Assessment of staffing needs for physicians and nurses at Upazila health complexes in Bangladesh using WHO workload indicators of staffing need (WISN) method.

Autor:	Joarder T; BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh taufiquejoarder@gmail.com.; Bangladesh Office, FHI 360, Dhaka, Bangladesh., Tune SNBK; BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh., Nuruzzaman M; World Health Organization Bangladesh Country Office, Dhaka, Bangladesh., Alam S; Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh., de Oliveira Cruz V; World Health Organization Bangladesh Country Office, Dhaka, Bangladesh., Zapata T; WHO South-East Asia Regional Office, New Delhi, India.
Jazyk:	angličtina
Zdroj:	BMJ open [BMJ Open] 2020 Feb 13; Vol. 10 (2), pp. e035183. Date of Electronic Publication: 2020 Feb 13.
DOI:	10.1136/bmjopen-2019-035183
Abstrakt:	Objective: This study aimed to assess the current workload and staffing need of physicians and nurses for delivering optimum healthcare services at the Upazila Health Complexes (UpHCs) in Bangladesh. Design: Mixed-methods, combining qualitative (eg, document reviews, key informant interviews, in-depth interviews, observations) and quantitative methods (time-motion survey). Setting: Study was conducted in 24 health facilities of Bangladesh. However, UpHCs being the nucleus of primary healthcare in Bangladesh, this manuscript limits itself to reporting the findings from the providers at four UpHCs under this project. Participants: 18 physicians and 51 nurses, males and females. Primary Outcome Measures: Workload components were defined based on inputs from five experts, refined by nine service providers. Using WHO Workload Indicator of Staffing Need (WISN) software, standard workload, category allowance factor, individual allowance factor, total required number of staff, WISN difference and WISN ratio were calculated. Results: Physicians have very high (WISN ratio 0.43) and nurse high (WISN ratio 0.69) workload pressure. 50% of nurses' time are occupied with support activities, instead of nursing care. There are different workloads among the same staff category in different health facilities. If only the vacant posts are filled, the workload is reduced. In fact, sanctioned number of physicians and nurses is more than actual need. Conclusions: It is evident that high workload pressures prevail for physicians and nurses at the UpHCs. This reveals high demand for these health workforces in the respective subdistricts. WISN method can aid the policy-makers in optimising utilisation of existing human resources. Therefore, the government should adopt flexible health workforce planning and recruitment policy to manage the patient load and disease burden. WISN should, thus, be incorporated as a planning tool for health managers. There should be a regular review of health workforce management decisions, and these should be amended based on periodic reviews. Competing Interests: Competing interests: None declared. (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)
Databáze:	MEDLINE
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