future preparedness plans must take into account the impact that epidemics have on the ability of the health system to continue to provide vital routine and emergency maternal and newborn health care. Healthcare providers need to have a stronger voice in health system rebuilding and planning and management to ensure that health service can continue to provide vital maternal and newborn care during epidemics.

IntroductionBefore the 2014, Ebola epidemic in Sierra Leone, healthcare workers (HCWs) faced many challenges. Workload and personal risk of HCWs increased but their experiences of these have not been well explored. HCWs evaluation of their quality of life (QoL) and risk factors for developing work-based stress is important in helping to develop a strong and committed workforce in a resilient health system.MethodsCross-sectional study using World Health Organisation Quality of Life (WHOQOL)-BREF and Health and Safety Executive (HSE) Standards Tools in 13 Emergency Obstetric Care facilities to (1) understand the perceptions of HCWs regarding workplace risk factors for developing stress, (2) evaluate HCWs perceptions of QoL and links to risk factors for workplace stress and (3) assess changes in QoL and risk factors for stress after a stress management programme.Results222 completed the survey at baseline and 156 at follow-up. At baseline, QoL of HCWs was below international standards in all domains. There was a significant decrease in score for physical health and psychological well-being (mean decrease (95% CI); 2.3 (0.5–4.1) and 2.3 (0.4–4.1)). Lower cadres had significant decreases in scores for physical health and social relationships (13.0 (3.6–22.4) and 14.4 (2.6–26.2)). On HSE peer-support and role understanding scored highly (mean scores 4.0 and 3.7 on HSE), workplace demands were average or high-risk factors (mean score 3.0). There was a significant score reduction in the domains relationships and understanding of role (mean score reduction (95% CI) 0.16 (0.01–0.31) and 0.11 (0.01–0.21)), particularly among lower cadres (0.83 (0.3–1.4).ConclusionHCWs in low-resourced settings may have increased risk factors for developing workplace stress with low QoL indicators; further exploration of this is needed to support staff and develop their contribution to the development of resilient health systems.

It is important that the key personnel be involved in the development and introduction of training programmes for new cadres of staff from the earliest stages of development. On-going programme review and development is essential and those implementing the programme are the best placed to lead and contribute to this. Gathering the experiences and perceptions of key informants helps provide an in-depth examination that can inform recommendations.

Interventions to improve the quality of teaching are urgently needed and should include training on teaching techniques and student assessment for tutors, provision of audio visual equipment and teaching aides such as posters and mannequins. Monitoring and Evaluation of interventions is critical to be able to amend the programmes approach and address further challenges at an early stage.

The development of a workload management system for use in the accident and emergency department is described. The system is capable of capturing the work all professional groups, allowing the user to roster staff according to anticipated workload, and gives accurate information on whether staffing requirements are sufficient to provide the desired standard of care.(7 Accid Emerg Med 1997;14:88-91) Keywords: workload management; accident and emergency department.The system has been in use for many years, and although it is capable of capturing workloads of all professional staff (medical, nursing, clerical physiotherapists, etc), its main use is as a tool for rostering nursing staffusing individual patient charts for patient care plans and completing them daily, it is possible to determine how many hours of nursing care will be required over the following 24 hours and roster appropriate numbers of staff.Over the last three years, we examined the possibility of adapting the system for use in accident and emergency (A&E). However, due to the nature of emergency work, it is impossible to predict the type of patients attending a department and the care they will require. A very different approach was necessary.