Applying the Workload Indicators of Staffing Needs Method in Nursing Health Workforce Planning: Evidences from Four Hospitals in Vietnam

Abstract Background: Vietnam has encountered difficulties in ensuring an adequate and equitable distribution of health workforce. The traditional staffing norms stated in the Circular 08/TT-BYT issued in 2007 based solely on population or institutional size and do not adequately take into consideration the variations of need such as population density, mortality and morbidity patterns. To address this problem, more rigorous approaches are needed to determine the number of personnel in health facilities. One such approach is Workload Indicators of Staffing Need (WISN) developed by the World Health Organization (WHO), a facility-based workforce planning method that assists managers in defining the responsibilities of different workforce categories and improving the appropriateness and efficiency of a staff mix. Methods: This study applied the WISN approach and was employed in 22 clinical departments at four hospitals in Vietnam between 2015 and 2018. 22 targeted group discussions involving nurses were conducted. Hospital personnel records have been retrieved. The data were analyzed according to WISN instructions. Results: Of the 22 departments, there was a shortage of 1 to 2 nurses in 10 departments, with WISN ratios ranging between 0.88 and 0.95. Only 01 clinical colleges at Can Tho Hospital lacked 05 nurses, facing a high workload with a WISN ratio of 0.78. Administrative time represented 20-40% of the total work time of a nurse. In comparison, nurses at Can Tho Hospital spent time on administration from 24 onwards. 5% to 41.7% of their working time while nurses at Thanh Hoa Hospital spent 21% to 33%. Conclusion: The application of the WISN enabled health managers to analyze the workload of nurses, calculate staffing needs, and thus effectively contribute to the workforce planning process. It is expected that the results of this research will encourage the use of the WISN tool in other hospitals and health facilities across the health system. At provincial and national levels, this study provides important evidence to help policy makers develop guidelines for personnel norms for health facilities in the context of limited resources, while the existing regulation is no longer appropriate.

Assessment of staffing needs for physicians and nurses at Upazila health complexes in Bangladesh using WHO workload indicators of staffing need (WISN) method

BMJ Open ◽

10.1136/bmjopen-2019-035183 ◽

2020 ◽

Vol 10 (2) ◽

pp. e035183

Author(s):

Taufique Joarder ◽

Samiun Nazrin Bente Kamal Tune ◽

Md Nuruzzaman ◽

Sabina Alam ◽

Valeria de Oliveira Cruz ◽

...

Keyword(s):

Health Workforce ◽

Quantitative Methods ◽

Service Providers ◽

Workforce Planning ◽

Healthcare Services ◽

Health Facilities ◽

Time Motion ◽

High Workload ◽

The Government ◽

ObjectiveThis study aimed to assess the current workload and staffing need of physicians and nurses for delivering optimum healthcare services at the Upazila Health Complexes (UpHCs) in Bangladesh.DesignMixed-methods, combining qualitative (eg, document reviews, key informant interviews, in-depth interviews, observations) and quantitative methods (time-motion survey).SettingStudy was conducted in 24 health facilities of Bangladesh. However, UpHCs being the nucleus of primary healthcare in Bangladesh, this manuscript limits itself to reporting the findings from the providers at four UpHCs under this project.Participants18 physicians and 51 nurses, males and females.Primary outcome measuresWorkload components were defined based on inputs from five experts, refined by nine service providers. Using WHO Workload Indicator of Staffing Need (WISN) software, standard workload, category allowance factor, individual allowance factor, total required number of staff, WISN difference and WISN ratio were calculated.ResultsPhysicians have very high (WISN ratio 0.43) and nurse high (WISN ratio 0.69) workload pressure. 50% of nurses’ time are occupied with support activities, instead of nursing care. There are different workloads among the same staff category in different health facilities. If only the vacant posts are filled, the workload is reduced. In fact, sanctioned number of physicians and nurses is more than actual need.ConclusionsIt is evident that high workload pressures prevail for physicians and nurses at the UpHCs. This reveals high demand for these health workforces in the respective subdistricts. WISN method can aid the policy-makers in optimising utilisation of existing human resources. Therefore, the government should adopt flexible health workforce planning and recruitment policy to manage the patient load and disease burden. WISN should, thus, be incorporated as a planning tool for health managers. There should be a regular review of health workforce management decisions, and these should be amended based on periodic reviews.

Global accreditation practices for accelerated medically trained clinicians: a view of five countries

Human Resources for Health ◽

10.1186/s12960-021-00646-4 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

James Antwi ◽

Anthony Asare Arkoh ◽

Joseph Kiprop Choge ◽

Turi Woticha Dibo ◽

Alias Mahmud ◽

...

Keyword(s):

Health Workforce ◽

Interprofessional Education ◽

Data Extraction ◽

Healthcare Providers ◽

Workforce Planning ◽

Continuing Professional Development ◽

World Health ◽

Local Context ◽

Resource Information ◽

Abstract Background Shortages and maldistribution of healthcare workers persist despite efforts to increase the number of practitioners. Evidence to support policy planning and decisions is essential. The World Health Organization has proposed National Health Workforce Accounts (NHWA) to facilitate human resource information systems for effective health workforce planning and monitoring. In this study, we report on the accreditation practices for accelerated medically trained clinicians in five countries: Ethiopia, Ghana, Kenya, Malaysia, and Mongolia. Method Using open-ended survey responses and document review, information about accreditation practices was classified using NHWA indicators. We examined practices using this framework and further examined the extent to which the indicators were appropriate for this cadre of healthcare providers. We developed a data extraction tool and noted any indicators that were difficult to interpret in the local context. Results Accreditation practices in the five countries are generally aligned with the WHO indicators with some exceptions. All countries had standards for pre-service and in-service training. It was difficult to determine the extent to which social accountability and social determinants of health were explicitly part of accreditation practices as this cadre of practitioners evolved out of community health needs. Other areas of discrepancy were interprofessional education and continuing professional development. Discussion While it is possible to use NHWA module 3 indicators there are disadvantages as well, at least for accelerated medically trained clinicians. There are aspects of accreditation practices that are not readily coded in the standard definitions used for the indicators. While the indicators provide detailed definitions, some invite social desirability bias and others are not as easily understood by practitioners whose roles continue to evolve and adapt to their health systems. Conclusion Regular review and revision of indicators are essential to facilitate uptake of the NHWA for planning and monitoring healthcare providers.

Implementation of the Workload Indicators of Staffing Need (WISN) Method in Determining Staff Requirements in Public Health Laboratories in Serbia

Disaster Medicine and Public Health Preparedness ◽

10.1017/dmp.2020.133 ◽

2020 ◽

pp. 1-9

Author(s):

Katica Tripković ◽

Milena Šantrić Milićević ◽

Marina Mandić Miladinović ◽

Lazo Kovačević ◽

Vesna Bjegović Mikanović ◽

...

Keyword(s):

Public Health ◽

World Health ◽

Local Context ◽

Work Processes ◽

Laboratory Services ◽

The World ◽

High Workload ◽

Laboratory Workers ◽

Health Organization ◽

ABSTRACT Objectives: This study aimed at identifying the needs for the health workforce in 16 public health laboratories in the Serbian capital by assessing the workforce stock, workload activities, activity standards, and workload pressure. Methods: A review of laboratory records and regulations, interviews with key respondents, and observing work processes provided data for the World Health Organization method for determining staffing needs based on workload indicators (Workload Indicators of Staffing Need, WISN). Results: A total of 99 laboratory workers spend almost 70% of their available working time in undertaking core activities. Core activities per sample can take from 0.25 to 180 min. Laboratory workers are under moderate or high workload pressure (the WISN ratio from 0.86 to 0.50). The WISN difference indicates a shortage of 22.22% of laboratory analysts and 20.63% of laboratory technicians. To balance the staffing to workload, these laboratories need an additional 8 FTE analysts and 13 FTE technicians. They could also consider selectively reducing workload pressure by automating some of the additional activities while maintaining the competence of laboratory workers and opportunities for professional development. Conclusions: Staffing policy should account for work processes, activity standards, and workload pressure to determine necessary staffing to meet the need for laboratory services in the local context.

Global Accreditation Practices for Accelerated Medically Trained Clinicians: A View of Five Countries

10.21203/rs.3.rs-487085/v1 ◽

2021 ◽

Author(s):

James Antwi ◽

Anthony Asare Arkoh ◽

Joseph Kiprop Choge ◽

Turi Woticha Dibo ◽

Alias Mahmud ◽

...

Keyword(s):

Health Workforce ◽

Interprofessional Education ◽

Data Extraction ◽

Healthcare Providers ◽

Workforce Planning ◽

Continuing Professional Development ◽

World Health ◽

Local Context ◽

Resource Information ◽

Abstract Background: Shortages and maldistribution of healthcare workers persist despite efforts to increase the number of practitioners. Evidence to support policy planning and decisions is essential. The World Health Organization has proposed National Health Workforce Accounts (NHWA) to facilitate human resource information systems for effective health workforce planning and monitoring. In this study, we report on the accreditation practices for accelerated medically trained clinicians in six countries: Ethiopia, Ghana, Kenya, Malaysia, and Mongolia. Method: Using open-ended survey responses and document review, information about accreditation practices was classified using NHWA indicators. We examined practices using this framework and further examined the extent to which the indicators were appropriate for this cadre of healthcare providers. We developed a data extraction tool and noted any indicators that were difficult to interpret in the local context.Results: Accreditation practices in the five countries generally aligned with the WHO indicators with some exceptions. All countries had standards for pre-service and in-service training. It was difficult to determine the extent to which social accountability and social determinants of health were explicitly part of accreditation practices as this cadre of practitioners evolved out of community health needs. Other areas of discrepancy were interprofessional education and continuing professional development. Discussion: While it is possible to use the module 3 indicators there are disadvantages as well, at least for accelerated medically trained clinicians. There are aspects of accreditation practices that are not readily coded in the standard definitions used for the indicators. While the indicators provide detailed definitions, some invite social desirability bias and others are not as easily understood by practitioners whose roles continue to evolve and adapt to their health systems.Conclusion: Regular review and revision of indicators are essential to facilitate uptake of the NHWA for planning and monitoring healthcare providers.

Bringing greater transparency to health workforce planning in Tajikistan: using the WISN approach

European Journal of Public Health ◽

10.1093/eurpub/ckz185.616 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

H Prytherch ◽

Z Kasymova ◽

F Lechthaler ◽

S Kiefer ◽

S Yarbaeva ◽

...

Keyword(s):

Sensitivity Analysis ◽

Health Workforce ◽

Workforce Planning ◽

World Health ◽

Family Doctors ◽

Health Workforce Planning ◽

Health Centres ◽

Facility Level ◽

Staffing Requirements ◽

Abstract Background For many countries, overcoming problems related to human resources is critical for progress towards Universal Health Coverage. Planning the workforce means to make decisions on required number, qualification and distribution of health workers. In Tajikistan, despite significant reforms, the health workforce is unequally distributed with physicians being mainly specialized and concentrated in urban areas. Description Using the Tajik case, we present a first comprehensive assessment of the Primary Health Care (PHC) staffing situation in a Central Asian setting applying and critically discussing the Workload Indicators of Staffing Need (WISN) method developed by the World Health Organization. Staffing requirements were derived using annual service statistics, obtained from a re-count of monthly routine data from registration books at facility level in the year 2016. Available health cadres in PHC at district and facility level were compared to the according staffing needs. Sensitivity analysis was performed to test the robustness of the predictions, and to identify the main contributors to uncertainty in the predicted staff requirements. Results For doctors performing general tasks in the PHC, there is currently an excess of full time equivalents. Moreover, health centres are overstaffed in terms of nurse positions. If the various speciality doctors currently working at rural health centres are not included, there is a shortage of family doctors in place. Sensitivity analysis revealed that staffing requirements in the PHC sector in Tajikistan are most importantly influenced by antenatal care visits. Lessons The present study concludes that there is an oversupply of doctors and nurses at PHC and a shortage of family doctors working at the level of health centres. Consequently, a more rational health workforce planning based on well-grounded methodology such as WISN has potential to contribute to more efficient and effective health service delivery in Tajikistan. Key messages Countries shifting towards a family medicine model face challenges like an oversupply of specialists performing general medical tasks and a lack of general/family doctors in the transition phase. To identify staffing requirements a transparent and reproducible approach, such as the WISN methodology, is required to steer future staffing needs and possible re-training of current staff.

Newborns at risk of Covid-19 ― lessons from the last year

Journal of Perinatal Medicine ◽

10.1515/jpm-2021-0258 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Malika D. Shah ◽

Ola Didrik Saugstad

Keyword(s):

Horizontal Transmission ◽

Mode Of Delivery ◽

Newborn Infants ◽

World Health ◽

Premature Delivery ◽

Mortality And Morbidity ◽

Skin Contact ◽

Cord Clamping ◽

Increased Risk ◽

Abstract After more than 1 year of the SARS-CoV-2 pandemic, a great deal of knowledge on how this virus affects pregnant women, the fetus and the newborn has accumulated. The gap between different guidelines how to handle newborn infants during this pandemic has been minimized, and the American Academy of Pediatrics (AAP)’s recommendations are now more in accordance with those of the World Health Organization (WHO). In this article we summarize present knowledge regarding transmission from mother to the fetus/newborn. Although both vertical and horizontal transmission are rare, SARS-CoV-2 positivity is associated with an increased risk of premature delivery and higher neonatal mortality and morbidity. Mode of delivery and cord clamping routines should not be affected by the mother’s SARS-CoV-2 status. Skin to skin contact, rooming in and breastfeeding are recommended with necessary hygiene precautions. Antibodies of infected or vaccinated women seem to cross both the placenta and into breast milk and likely provide protection for the newborn.

The Mentor Mothers Program in the Department of Defense in Nigeria: An Evaluation of Healthcare Workers, Mentor Mothers, and Patients’ Experiences

Healthcare ◽

10.3390/healthcare9030328 ◽

2021 ◽

Vol 9 (3) ◽

pp. 328

Author(s):

Josephine Moshe Ibu ◽

Euphemia Mbali Mhlongo

Keyword(s):

Department Of Defense ◽

Healthcare Workers ◽

Psychosocial Support ◽

Hiv Infections ◽

Health Facilities ◽

World Health ◽

Group Discussions ◽

Analysis Technique ◽

Hiv Awareness ◽

Nigeria contributes the highest to the global burden of HIV/AIDS and also accounts for the largest proportion of new vertically transmitted HIV infections among children. The Mentor Mothers program in the Nigerian Department of Defense was introduced in accordance with the World Health Organization and its implementing partner guidelines to curb the high incidence of vertically acquired HIV infections. Understanding the experiences of participants could serve as a gateway to evaluating the effectiveness of the program to better provide quality services within targeted health facilities. This qualitative study employed key informant interviews with six healthcare workers as well as two focus group discussions with six mentor mothers and six prevention of mother-to-child transmission (PMTCT) patients in four selected hospitals in the Nigerian Department of Defense to explore their experiences of the Mentor Mothers program. A thematic analysis technique was used to analyze the collated data. As a result, four main themes emerged, with the program perceived by most participants as providing psychosocial support to the patients, a valuable educational resource for raising HIV awareness, a valuable resource for promoting exclusive breastfeeding and mitigating vertical transmission of the virus, and functioning as a link between patients and the healthcare system. The participants reported that the program had effectively decreased HIV infections in children, reduced child and maternal mortality, and supported the livelihood and development of women, families, and communities in and around the Nigerian Department of Defense health facilities.

National Antimicrobial Consumption: Analysis of Central Warehouses Supplies to In-Patient Care Health Facilities from 2017 to 2019 in Uganda

Tropical Medicine and Infectious Disease ◽

10.3390/tropicalmed6020083 ◽

2021 ◽

Vol 6 (2) ◽

pp. 83

Author(s):

Juliet Sanyu Namugambe ◽

Alexandre Delamou ◽

Francis Moses ◽

Engy Ali ◽

Veerle Hermans ◽

...

Keyword(s):

Inpatient Care ◽

Health Facilities ◽

World Health ◽

Defined Daily Dose ◽

Antimicrobial Consumption ◽

National Medical ◽

The World ◽

Daily Dose ◽

Care Health ◽

Antimicrobial consumption (AMC) surveillance at global and national levels is necessary to inform relevant interventions and policies. This study analyzed central warehouse antimicrobial supplies to health facilities providing inpatient care in Uganda. We collected data on antimicrobials supplied by National Medical Stores (NMS) and Joint Medical Stores (JMS) to 442 health facilities from 2017 to 2019. Data were analyzed using the World Health Organization methodology for AMC surveillance. Total quantity of antimicrobials in defined daily dose (DDD) were determined, classified into Access, Watch, Reserve (AWaRe) and AMC density was calculated. There was an increase in total DDDs distributed by NMS in 2019 by 4,166,572 DDD. In 2019, Amoxicillin (27%), Cotrimoxazole (20%), and Metronidazole (12%) were the most supplied antimicrobials by NMS while Doxycycline (10%), Amoxicillin (19%), and Metronidazole (10%) were the most supplied by JMS. The majority of antimicrobials supplied by NMS (81%) and JMS (66%) were from the Access category. Increasing antimicrobial consumption density (DDD per 100 patient days) was observed from national referral to lower-level health facilities. Except for NMS in 2019, total antimicrobials supplied by NMS and JMS remained the same from 2017 to 2019. This serves as a baseline for future assessments and monitoring of stewardship interventions.

What is the level of uptake of Partner Notification Services in HIV testing in Selected Health Facilities in Muranga County – Kenya; a retrospective Study

10.21203/rs.2.24494/v2 ◽

2020 ◽

Author(s):

Rewel Kariuki ◽

Gilbert Koome Rithaa ◽

Oyugi Elvis ◽

Daniel Gachathi

Keyword(s):

Hiv Testing ◽

Partner Notification ◽

Sexual Partners ◽

Health Facilities ◽

World Health ◽

Hiv Positive ◽

People Living With Hiv ◽

Cross Sectional ◽

Case Identification ◽

Abstract Background: Identification of people living with HIV is key in HIV prevention and control. Partner Notification service is a World Health Organization backed strategy of reaching out to sexual partners of people diagnosed with HIV for HIV testing. However, its adoption and success rate in Kenya remains unknown.Methods: A cross sectional facility based study was undertaken in five purposively selected health facilities in Muranga County, Kenya. A retrospective review of patient medical records data for HIV positive index clients and their Sexual Partners conducted. Census approach applied to extract data for study subjects from Partner Notification Service registers for the period covering January 2017 to August 2018. Epi Info software was used for data analysis.Results: A total of 183 index clients offered Partner notification services. The mean age of the indexed clients studied was 39(SD ±13.1). Females comprised 64 % of clients studied. Of the 183 indexed clients, 89% accepted the services and elicited 216 sexual partners for tracing. The ratio of elicited sexual partners to index client was 1.3:1. Out of the 216 sexual partners, 77% were reached and tested. A total of 46 [32%] of the sexual partners elicited and traced, tested HIV positive. The most preferred approaches were provider referral (51%) and contract referral (45%). Dual referral (4%) was the least preferred approach. Conclusions: Partner notification services is acceptable and an effective strategy of increasing HIV case identification and raising awareness to exposed sexual partners in low resource countries.

Quality Evaluation of Ethambutol Hydrochloride Tablet Batches Available in Governmental Health Facilities of Jimma Town, Southwest Ethiopia

Advances in Pharmacological and Pharmaceutical Sciences ◽

10.1155/2021/9969157 ◽

2021 ◽

Vol 2021 ◽

pp. 1-8

Author(s):

Meseret Yirdaw ◽

Belachew Umeta ◽

Yimer Mokennen

Keyword(s):

World Health Organization ◽

The United States ◽

Health Facilities ◽

World Health ◽

Southwest Ethiopia ◽

Weight Variation ◽

The World ◽

Storage Area ◽

Health Organization ◽

Jimma Town

Background. The availability of poor-quality drugs on the drug market might favor the ineffectiveness of the drug and/antimicrobial resistance. Aim. To evaluate the quality of similar batches of ethambutol hydrochloride tablets available in different governmental health facilities of Jimma town, southwest Ethiopia. Methods. The World Health Organization checklist was used to inspect the storage area of health facilities and check medicines for the sign of counterfeit. The test was conducted as per the United States Pharmacopeia on six similar batches of ethambutol hydrochloride sampled from different governmental health facilities. Data were analyzed using SPSS version 20, and one-way ANOVA was used for comparing the dissolution profile and weight variation of batches. Results. Three health facilities did not comply with the storage area specifications for pharmaceuticals. No batches have shown any sign of counterfeit. All of the tablet batches tested complied with USP specifications for weight variation, percentage purity, and dissolution test. Conclusions and Recommendation. The entire tablet batches complied with the World Health Organization specification for packaging and labelling of pharmaceuticals. All tablet batches complied with the test for weight variation, purity of drug substance, and dissolution. Since some health facilities did not comply with at least one specification for storage of pharmaceuticals, regulatory agencies and stack holders are advised to inspect the health facilities to ensure appropriate storage of pharmaceuticals in health facilities.