Human Resources for Health in Maternal, Neonatal and - HRH ...

Workforce planning for the community level must be connected to planning at other levels
and vice versa. Planning the workforce in MNRH at community level is addressed in some
countries by specific national level plans that focus on SBAs such as the Laos plan (Lao
People‘s Democratic Republic Ministry of Health 2009) or more broadly through HRH plans
and MNRH or population health strategies and plans. However the cadres often missing from
this planning is the community health and volunteer workforce. In Fiji‘s workforce plan for
example these groups are assumed under ―other cadres‖ but not specifically defined (Ministry
of Health Fiji 1997). As TBAs are not often recognised by governments despite attending a
large number of births in some countries they are often not included. One exception is
Afghanistan‘s National Policy On Human Resources Development for Health which includes
all cadres (Transitional Islamic State of Afghanistan Ministry of Health 2003).
Workforce planning in countries excludes areas where data is not collected. This includes
sectors of illegal practice such as solo nurse practitioners at community level in Indonesia
(Heywood and Harahap 2009). Often the non state sector is not included in national planning
despite heavy dependence on them for MNRH care and services in countries such as Papua
New Guinea.
Much has been written about the need to involve staff and community members in workforce
planning to identify and implement solutions to problems (Srisuphan 1998; Dieleman,
Gerretsen et al. 2009). However a paucity of knowledge is available on approaches to
planning at community level in developing contexts or reports documenting planning
experiences. The move to replace TBAs with SBAs requires workforce planning based upon
data (Kamal 1998) but it is not well understood how countries have approach this challenge.
In addition it is not clear how countries have projected needs and upon what calculations. For
example Nursing Staff ratios in the community are often measured by community visits
(O‘Brien-Pallas 1997). The WHO‘s workload indicator of staff needs(WISN) tool was used
at in one study in South Africa to determine HRH requirements for PHC (Daviaud and
Chopra 2008). Average values were calculated to give an average time per type of
consultation including child and antenatal consultations. The tool was found to be useful in
this context as it could be adapted to help to better deploy staff between facilities, a kind of
optimum management of scarcity, but can also help quantify the gaps to inform planning,
training and allocation decisions at local level.
Information on workforce planning in MNRH at community and PHC level is mostly
available from developed nations particularly the UK. Hurst‘s study provides some insight
into planning in the UK at PHC level that may be applicable to developing contexts. Primary
and community care managers were provided with information, allowing them to: (a)
evaluate the size and mix of their workforce; and (b) develop knowledgeable and skilled
teams to meet the demands of growing and changing services. Hurst concludes that
P a g e | 79