Workload Indicators of Staffing Need method in determining optimal staffing levels at Moi Teaching and Referral Hospital.

BACKGROUND: There is an increasing demand for quality healthcare in the face of limited resources. With the health personnel consuming up to three quarters of recurrent budgets, a need arises to ascertain that a workforce for any health facility is the optimal level needed to produce the desired product. OBJECTIVE: To highlight the experience and findings of an attempt at establishing the optimal staffing levels for a tertiary health institution using the Workload Indicators of Staffing Need (WISN) method popularised by the World Health Organisation (WHO), Geneva, Switzerland. DESIGN: A descriptive study that captures the activities of a taskforce appointed to establish optimal staffing levels. SETTING: Moi Teaching and Referral Hospital (MTRH), Eldoret, Kenya, a tertiary hospital in the Rift Valley province of Kenya from September 2005 to May 2006. MAIN OUTCOME MEASURES: The cadres of workers, working schedules, main activities, time taken to accomplish the activities, available working hours, category and individual allowances, annual workloads from the previous year's statistics and optimal departmental establishment of workers. RESULTS: There was initial resentment to the exercise because of the notion that it was aimed at retrenching workers. The team was given autonomy by the hospital management to objectively establish the optimal staffing levels. Very few departments were optimally established with the majority either under or over staffed. There were intradepartmental discrepancies in optimal levels of cadres even though many of them had the right number of total workforce. CONCLUSION: The WISN method is a very objective way of establishing staffing levels but requires a dedicated team with adequate expertise to make the raw data meaningful for calculations.

Randomised clinical trial to determine optimum initiation time of norgestrel-progestin only contraception in Eldoret Teaching Hospital, Kenya.

In a randomised controlled trial to determine the optimum time of initiation of Ovrette, a progestin only oral contraceptive among postpartum women, who fully or nearly fully breast-fed their infants in the first six months, no difference was found between group 1 (initiating at six weeks postpartum) and group 2 (initiating the pill at return of menses or 6 months postpartum). There were no pregnancies in either group during the 18 month follow-up. There were no significant differences in the continuation rates between the two group.

PIP: The optimal time for initiation of progestin-only oral contraception (POC) among fully or nearly fully breast-feeding women was investigated in a comparative study conducted among 200 women delivering at Kenya's Eldoret Teaching Hospital in a 2-year period during 1992-94. 100 women were randomly assigned to initiate POC use at 6 weeks' postpartum (group 1), while the remaining 100 women deferred POC initiation until the onset of menses or 6 postpartum months (whichever event occurred first) (group 2). At 12 months postpartum, 53.57% of mothers in group 1 and 56.67% in group 2 were still taking Ovrette; at 18 months, these rates were 46.10% and 43.59%, respectively. The mean duration of use was 7.6 months in group 1 and 7.5 months in group 2. There were 178 episodes of adverse experiences with Ovrette, 16.9% of which involved menstrual disturbances. Adverse experiences were more likely to be perceived as serious and related to Ovrette in group 1 than in group 2. There were no pregnancies recorded, suggesting that initiation of Ovrette use at 6 months postpartum or when menses reappears is a feasible strategy. However, postpartum women should be provided with counseling on the efficacy of the lactational amenorrhea method.