Workforce problems at rural public health-centres in India: A WISN retrospective analysis and national-level modelling study

Nair, Aatmika; Jawale, Yash; Dubey, Sweta; Dharmadhikari, Surabhi; Zadey, Siddhesh

doi:10.21203/rs.3.rs-1050174/v1

Cited by 4 publications

(5 citation statements)

References 15 publications

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“…7 Gaps were most striking in availability of skilled human resources and emergency obstetric services was observed by Sharma et al 8 Similar result was seen for CHC by Nair et al in 2019, at the national-level, WISN differences, who depicted workforce shortages for all considered HRH cadres. 9 Out of all the CHCs assessed 41% obtained "A" grade, 47% fell in "B" grade and 12% in "C" grade and none fell in "D" grade. A project on assessment of quality assurance programme was carried out by Misra et al in the year 2009.…”

Section: Discussionmentioning

confidence: 90%

Quality of reproductive health care provided by community health centers of a district located in western India- a mixed method study

Misra¹,

Desai²

2022

Int J Community Med Public Health

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Background: Under National Rural Health Mission in 2007, Indian Public Health Standards (IPHS) were introduced to strengthen health care services. As majority of health infrastructure is in existence before introduction of IPHS, there was scant information available on assessment of these standards. This study was carried out with the objective to assess quality of reproductive health care provided by community health centers (CHC).Methods: A cross-sectional study was carried out in 2013. All of the 17 community health centers from 12 talukas of the district were studied. Data collection was carried out by administering pilot tested checklist and interviewing clients.Results: All the CHCs had adequate infrastructure. Highest score was obtained for input (64%). The overall score in process section was 45%. None of the CHCs had a full-time anesthetist, physician, public health programme manager or public health nurse. At only three CHCs, general surgeon was available. Availability of MOs was 85% and Pharmacist was 88% respectively.Conclusions: Deployment and availability of specialist is the need of the hour. Adequate emphasis needs to be given to processes and outputs as well, apart from inputs. Public private partnership can be explored for better utilization of services. There is a need of up gradation of existing CHCs keeping in the view of IPHS norms.

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Section: Discussionmentioning

confidence: 90%

Quality of reproductive health care provided by community health centers of a district located in western India- a mixed method study

Misra¹,

Desai²

2022

Int J Community Med Public Health

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“…WISN is an important complement to enhance national health work force account (NHWA) data quality [37], and ensure equity in distribution of cadres among health facilities [41]. During monitoring and evaluation of health system, WISN can be used to enhance human resources for health investment [44]; to update current sanctioning norms [42]; to decide what activities and tasks of a cadre should shift to other cadre [41]; to effectively and e ciently manage health workforce [46]; to observe details in the work process that were not perceived as a source of work overload [48].…”

Section: Implications Challenges and Limitations Of Using Wisn Method...mentioning

confidence: 99%

“…Limitations of WISN method during health workforce planning WISN method of health workforce planning has some limitations according to the reviewed articles. The limitations include use of last year health service performance data to forecast this year sta ng requirement, no clear consideration of frequent service interruption during workload analysis, differences in the severity of illness for which patients sought consultation time was not considered, activity standards did not consider individual professional variations in performing an activity, sudden surge of patients was not assumed, lack of standards for certain activities, on-call time workers were not considered and weekend and holiday workers were not considered during workload calculation [25,26,30,34,35,38,42,50].…”

Section: Challenges Of Using Wisn Methods Of Health Workforce Planningmentioning

confidence: 99%

Workload Indicators of Staffing Need (WISN) Method for Health Workforce Planning at Health Facility: A scoping review

Asres¹,

Gessesse²

2022

Preprint

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Background In the presence of diverse workforce planning method, identifying advantages, challenges and limitations of each method is very important. Population to health workforce ratio method faced challenges of continuous population growth and variations of health care needs over time. Standard staffing schedule was used to solve challenges of population ratio method but itself faced another challenge on how to distribute health workforces between health facilities with in a country. A workload indicator of staffing need (WISN) method was designed to alleviate challenges of the above mentioned methods. Challenges and limitations of WISN method have not been systematically reviewed and that is why this scoping review was designed Methods We conducted a scoping review of literatures with the objective of identifying implications, challenges and limitations of WISN method workforce planning at health facilities. Arksey and O’Malley’s methodological steps were followed to develop the research questions, identify relevant studies, include/ exclude studies, extract data, and report the findings. To ensure methodological quality PRISMA guideline and PRISMA- ScR checklist was used. Results A total of 27 studies were eligible and more than 83% were published between 2019 and 2022. Majority of studies used retrospective quantitative data with cross sectional study design but four studies incorporated qualitative parts too. The major challenges identified were health service activity standard of workload component, data quality or availability and technical details of the WISN itself. This review reveled WISN method limitations on precision of WISN result as it depends on last year record, service interruptions, time differences in completing clinical activity based on patient status and professional variations and over time health care activities. Conclusion WISN model of human resources for health planning adjusts workload pressure among health care workers within and between health facilities. Health care administrators or authorities use it for task shifting indicator within a health facility and equitable distribution indicator between health facilities. Being a very useful human resource planning tool, WISN has challenges and limitations too.

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“…The health facilities use WISN to understand the level of workload pressure, the cause of shortage or surplus and staff reassignment [ 20 , 22 ]. During the monitoring and the evaluation of the health system, WISN can be used for various purposes like enhancing human resources for health investment [ 23 , 24 ]; updating the system based on current sanctioning norms; managing task division among employees; managing health workforce; observing details in the work process that were not perceived as a source of work overload [ 25 – 27 ]. Most importantly, WISN can also be used for data quality improvement, health service quality improvement, staff satisfaction and patient satisfaction by matching each employee’s skills and competences with the right tasks in order to deliver a high-quality health service [ 28 ].…”

Section: Introductionmentioning

confidence: 99%

“…The health facilities use WISN to understand the level of workload pressure, the cause of shortage or surplus and reassign staff [20,24]. During monitoring and evaluation of health system, WISN can be used to enhance human resources for health investment [25,26]; to update current sanctioning norms; to decide what activities and tasks of a cadre should shift to other cadre; to effectively and e ciently manage health workforce ; to observe details in the work process that were not perceived as a source of work overload [27][28][29]. More importantly, WISN is used to improve the health sector headaches that are data quality improvement, health service quality improvement, staff satisfaction and patient satisfaction by ensuring scope of practice matches with the training received by speci c cadres, and assuring that those skills are being used at recommended workload to deliver quality health service [30].…”

Section: Introductionmentioning

confidence: 99%

Workload Indicators of Staffing Need (WISN) Method for Midwives Planning and Estimation at Asrade Zewude Memorial Primary Hospital, North west Ethiopia

Asres¹

2023

Discov Health Systems

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Background Workforce is a crucial component of the health service delivery system. Ethiopia faces health workforce challenges when it comes to evidence based health workforce planning. Workforce planning was initially determined by comparing the health worker ratio to the general population number. Later, it was determined by standard staffing schedules for each health facility level. However, neither of these methods addressed the evidence based workload variation issue among the same level facilities all around the country. A workload indicator of staff needs (WISN) method can address these variations. Therefore this research was carried on to determine workload pressure excess or gap in midwives, thereby to promote the WISN use in health facilities, based on WISN results of midwives at Asrade Zewude memorial Hospital. Methods A cross sectional study using WISN model was used to determine the workload excess and gap pressure in midwives at Asrade Zewude Memorial primary hospital, North West Ethiopia. Midwives were selected based on a priority point scale as outlined in the WISN method. Results According to the data obtained, midwives worked five days a week and 1030 h per year. This working time was spent on health service activities (58.4%), additional activities (36.6%) and support activities (5%). WISN calculations demonstrated a shortage of five midwives with WISN ratio of 0.8 at Asrade Zewude Memorial primary hospital North West Ethiopia. Conclusion Midwives at the study area were carrying on their routine tasks even though there was a staff gap of 5: thus, the midwives had a workload excess of 20%. Under these conditions, it may be hard for the facility to achieve universal health service goals. Therefore the hospital should institutionalize WISN method planning to objectively employ midwifery professionals. This study had limitations too as it used retrospective annual service statistics and small sample size which affects generalization of the results to other health facilities and other health worker cadres within the study hospital.

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Workforce problems at rural public health-centres in India: A WISN retrospective analysis and national-level modelling study

Cited by 4 publications

References 15 publications

Quality of reproductive health care provided by community health centers of a district located in western India- a mixed method study

Quality of reproductive health care provided by community health centers of a district located in western India- a mixed method study

Workload Indicators of Staffing Need (WISN) Method for Health Workforce Planning at Health Facility: A scoping review

Workload Indicators of Staffing Need (WISN) Method for Midwives Planning and Estimation at Asrade Zewude Memorial Primary Hospital, North west Ethiopia

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