Abstract
BackgroundUganda’s health workforce is characterized by shortages and inequitable distribution of qualified health workers. To ascertain staffing levels, Uganda uses fixed government-approved norms determined by facility type. This approach cannot distinguish between facilities of the same type that have different staffing needs. The Workload Indicators of Staffing Need (WISN) method uses workload to determine number and type of staff required in a given facility. The national WISN assessment sought to demonstrate the limitations of the existing norms and generate evidence to influence health unit staffing and staff deployment for efficient utilization of available scarce human resources.MethodsA national WISN assessment (September 2012) used purposive sampling to select 136 public health facilities in 33/112 districts. The study examined staffing requirements for five cadres (nursing assistants, nurses, midwives, clinical officers, doctors) at health centres II (n = 59), III (n = 53) and IV (n = 13) and hospitals (n = 11). Using health management information system workload data (1 July 2010–30 June 2011), the study compared current and required staff, assessed workload pressure and evaluated the adequacy of the existing staffing norms.ResultsBy the WISN method, all three types of health centres had fewer nurses (42–70%) and midwives (53–67%) than required and consequently exhibited high workload pressure (30–58%) for those cadres. Health centres IV and hospitals lacked doctors (39–42%) but were adequately staffed with clinical officers. All facilities displayed overstaffing of nursing assistants. For all cadres at health centres III and IV other than nursing assistants, the fixed norms or existing staffing or both fell short of the WISN staffing requirements, with, for example, only half as many nurses and midwives as required.ConclusionsThe WISN results demonstrate the inadequacies of existing staffing norms, particularly for health centres III and IV. The results provide an evidence base to reshape policy, adopt workload-based norms, review scopes of practice and target human resource investments. In the near term, the government could redistribute existing health workers to improve staffing equity in line with the WISN results. Longer term revision of staffing norms and investments to effectively reflect actual workloads and ensure provision of quality services at all levels is needed.
Highlights
Uganda’s health workforce is characterized by shortages and inequitable distribution of qualified health workers
We describe Uganda’s Workload Indicators of Staffing Need (WISN) experience from a national-level perspective, presenting key findings and discussing implications that have the potential to reshape staffing policy and investments locally and in countries with a comparable human resources for health (HRH) context. Scope and setting This national WISN assessment was conducted in September 2012 in 136 public health facilities from 33 of 112 districts
Where districts lack general hospitals and health centre IV facilities are functioning by default as hospitals, with correspondingly higher workloads, the need for workloadbased staffing norms is even more pressing and requires that those health centres essentially be staffed as hospitals
Summary
Uganda’s health workforce is characterized by shortages and inequitable distribution of qualified health workers. Uganda uses fixed government-approved norms determined by facility type. This approach cannot distinguish between facilities of the same type that have different staffing needs. The national WISN assessment sought to demonstrate the limitations of the existing norms and generate evidence to influence health unit staffing and staff deployment for efficient utilization of available scarce human resources. In Uganda, the shortage of qualified health workers, inappropriate skill mix and inequitable urban–rural distribution of health workers hinder the country’s ability to deliver basic health care services [3]. Due to limited wage provisions and the difficulty of attracting and retaining qualified health workers in rural districts, a 2010 report found that on average only 56% of approved positions were filled by appropriately trained health workers, leaving a 44% national vacancy rate [4]
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