Applying the workload indicators of staffing need (WISN) method in Namibia: challenges and implications for human resources for health policy.

INTRODUCTION: As part of ongoing efforts to restructure the health sector and improve health care quality, the Ministry of Health and Social Services (MoHSS) in Namibia sought to update staffing norms for health facilities. To establish an evidence base for the new norms, the MoHSS supported the first-ever national application of the Workload Indicators of Staffing Need (WISN) method, a human resource management tool developed by the World Health Organization. APPLICATION: The WISN method calculates the number of health workers per cadre, based on health facility workload. It provides two indicators to assess staffing: (1) the gap/excess between current and required number of staff, and (2) the WISN ratio, a measure of workload pressure. Namibian WISN calculations focused on four cadres (doctors, nurses, pharmacists, pharmacy assistants) and all four levels of public facilities (clinics, health centers, district hospitals, intermediate hospitals). WISN steps included establishing a task force; conducting a regional pilot; holding a national validation workshop; field verifying data; collecting, uploading, processing, and analyzing data; and providing feedback to policy-makers. CHALLENGES: The task force faced two challenges requiring time and effort to solve: WISN software-related challenges and unavailability of some data at the national level. FINDINGS: WISN findings highlighted health worker shortages and inequities in their distribution. Overall, staff shortages are most profound for doctors and pharmacists. Although the country has an appropriate number of nurses, the nurse workforce is skewed towards hospitals, which are adequately or slightly overstaffed relative to nurses' workloads. Health centers and, in particular, clinics both have gaps between current and required number of nurses. Inequities in nursing staff also exist between and within regions. Finally, the requirement for nurses varies greatly between less and more busy clinics (range = 1 to 7) and health centers (range = 2 to 57). POLICY IMPLICATIONS: The utility of the WISN health workforce findings has prompted the MoHSS to seek approval for use of WISN in human resources for health policy decisions and practices. The MoHSS will focus on revising staffing norms; improving staffing equity across regions and facility types; ensuring an appropriate skill mix at each level; and estimating workforce requirements for new cadres.

Human resource development: new assessments and new directions.

The National Health Plan (NHP) 2001-2010 required a health workforce situation analysis and strategy to match the NHP's priorities and strategies. This paper is based on the work that was done in 2001 to support the preparation of a Health Human Resource Development Strategy for Papua New Guinea (PNG). The analysis showed that changes in health sector financing, population growth and changing health needs had created many human resource problems and challenges. This paper focuses on the main categories of health worker in PNG: doctors, health extension officers, nurses and community health workers. It presents analyses of workforce numbers and costs, and discusses future health system and human resource strategies based on the 2001 study and subsequent developments.

Human resource development: new assessments and new directions

The National Health Plan (NHP) 2001-2010 required a health workforce situation analysis and strategy to match the NHP's priorities and strategies. This paper is based on the work that was done in 2001 to support the preparation of a Health Human Resource Development Strategy for Papua New Guinea (PNG). The analysis showed that changes in health sector financing, population growth and changing health needs had created many human resource problems and challenges. This paper focuses on the main categories of health worker in PNG: doctors, health extension officers, nurses and community health workers. It presents analyses of workforce numbers and costs, and discusses future health system and human resource strategies based on the 2001 study and subsequent developments.

Decentralization's impact on the health workforce: Perspectives of managers, workers and national leaders.

Designers and implementers of decentralization and other reform measures have focused much attention on financial and structural reform measures, but ignored their human resource implications. Concern is mounting about the impact that the reallocation of roles and responsibilities has had on the health workforce and its management, but the experiences and lessons of different countries have not been widely shared. This paper examines evidence from published literature on decentralization's impact on the demand side of the human resource equation, as well as the factors that have contributed to the impact. The elements that make such an impact analysis exceptionally complex are identified. They include the mode of decentralization that a country is implementing, the level of responsibility for the salary budget and pay determination, and the civil service status of transferred health workers.The main body of the paper is devoted to examining decentralization's impact on human resource issues from three different perspectives: that of local health managers, health workers themselves, and national health leaders. These three groups have different concerns in the human resource realm, and consequently, have been differently affected by decentralization processes. The paper concludes with recommendations regarding three key concerns that national authorities and international agencies should give prompt attention to. They are (1) defining the essential human resource policy, planning and management skills for national human resource managers who work in decentralized countries, and developing training programs to equip them with such skills; (2) supporting research that focuses on improving the knowledge base of how different modes of decentralization impact on staffing equity; and (3) identifying factors that most critically influence health worker motivation and performance under decentralization, and documenting the most cost-effective best practices to improve them. Notable experiences from South Africa, Ghana, Indonesia and Mexico are shared in an annex.

Myths ans realities about the decentralization of health systems

Trata sobre la descentralización de sitema de slaud

Diagnóstico de Recursos Humanos

Entre las más grandes aportaciones del proyecto de Servicios de Salud descentralizados (SSD) se encuentra el financiamiento y asistencia técnica para capacitación en servicios cuya intención es apoyar la implementación de las intervenciones prioritarias de salud materna/supervivncia infantil (SM/SI) y la implementación de Sistemas Gerenciales que son prioridades para el Proyecto

Human resources planning: issues and methods

INTRODUCTION: During the past half century, the focus of development of human resources for health (HRH) has evolved from increasing the numbers of conventional health personnel, through efforts to improve the education of all health workers, to current attempts to increase their effectiveness and the quality of their work. Since 1976 the official policy of the World Health Organization (WHO) has been to encourage the integration of health services with development of health personnel. This concept, known as coordinated health and human resources development, stipulates that planning, production, and management functions for HRH should be a unified process, that human resources must serve the needs of the health system, and that the health system must serve the needs of the people. A major goal of this work was to identify the important issues in HRH develop- ment as well as the factors that impede progress. Developing countries have experienced imbalances in the numbers and types of health personnel trained as well as in their function and distribution and in the quality of their training in relation to future responsibilities. Furthermore, insufficient attention to the economic aspect of HRH planning has led, in some cases, to the training of more high-level personnel (e.g., physicians) than the economy of a developed country can support. Since the cost of training a medical auxiliary is a small fraction of the cost of training a physician, improved HRH management and planning could lead to more effective allocation of human and financial resources. Among the obstacles to HRH development in many countries are misplaced priorities, lack of coherent policies and appropriate planning processes, inade-quate management capacity, poorly developed methodology, and lack of essential information. Decision makers may be overwhelmed with routine health statistics yet unaware of or unable to use results of HRH research. CONCLUSION: Thus there is need not only for research in this area but, more importantly, to make data from HRH studies accessible to those responsible for HRH planning. An analytic approach to HRH development should consider supply and requirement projections as well as determination of proper staffing standards and mix. Use of modelling may facilitate making HRH projections that account for interactions among many variables. Although most of the work with modelling thus far has been done in developed countries, notably the United States and Great Britain, this technique has potential applicability as a planning tool in developing countries.