Determining staffing standards for primary care services using workload indicators of staffing needs in the Philippines

Abstract

Background Health services cannot be delivered without an adequate, competent health workforce. Evidence suggests a direct relationship between density of health workforce and health outcomes. The Philippines is faced with health workforce challenges including shortages, inequitable distribution and inadequate skill mix which hinder health service delivery. Evidence-based workforce planning is, therefore, critical to achieve universal health care. Methods The Philippines adopted the World Health Organization’s workload indicators of staffing need methodology. Using a multistage sampling method, nine regions with poor health indicators in tuberculosis, family planning, and maternal child health were identified. Physicians, nurses, midwives, and medical technologists were prioritized in the study from 89 primary care health facilities (barangay health stations, rural health units, and city health offices). Data was collected using in-depth interviews, document reviews, observations, and field visits. The workload indicators of staffing need software were used for data analysis to determine staffing requirements and analyse workforce pressure. Results The study showed varied results in terms of staffing requirements and workload pressure across cadres and facility types. Some health facilities exhibited staff shortages and high workload pressure. Out of the 40 rural health units and city health offices, only three had the required physicians needed and 22 facilities had a shortage of physicians working under high workload pressure. Other facilities had excess staff compared to the calculated requirements. Nurses at the rural health units showed high workload pressure. Ten rural health units had no medical technologists. Midwives at barangay health stations exhibited extremely low workload pressures. Conclusion The study identifies the need for the Philippine Health System, both through the Department of Health and the local governments to efficiently optimize the available health workers by revising the services offered at the primary health care facilities. The results provide evidence for staffing requirements at various levels of care based on workloads, scope of practice and time taken to undertake specific tasks at the barangay health stations, rural health units and city health offices to be integrated into the human resources for health management systems.

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“…Although ‘task shifting’ is recommended as an important intervention in LMICs, if it is implemented irrationally, it can lead to inefficiency [ 37 ]. The PMCIs did not have documents on the number of ‘approved’ positions for cadres other than medical and nursing officers, highlighting the need for developing and conducting staffing establishment assessments for PMCI based on service utilization and size of the catchment areas [ 38 , 39 , 40 ].…”

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“…We compare the various assessment approaches in Table 1. [21][22][23][24] The WHO has promoted the Workload Indicators of Staffing Need (WISN) as a systematic approach to guide staffing decisions based on health workers' workload in a given facility against activity time standards. 25 The DOH previously piloted the use of WISN to assess health workforce shortages in selected regions in the Philippines.…”

“…25 The DOH previously piloted the use of WISN to assess health workforce shortages in selected regions in the Philippines. 24 Although considered to be a comprehensive tool, Shared workspace allowed for daily interactions and sessions which contributed to better understanding between researchers, policy makers, and program managers.…”

“…21 However, we wanted to determine the share of each health profession instead of a combined density. Therefore, we referred to the WHO benchmark of 30.2 nurses and midwives per 10,000 people to achieve UHC and the SDGs, 24 No approach to guide planning; market forces determine health workforce quantity, skill mix, and distribution.…”

“…25 The DOH previously piloted the use of WISN to assess health workforce shortages in selected regions in the Philippines. 24 Although considered to be a comprehensive tool, WISN would require the training of staff for data collection and analysis and additional resources for national scale-up.…”