Health Service Activity Standards and Standard Workloads for Primary Healthcare in Ghana: A Cross-Sectional Survey of Health Professionals

Abstract

The attainment of health system goals is largely hinged on the health workforce availability and performance; hence, health workforce planning is central to the health policy agenda. This study sought to estimate health service activity standards and standard workloads at the primary health care level in Ghana and explore any differences across health facility types. A nationally representative cross-sectional survey was conducted among 503 health professionals across eight health professions who provided estimates of health service activity standards in Ghana’s Primary Health Care (PHC) settings. Outpatient consultation time was 16 min, translating into an annual standard workload of 6030 consultations per year for General Practitioners. Routine nursing care activities take an average of 40 min (95% CI: 38–42 min) for low acuity patients; and 135 min (95% CI: 127–144 min) for high dependency patients per inpatient day. Availability of tools/equipment correlated with reduced time on clinical procedure. Physician Assistants in health centres spend more time with patients than in district hospitals. Midwives spend 78 min more during vaginal delivery in health centres/polyclinics than in district/primary hospital settings. We identified 18.9% (12 out of 67) of health service activities performed across eight health professional groups to differ between health centres/polyclinics and district/primary hospitals settings. The workload in the health facilities was rated 78.2%, but as the workload increased, and without a commensurate increase in staffing, health professionals reduced the time spent on individual patient care, which could have consequences for the quality of care and patient safety. Availability of tools and equipment at PHC was rated 56.6%, which suggests the need to retool these health facilities. The estimated standard workloads lay a foundation for evidence-based planning for the optimal number of health professionals needed in Ghana’s PHC system and the consequent adjustments necessary in both health professions education and the budgetary allocation for their employment. Finally, given similarity in results with Workload Indicators of Staffing Need (WISN) methodology used in Ghana, this study demonstrates that cross-sectional surveys can estimate health service activity standards that is suitable for health workforce planning just as the consensus-based estimates advocated in WISN.

Modelling the supply and need for health professionals for primary health care in Ghana: Implications for health professions education and employment planning

“…From our cross-sectional survey [ 48 ], the average practice variation in how much time health professionals perform the various task was ±18%. Altering all the professional standards by ±18%, the staffing requirements increased by 25% when the upper limits are assumed but reduced by 15% when the lower limits are assumed.…”

“…The list of tasks performed by health professionals (matched with the services required to address the disease burden identified above) was extracted from the job descriptions of the respective health professionals and those of a previous Workload Indicators of Staffing Needs (WISN) study [ 47 ]. The standard time it would take the individual health professionals to perform these health service tasks were elicited through a nationally representative cross-sectional survey completed by 503 health professionals (the detailed methodology and results of the survey have been reported in a separate piece) [ 48 ].…”

Developing a Quantitative Staffing to Workload Tool in an Ambulatory Setting

“…9 Ambulatory nurse staffing is closely aligned with provider staffing and fill rates 10 and must include both visit and nonvisit care time. Asamani et al 11 quantified patient care workload in minutes in the ambulatory setting, recognizing that as provider volumes changed, allied health support increased to avoid gaps in quality of care for patients. The literature has established a relationship among patient volumes, visit and nonvisit care, and allied health team composition required to support provider practices.…”

Teaching and Learning of Clinical Competence in Ghana: Experiences of Students and Post-Registration Nurses

“…Consequently, NEIs resort to placing students in clinical settings to enhance their clinical competence [ 19 , 20 ]. However, challenges in the CPS, such as the lack of resources and support, and the emergence of pandemics appear to be excessively restrictive, limiting learning opportunities and impeding clinical competence development [ 13 , 21 ].…”