Melody Chimara, registered nurse performing her duties at the Oncology Ward at Windhoek Central Hospital, Windhoek, Namibia. The results of the workload analysis will ensure the country is adequately staffed with nurses like Melody. (Photo credit: Studio 7 Nam for FHI 360)
Grace Namaganda, Senior Human Resources for Health Advisor, Open Development
Annick Ranirisoa, Health Policy Advisor, Open Development
Kate Steger, Communications specialist, Open Development
Committed to achieving universal health coverage by 2030, the Namibian Ministry of Health and Social Services (MoHSS) is strengthening the health system by revising its essential health services package (EHSP), the set of health services deemed essential to meeting the population’s core health needs). To revise the EHSP, the MoHSS needs to determine how many and what types of health care workers (HCWs) are needed to provide these essential health services.
For example, if one nurse assisting in the delivery of one baby takes about 40 minutes, how many nurses are needed to assist in the births of all the babies that will be born in the country? Similarly, if one doctor spends 20 minutes on a single consultation, how many doctors are required at each facility, considering the total number of outpatients and the available working hours per year? These are the kinds of questions 400 experts from all regions and hospitals were asking when they gathered in Windhoek, Namibia July 17–August 15, 2023 for a series of workshops to set the activity standard for every task a health worker performs.
A group of nursing cadres and WISN facilitators at the WISN Activity Setting Workshop on the 20th July 2023, Roof of Africa, Windhoek Namibia. (Photo credit: Studio 7 Nam for FHI 360)
Workshop participants were selected from 28 categories of HCWs (nurses, health assistants, community health workers, dentists, medical officers, pharmacists, etc.), representing all 14 regions of the country and the five referral hospitals. They methodically documented every essential duty, from promotive to palliative services, and from community to tertiary level facilities.
With funding from the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) through the U.S. Agency for International Development (USAID), the Meeting Targets and Maintaining Epidemic Control (EpiC) project provided technical and financial support for the workshops to conduct a nationwide health workforce analysis using the WISN method, or Workload Indicator of Staffing Need. Using this World Health Organization (WHO) human resource management tool, the EpiC team guided MoHSS to define the tasks each type of health worker performs and the estimated average time to complete the task. This information will aid health planners to determine the number and types of health workers required across the country.
Throughout the workshop, the nurses shared that they often need to manage many responsibilities beyond the conventional scope of their roles and the established benchmarks for patient care. They are called upon to collect samples for laboratory analysis, dispense medications, manage revenue collection, and even transport the deceased to the mortuary when there is a shortage of staff responsible for these services. These additional responsibilities, which do not require specialized nursing skills and training, rob them of time and contribute to an increased workload, heightened work pressure, and at times, diminished quality of care. In candid conversations at the WISN workshop, nurses identified the optimal and cost-effective cadres suited for these ancillary tasks. They were also able to identify the most suitable health care provider for a specific task among enrolled nurses, registered nurses, and medical officers (who are not available at clinics).
Social Workers participating in a WISN Activity Setting Workshop in Windhoek, Namibia. 2nd August 2023. (Photo credit: Studio 7 Nam for FHI 360)
The result of the consultation with the group of nurses is a detailed list of key activities, estimates of the average time needed in minutes to complete each task to the required professional standards and quality, and the potential for shifting unskilled tasks to other cadres. These standards will be used to determine the required number of nurses by using the WISN method to divide the total workload by the available working time.
The EpiC team led workshop participants to conduct the same exercise for each of the 28 health worker categories. The results of which will be compiled in the Compendium of Activity Standards that will be used for the following activities:
Calculate staffing needs based on the workload experienced.
Review the scopes of practice for different cadres.
Update job descriptions, schedules of work, duty sheets, and health care worker (HCW) performance indicators.
Update the outdated 2003 staffing norms.
Inform HCW optimization through task sharing and related initiatives.
Cost the EHSP.
Time is valuable and every minute counts. When there are a limited number of hours in each shift, how HCWs’ time is spent has a direct impact on patient care. The outcomes of the WISN workshops will not only enhance the efficiency of HCWs’ operations but will also play a pivotal role in shaping future recruitment and strategic redeployment strategies. Through this collaborative effort, health planners can better allocate resources, streamline responsibilities, and ensure that health workers — the foundation of any strong health system — are in place to deliver care to those in need. Having the right types and numbers of qualified workers is a crucial step in addressing the gaps in health care quality and equity which is key in achieving universal health coverage in Namibia.