‘Indicators of staffing need’: assessing health staffing and equity in Papua New Guinea

Kolehmainen-Aitken, Riitta-Liisa; Shipp, Peter

doi:10.1093/heapol/5.2.167

Cited by 18 publications

(9 citation statements)

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“…There are a number of strategies that could help to improve the quality of care in these remote health services (see Table 5) such as service redesign that includes appropriate staffing based on service utilisation patterns and actual workload [44,45] with community based health service delivery by community workers (CWs) [46]. This might also reduce the high work load in HCs, allowing HC based clinicians to concentrate on providing acute care.…”

Section: Discussionmentioning

confidence: 99%

Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery

Bar-Zeev

Kruske

Barclay

et al. 2013

BMC Health Serv Res

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BackgroundRemote dwelling Aboriginal infants from northern Australia have a high burden of disease and frequently use health services. Little is known about the quality of infant care provided by remote health services. This study describes the adherence to infant guidelines for anaemia and growth faltering by remote health staff and barriers to effective service delivery in remote settings.MethodsA mixed method study drew data from 24 semi-structured interviews with clinicians working in two remote communities in northern Australia and a retrospective cohort study of Aboriginal infants from these communities, born 2004–2006 (n = 398). Medical records from remote health centres were audited. The main outcome measures were the period prevalence of infants with anaemia and growth faltering and management of these conditions according to local guidelines. Qualitative data assessed clinicians’ perspectives on barriers to effective remote health service delivery.ResultsData from 398 health centre records were analysed. Sixty eight percent of infants were anaemic between six and twelve months of age and 42% had documented growth faltering by one year. Analysis of the growth data by the authors however found 86% of infants experienced growth faltering over 12 months. Clinical management and treatment completion was poor for both conditions. High staff turnover, fragmented models of care and staff poorly prepared for their role were barriers perceived by clinicians’ to impact upon the quality of service delivery.ConclusionAmong Aboriginal infants in northern Australia, malnutrition and anaemia are common and occur early. Diagnosis of growth faltering and clinicians’ adherence to management guidelines for both conditions was poor. Antiquated service delivery models, organisation of staff and rapid staff turnover contributed to poor quality of care. Service redesign, education and staff stability must be a priority to redress serious deficits in quality of care provided for these infants.

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Section: Discussionmentioning

confidence: 99%

Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery

Bar-Zeev

Kruske

Barclay

et al. 2013

BMC Health Serv Res

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“…It was further damaged by the rejection of a previous, major national workforce planning effort (Davies, 1980(Davies, , 1981 by the DFP and DPM as failing to account for financial realities. Staffing standards were not formulated at the national level until 5 years after decentralization (Kolehmainen-Aitken and Shipp, 1990). In the provinces, the level of planning expertise was very inadequate , and no effort was made at that level to develop provincial staffing standards.…”

Section: Responsibility For Planningmentioning

confidence: 99%

“…Problems remained even after the Resource Management Committee (a high-level committee immediately below the national Cabinet) finally approved the DOH'S 'indicators of staffing need' in 1989 as the basis for health staffing in PNG (Kolehmainen-Aitken and Shipp, 1990). When the DOH forwarded an assessment of rural nurse staffing to the Finance Department as part of the annual budgetary process that year, it discovered that the financial arrangements accompanying decentralization allowed no changes to be made in the eight financially autonomous provinces.…”

Section: Ability To Implement Planning Decisionsmentioning

confidence: 99%

“…This was a major shortcoming, which later affected the ability of the DOH to exert a role in national resource allocation decisions and to ensure an equitable development of health services in the country. In the latter part of the 1980s, much effort was put into developing staffing standards for rural and hospital staff that would allow a rational comparison of workloads and staffing between provinces and between individual health institutions (Kolehmainen-Aitken and Shipp, 1990). Cost standards for rural health services (Mitchell et al, 1988) and facility standards were also developed.…”

Section: Importance Of Standard Settingmentioning

confidence: 99%

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The impact of decentralization on health workforce development in Papua New Guinea

Riitta-Liisa

Kolehmainen-Aitken

1992

Public Admin & Development

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Papua New Guinea decentralized a wide range of health functions to provincial governments between 1977 and 1983. The national Department of Health (DOH) was given no role in provincial budget and staffing decisions, and the national health budget was fragmented into the health components of provincial budgets. The impact of decentralization on health workforce development was particularly severe and largely unforeseen. Many difficulties were inherent in the manner in which decentralization regulations structured power relationships. Others arose as a result of the administrative confusion and inflamed relationships that accompanied the forceful transfer of power from a very reluctant national DOH to the provinces. Even though policy formulation and planning were retained as national functions, decentralization hampered their effective execution. Human resource data bases deteriorated, responsibility for planning became confused, and the ability of the DOH to implement its planning decisions was compromised. In reality, health workforce planning was carried out by the Departments of Finance and Planning, and Personnel Management through the annual budgetary process of provincial financial limits and staff ceilings, without any attempt to assess health service needs, either in the country as a whole or between the provinces. Decentralization brought a need for new management skills, and it complicated administrative relationships between training institutions and the provinces. The Papua New Guinea experience has shown that in a decentralized health service, there is a great potential for conflict between national goals and the aspirations of individual provinces. To achieve an equitable, appropriate and effective staffing of services, standards must be formulated as the basis for planning and conflict resolution. Effective linkages between central government departments and between the national and provincial health authorities must be developed, and management and technical skills of health managers improved.

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“…3 Development of the method continued with pilot applications in a number of countries and culminated with its adoption, publication and promotion by the World Health Organization. 4,5,6 This paper reports on experiences surrounding the use of this method in the maternity ward of MCH, Kolkata. Hospitals are the most appropriate institutions in which the WISN method gives the most reliable result.…”

Section: Introductionmentioning

confidence: 99%

A study to calculate the nursing staff requirement for the Maternity Ward of Medical College Hospital, Kolkata Applying WISN method.

S¹

2013

IOSR-JDMS

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‘Indicators of staffing need’: assessing health staffing and equity in Papua New Guinea

Cited by 18 publications

References 0 publications

Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery

Adherence to management guidelines for growth faltering and anaemia in remote dwelling Australian Aboriginal infants and barriers to health service delivery

The impact of decentralization on health workforce development in Papua New Guinea

A study to calculate the nursing staff requirement for the Maternity Ward of Medical College Hospital, Kolkata Applying WISN method.

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