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

Abstract

ObjectiveThis 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.DesignMixed-methods, combining qualitative (eg, document reviews, key informant interviews, in-depth interviews, observations) and quantitative methods (time-motion survey).SettingStudy 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.Participants18 physicians and 51 nurses, males and females.Primary outcome measuresWorkload 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.ResultsPhysicians 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.ConclusionsIt 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.

A Policy Analysis Regarding Education, Career, and Governance of the Nurses in Bangladesh: A Qualitative Exploration

“…For example, nurses have had little say over the decisions related to their profession, they were not allowed to perform unsupervised clinical duties, experience heavy workloads leading to performance failures, and a lack of clear plan for career progression. These issues have been supported by other studies as well (Darkwa et al., 2015; Joarder et al., 2020; Zaman, 2009). The dominance of physicians in health sector decision-making and nurses’ disapproval to this, particularly in clinical decision-making is well-documented in other countries as well (Amsalu et al., 2014; Mehrabi et al., 2016).…”

“…The dominance of physicians in health sector decision-making and nurses' disapproval to this, particularly in clinical decision-making is well-documented in other countries as well (Amsalu et al, 2014;Mehrabi et al, 2016). Joarder et al (2020), based on Workload Indicator of Staffing Needs studies, showed that nurses in Bangladesh suffered a high workload (workload indicator of staffing needs ratio of 0.69, where lower than 1 indicates higher workload), and Darkwa et al (2015) showed that lack of career development was a hindrance for nurses to work in rural areas.…”

Workload Indicators of Staffing Need Method in Determining Anesthesia and Surgical Technologist Staff in Operating Room

“…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 sub-districts (16). The study was conducted by Farahi Shahgholi aimed to calculation of workload and estimation of the required number of health staff related to family medicine program in East Azerbaijan province based on WISN.…”

“…If only the vacant posts are filled, the workload is reduced. In fact, sanctioned number of physicians and nurses is more than actual need (16).…”

“…In fact, sanctioned number of physicians and nurses is more than actual need.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 sub-districts(16).The WISN tool was used in assessing the staffing requirements of the frontline health workforce for select primary level facilities in Rivers State in Nigeria. Findings showed Health facilities in Port Harcourt City Local Government Area (PHALGA) had a WISN ratio of 0.63 and a shortage The results showed that significant obligations for 25000 populations were consisted of family health services (0.87), prevention of disease (1.067), health schools and health education (0.105).…”