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

Human Resources for Health

Norbert Forster²  Riitta-Liisa Kolehmainen-Aitken³  Pamela A McQuide¹ 

[1]IntraHealth International, Eros, PO Box 9942, Windhoek, Namibia

[2]Ministry of Health and Social Services, P/Bag 13198, Windhoek, Namibia

[3]Calle Obispo Hurtado 24–9 F, Granada 18004, Spain

关键词: Namibia;    Workload;    Health workforce;    Human resources;    WISN;    Workload Indicators of Staffing Need;   

Others  :  822112
DOI  :  10.1186/1478-4491-11-64

 received in 2013-09-02, accepted in 2013-11-25,  发布年份 2013

【 摘 要 】

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.

【 授权许可】

   
2013 McQuide et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]The World Bank: Data: Namibia. [http://data.worldbank.org/country/namibia webcite] (accessed 22 July 2013)
• [2]The World Bank: Namibia overview. [http://www.worldbank.org/en/country/namibia/overview webcite] (accessed 22 July 2013).
• [3]Ministry of Health and Social Services: Towards Achieving Health and Social Well Being for all Namibians: a Policy Framework. Windhoek; 1998.
• [4]Ministry of Health and Social Services: Equity in Health Care in Namibia: Towards Needs-based Allocation Formula. Harare: Regional Network for Equity in Health in Southern Africa (EQUINET) Discussion Paper; 2005. Volume 26
• [5]Ministry of Health and Social Services: Report of the Presidential Commission of Inquiry: Ministry of Health and Social Services to His Excellency, President Hifikepunye Pohamba. Windhoek; 2013.
• [6]Shipp P: Workload Indicators of Staffing Need: a Manual for Implementation. Geneva: World Health Organization; 1998.
• [7]World Health Organization: Workload Indicators of Staffing Need: User’s Manual. Geneva: WHO Press; 2010.
• [8]Hagopian A, Mohanty MK, Das A, House PJ: Applying WHO’s ‘workforce indicators of staffing need’ (WISN) method to calculate the health worker requirements for India’s maternal and child health service guarantees in Orissa State. Health Policy Plan 2012, 27:11-18.
• [9]Kolehmainen-Aitken R-L, Shipp P: ‘Indicators of staffing need’: assessing health staffing and equity in Papua New Guinea. Health Policy Plan 1990, 5:167-176.
• [10]World Health Organization: Applying the WISN Method in Practice: Case Studies from Indonesia, Mozambique and Uganda. Geneva: WHO Press; 2010.
• [11]WISN Tool: Workload Indicators of Staffing Need. Applying the WISN Method in Practice. Case Studies from Jersey, Newcastle and Derbyshire: WHO/EURO; forthcoming
• [12]Musau P, Nyongesa P, Shikhule A, Birech E, Kirui D, Njenga M, Mbiti D, Bett A, Lagat L, Kiilu K: Workload indicators of staffing need method in determining optimal staffing levels at Moi Teaching and Referral Hospital. East Afr Med J 2008, 85:232-239.
• [13]Ozcan S, Hornby P: Determining hospital workforce requirements: a case study. Int J Health Plann Manage 1995, 10:305-319.
• [14]Hossain B, Alam SA: Likely benefit of using Workload Indicators of Staffing Need (WISN) for human resources management and planning in the health sector of Bangladesh. Hum Resour Health 1999, 3:99-111.
• [15]World Health Organization: Increasing Access to Health Workers in Remote and Rural Areas Through Improved Retention: Global Policy Recommendations. Geneva: WHO Press; 2010.
• [16]Dovlo D: Using mid-level cadres as substitutes for internationally mobile health professionals in Africa. A desk review. Hum Resour Health 2004, 2:7-18. BioMed Central Full Text
• [17]Alliance GHW: Mid-level Health Providers: a promising resource to achieve the health millennium development goals. Geneva: WHO Press; 2010.