INTRODUCTION TO WORKFORCE PLANNING

1. INTRODUCTION TO WORKFORCE PLANNING

2. HR Planning Transfers from other sectors Gains Training Schools In-migration Health Workforce Change profession Retirement Death Disablement Transfer to Other sectors Out Migration Losses AIDS

3. HR Planning Methodology Ratios –limited broad application Health Facility Staffing- define number and type of staff per facility serving a defined population Dewdney Model – practical in places where information is limited. Uses simple spreadsheets Hall Model –complex computer model, required intensive training. Can only be used in countries where there is easily obtainable national data and statistics Workload Indicators for Staffing Needs (WISN) – useful and can be used to identify requirements for individual facilities

5. Forecasting to improve performance • What factors determine workload? • How can staff performance be measured? • How to forecast numbers of posts required in the future

6. Take into Account the prevailing External Labour Market • Unemployment Levels • Competition with other employers • Output from training • Local living conditions/cost of living

7. Recruitment and Selection • Job descriptions • Objective recruitment and selection process • Ensuring the most appropriately trained and experienced person is selected

8. Other Methods of Filling Posts • Reallocation of duties • Transfer of posts • Redeployment • Outsourcing • Appointment of a previously identified successor

9. The 3 Dangers in Personnel Management!!! Discrimination Nepotism Corruption

10. Practical Approach to Planning your Workforce • Find out what you have • Survey - a snapshot only is not useful for dynamic planning and management • Registration of Health workers and development of a personnel records system that contains ALL the data required for all purposes in the health system

11. Who Needs HR Data • Health Management Information System - only requires 3 or 4 quantitative data fields (e.g. Profession, place of work, facility where working) • Personnel Administration/Civil Service – requires data for personnel administration only (e.g. Name, age, profession, post, grade/ eschelon, salary grade and incremental level etc.) • HRD Planning and Management – requires both quantitative and qualitative data (all the above data + details of educational level , professional qualifications, in-service training, work history etc) • Professional Associations – Membership data

12. Survey of different HR information systems in Indonesia

13. Managing the HR Data • Data can be maintained in manual personnel record files • Can be maintained in a computerised system (e.g. Access Database or SQL) which is set up to export certain fields as required by particular users (e.g. The 3 or 4 data fields for Health MIS; data to civil service database) • HR Information systems are completely useless if they are not updated and maintained.

14. Putting it all together – NATIONAL AND REGIONAL WORKFORCE PLANNING Dewdney Workforce Planning Methodology • Uses Spreadsheets • Incorporates all aspects required for planning • Can start with limited data and as clearer data is available it can be entered and data modified • Can generate workforce projections • Can estimate costs of what is planned • Is a Rolling plan

15. Facility Based Workforce Planning Workload Indicators for Staffing Needs (WISN) is a practical method to assess staffing needs based on the actual work that health workers do (their workload) Can be applied to all personnel categories -medical staff -paramedical staff - non medical staff

16. Steps of WISN Step 1. Decide WISN target Group HRH category Type of Facility Geographic Area e.g. Nurse at health centre level in a particular region

17. - Cont WISN Steps Step 2. Estimate Working Time Count annual working days. Estimate days for vacation, public holidays, other annual leave and absence days per year Deduct days off from annual working days. e.g. There are 260 working days in a year. A health centre nurse has 40 days off, so she works 220 days in a year.

18. -cont WISN Steps Step 3. Define Components of Work Define the main activities of the HRH category E.g. Health Centre nurse has the following main activities: In-patients Out Patients Out reach to health posts

19. -cont WISN STEPS Step 4. Activity Standards Activity Standard: The time it takes a well trained well-motivated member of a particular staff category to perform the action to acceptable professional standards in the circumstances of the country.

20. - Cont WISN steps Two Types of Activity Standards • Service Standards • Allowance Standards • These are used differently in calculating the final HRH requirements

21. Service Standards For activities that are reported in annual service statistics Eg. • Inpatients • Outpatients Shown as a unit time or rate of working Eg. • 15 minutes per patient or • 30 patients per day

22. Allowance Standards For activities that are NOT reported in annual statistics e.g. • Recording and reporting • Attending meetings • Attending training courses • Providing training Shown as % of working time or actual working time e.g. • 10% of working time • One hour per day

23. Step 5. Calculate Standard workloads Standard workload: Amount of work (within one activity) that one person could do in a year

24. Step 5 Calculate Standard Workloads -continued • I expressed as a unit of time for the activity: Std workload = Available working time in a year Unit time for the activity • If expressed as rate of working: Std workload = Rate x Available working time in a year

25. Step 6: Calculate Allowance Factors Two types calculated from Allowance Standards Category Allowance Factor Applies to all workers in a particular category e.g. all nurses in a health centre Individual Allowance Factor Applies to a fixed number of workers in a particular category e.g. Only the nurse in charge

26. Step 7: Calculate the required HRH Divide annual service statistic by the Standard workload (for each activity) Add together HRH requirements of all activities Apply Category Allowance Factor (formula) Add Individual Allowance Factor(s) (whole time equivalent)

27. Using WISN Results Two kinds of comparisons: Difference between actual and required number of HRH Shows level of shortage or surplus of HRH Ratio of actual to required number of HRH (WISN ratio) Shows the amount of pressure which HRH category works under WISN ratio = 1: HRH sufficient WISN ratio less than 1: HRH NOT sufficient WISN ratio greater than 1: More than enoughtstaff

28. Example from Indonesia WISN calculation for TTS district

29. Requirements to Implement WISN • Steering Committee (SC)of decision makers who review Activity and Allowance Standards and consider WISN results for management action. • Task Force (TF) of experienced competent professionals from the category, facility and level being addressed by WISN who implement and can train in the methodology

30. Questions for SC to raise with the TF • If a facility is overstaffed: • Why ? Is it underused? • How does it engage with the community? • Are there other services which can be offered for which excess staff can be used?

31. Questions for SC to raise with the TF • If a facility is understaffed • Why is this happening? • Is it under pressure? • Will it affect service quality? • Can main and supporting activities be made more proportional? • Is there duplication of work between the different categories of professions? • Is there any category of health worker undertaking work for which they have not been trained?

32. ESSENTIAL LINKAGES • Health system defined Essential Package of Health Services (EHPS)S through a decentralised health delivery system • What kind of health workers are required and how many? • Are the training institutions producing the product and numbers required for the EPHS?

33. A CHW or an auxillary nurse may be considered by isolated communities to be “doctors” and are better trusted by that community than a doctor or a registered nurse posted from the capital. • How do health workers serve nomadic populations as well as fixed populations? • Is the role of HWs to “sit and wait” in the health facility or to do outreach?

34. What is the scope of practice of a nurse/midwife working in an area where no doctor will go? • What is the scope of practice of an auxillary working in a community where no nurse or doctor will go? • If the scope of practice is defined -- have they been trained to undertake this role??