the effects of the pandemic on availability, access, care-seeking and utilization of MNCAH services and potential solutions.ConclusionsWe call on partners, including governments, non-governmental organizations, research institutes, and donors, to address this urgent research agenda.

BackgroundMaternal mortality estimates globally show that by 2017 there were still 211 deaths per 100,000 live births; more strikingly, 99% of them happen in low and middle-income countries, including Tanzania. There has been insufficient progress in improving maternal and newborn health despite the efforts to strengthen the health systems, to improve the quality of maternal health in terms of training and deploying human resources for health, constructing health facilities, and supplying medical products. However, fewer efforts are invested in enhancing accountability toward the improvement of the quality of maternal health care. This the study was conducted to explore the perceptions of healthcare workers regarding accountability mechanisms for enhancing quality improvement in the delivery of maternal newborn and child health services in Tanzania.MethodsWe adopted phenomenology as a study design to understand how health workers perceive accountability and data were collected using semi-structured interviews. We then used thematic analysis to analyze themes and sub- themes.ResultsThe study revealed four categories of perceptions namely, differences in the conceptualization of accountability and accountability mechanisms, varied opinions about the existing accountability mechanisms, perceived the usefulness of accountability mechanisms, together with perceived challenges in the enforcement of accountability mechanisms.ConclusionPerceived variations in the understanding of accountability among healthcare workers signaled a proper but fragmented understanding of accountability in maternal care. Accountability mechanisms are perceived to be useful for enhancing hard work in the provision of maternal health services. Moreover, inadequate motivation resulting from health system bottlenecks tend to constrain enforcement of accountability in the provision of maternal care services. Thus, we recommend that the government should deal with health system constraints and enforce regular monitoring and supervision.

BackgroundCARE India designed and implemented a comprehensive, statewide quality improvement (QI) initiative to improve reproductive, maternal, newborn, and child health and nutrition (RMNCHN) services in public facilities in Bihar. We provide a description of this initiative and its key results during 2014-2017.MethodsWe reviewed program documents to identify QI strategies employed and ascertain their coverage. We analysed data from: a) two public facility assessments to ascertain the availability of essential equipment and supplies and the distribution of human resources by facility level; b) a four-phase provider mentoring and training intervention covering 319 facilities to examine changes in emergency obstetric and newborn care (EmONC) practices; and c) four state-representative household surveys to explore changes in selected RMNCHN service utilisation by health sector. Associations of interest were ascertained using χ2 tests.ResultsThirty-eight District Quality Assurance Committees and QI teams in 98% of facilities were formed to develop an implementation plan for the QI initiative and oversee its execution. QI strategies were to strengthen facilities’ infrastructure; build the state’s contracting, procurement, and inventory management capacities; rationalise human resources; improve providers’ skills; and modernise data systems. Implementation led to facility infrastructure upgrades, improved clinical staff distribution, and higher availability of equipment and supplies over time, especially in higher-level facilities. Following the mentoring and training intervention in facilities offering both basic and comprehensive EmONC, performance of key practices (eg, adequate administration of uterotonics <1 minute after birth, initiation of skin-to-skin care <5 minutes after birth) improved significantly (P < 0.05). CARE India collected program data and assisted with modernising data systems for tracking human resources, supplies, and program progress statewide. Of women seeking antenatal care, the proportion obtaining key screenings (eg, weight, blood pressure measurements) in public facilities increased over time (P < 0.05). A 6-percentage point decline in home deliveries during 2016-2017 was accompanied by a higher increase of deliveries in public than private facilities (5- vs 1-percentage point; P < 0.05).ConclusionSubstantial advances were made in improving RMNCHN service quality in Bihar. Continued improvement building on the established QI platform is expected and should be guided by data from now functional data systems.