Applying Workload Indicators of Staffing

Need (WISN) method at different levels of

health care in Bangladesh: Challenges

and opportunities

4th Global Forum on Human Resource for Health

Liaquat Ali 1, Faiz Ahmed 2,Sukumar Sarker 3, Israt Nayer 4 Masuma Mannan1

1 Bangladesh University of Health Sciences, 2. Human Resource Branch, Health Services Division ,MOHFW ,3 USAID Bangladesh 4 MaMoni HSS Project, Save the Children in Bangladesh

Background

• Bangladesh Health Workforce Strategy-2015

recommended determining service level wise health workforce need with a focus on adopting a workload

analysis approach.

• Need for developing and implementing a

comprehensive health workforce plan considering the skill mix and address health systems needs to

achieve universal health coverage (UHC)

• USAID funded MaMoni HSS Project provided support

to MOH&FW to conduct the study

Study Area

Rajshahi

Kushtia

Brahmanbaria

Study Facilities at different levels

Tertiary

Secondary

PrimaryUpazila Health Complex (UHC): 4

Union Health & Family Welfare Centre (UHFWC): 8

Community Clinic (CC): 4

District Hospital (DH): 2

Maternal and Child Welfare Centre

(MCWC): 2

Medical College

Hospital (MCH): 1

Methodology: Overview of Workload Indicators of Staffing Need (WISN) Method

Ref. WISN: Selected country implementation experiences. Human Resources for Health Observer series no. 15, WHO 2016

Methodology

� WISN method was customized for country context and applied

Phase I :- Define Workload components

- Set activity (time) standards

- In-depth discussion with experts and

experienced practitioners at the facilities

and field level

Methodology

Phase II:- Confirm workload components and activity

standards with key persons at study

facilities

- Matching time standard with findings of

direct observation

- Collect annual service statistics and

human resources data from facilities and

cross check with national level MIS and

HRIS

- Assessment of staffing need based on

workload

Results

� Workload of the direct health service

providers found very high at most facilities

and community level in the study area

� Significant proportion of available working

time of physicians and nurses spent for

support or additional activities

� All the sectioned posts are not filled up in

almost all the facilities and community

level. If all the positions were filled staff

gaps relative to workload would have

improved

• WISN ratio of selected direct health service providers at different levels of facilities in the study area

0

0.5

1

1.5

2

2.5

MC

H

DH

A

DH

B

UH

C A

UH

C B

UH

C C

UH

C D

MC

WC

A

MC

WC

B

MC

H

DH

A

DH

B

UH

C A

UH

C B

UH

C C

UH

C D

MC

WC

A

MC

WC

B

UH

FW

C A

UH

FW

C B

UH

FW

C C

UH

FW

C D

UH

FW

C E

UH

FW

C F

Physician Nurse FWV

Hig

h w

ork

load

Lo

w w

ork

load

No

rmal

• Proportion of available working time of physicians and nurses spent for health service ,support or additional activities

78.50%66.10% 71%

17.70%33.10% 17.70%

3.80% 0.80%11.30%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

MCH District Hospital UHC

Distribution of Physicians' Time

21.50% 21.60%28.20%

76.70% 77.70% 66.30%

1.90% 0.70% 5.40%

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%

MCH District Hospital UHC

Distribution of Nurses' Time

Health Service Support Service Additional Service

� Inequalities exist in workload of among same category of staff working at

different level of facilities as well as among same level of facilities.

� Existing number of different types of support services staff (eg. cleaning,

laundry, attending, kitchen, security etc) at different level facilities are

inadequate to manage the workload. Significant shortage of almost all category

of support staff.

Challenges

Physician

Resident Medical Officer

Medical Officer

Medical Officer MCH-FP

Indoor Medical Officer

Emergency Medical Officer

Registrar

Assistant Registrar

Nurse

Matron

Junior Matron

Nursing Supervisor

Senior Staff Nurse

Assistant Nurse

Large number of staff designations

• Many staff with different designations found to have same roles and responsibilities

• Over 900 types of staff designations were found. Grouped into 67 categories based on their interchangeable nature of job responsibilities

Service data not segregated in MIS• Department wise segregated outpatient data not available in MIS

District Hospital B : Annual outpatient service

Data source Consultants Physicians/ Lab.

etc.

Total

DHIS2 321,318

Hospital record 150,555 174,671 325,226

Number of staff currently working at the facility

• Mismatch between the HRIS data and actual HR at facility level

• Difficult into determine current number of staff due different types of posting

(eg. deputation, attachment, current charge etc.)

Type of

staff

Facility data HRIS

Sanctioned Currently working Sanctioned Filled

District Hospital (B) Physician 33 29 23 19

Nurse 209 151 205 133

Technologist 4 3 2 2

Upazila Health Complex (C)

Physician 10 9 10 3

Nurse 22 20 21 17

Technologist 2 1 3 1

Opportunities

• Apply the set Activity Standards to assess workload at similar facilities

throughout the country using respective facility’s human resource and service

data

• Decision for intra and inter-facility rearrangement to create better equity in

workload

• Shift some tasks of support or additional activities to others to allow the direct

health care providers more tome on patient care

• Review existing staff designations in health system and rationally categorized

based on analysis of their main workload components

• Determine health workforce need and project demand

Conclusion

• Proper record keeping system at facility level and regular updating of HIRS

data level is essential is for determining the workload more precisely

• Application of WISN will be useful in the rational planning of present as well as

future HRH in the country

Thank you!