The Knowledge library

Journal Articles

Applying the Workload Indicators of Staffing Need (WISN) Method in Namibia: Challenges and Implications for Human Resources for Health Policy

This article provides a comprehensive overview of the first-ever national application of the Workload Indicators of Staffing Need (WISN) tool developed by the World Health Organization. The article describes the steps involved in implementing WISN, a human resources management tool, in Namibia, discusses software and data challenges, summarizes key findings relating to health worker shortages and inequities, and reviews the utility of the WISN findings for policy-makers in Namibia. The authors observe that the WISN method can offer credible workload-based evidence to improve the equity and distribution of health workers within a region or across similar types of facilities nationwide. Perhaps most importantly, the WISN tool allows policy-makers to consider the potential impact of decisions on staff requirements before actually making the decisions.

Leveraging Information Technology to Bridge the Health Workforce Gap

CapacityPlus’s Dykki Settle contributed to this “Perspectives” feature in the special issue of the Bulletin of the World Health Organization published in conjunction with the Third Global Forum on Human Resources for Health. The article emphasizes the potential for leveraging recent investments in information technology infrastructure along with innovations in eHealth, mHealth, and social media in addressing global health workforce challenges. Ten recommendations are offered for training, empowering, and supporting health workers in resource-limited settings through the use of information and communication technologies (ICT). The authors conclude that “the ICT ‘train’ has left the station. It remains to be seen whether the global health workforce will ride along or remain behind.”

Community Health Workers for Universal Health Care Coverage: From Fragmentation to Synergy

This article—in a special issue of the Bulletin of the World Health Organization launched at the Third Global Forum on Human Resources for Health—explores the important role of community health workers in the effort to achieve universal health coverage. A range of current challenges related to inconsistent support for community health workers and failure to integrate them into national health systems has limited their potential contributions to primary health care. The article emphasizes the need for stronger public-sector leadership and more synergy among partners in better supporting and integrating community health workers as integral members of health teams that can increase accessibility and use of services.

Early Implementation of WHO Recommendations for the Retention of Health Workers in Remote and Rural Areas

The World Health Organization (WHO) issued 16 global recommendations for improving the recruitment and retention of health workers in rural areas—a challenge faced by most countries and a barrier to universal health coverage. This article discusses the challenges and lessons learned from adaptation and adoption of the recommendations in Lao People’s Democratic Republic and South Africa, and explores the influence of the recommendations regionally in Asia and Europe. In Lao PDR, the Ministry of Health partnered with CapacityPlus and the WHO to apply the Rapid Retention Survey Toolkit (developed by CapacityPlus using the WHO recommendations) and iHRIS Retain costing software to assess which of the recommendations would be most effective in the Laotian context and subsequently inform a new national policy for recruiting and retaining health workers.

Evaluation of Spaced Education as a Learning Methodology for In-Service Training of Health Workers in Ethiopia

Participation in in-service training can be a challenge for health workers, especially those stationed in remote areas. Spaced education is an innovative learning methodology that can be delivered electronically by Internet or mobile smartphone. CapacityPlus conducted a pilot study that followed a convenience sample of 37 Ethiopian nationals enrolled in a spaced education course over a six-month period to determine the acceptability and effectiveness of the methodology in a low-resource context. The course content was codeveloped by Ethiopian and international nutrition experts and focused on the recently revised Ethiopian Federal Ministry of Health guidelines on the feeding of infants of HIV-positive mothers. The study suggests that the Internet-based spaced education methodology is acceptable and effective for the acquisition of knowledge in a low-resource context for course participants with a clinical or public health background and moderately reliable Internet access. More research is needed to test the feasibility, acceptability, and effectiveness of the methodology among a wider population of health workers in developing countries, and particularly among government and volunteer health workers in rural and remote settings.

Net Costs of Health Worker Rural Incentive Packages: An Example from the Lao People’s Democratic Republic

Many developing countries are examining whether to institute incentive packages that increase the share of health workers who opt to locate in rural settings; however, uncertainty exists with respect to the expected net cost (or benefit) from these packages. CapacityPlus utilized findings from discrete choice experiment surveys applied to students training to be health professionals and costing analyses in Lao People’s Democratic Republic to model the anticipated effect of incentive packages on new worker location decisions and direct costs. In this example, incentive packages that do not invest in capital-intensive components generally should produce larger net benefits. Combining discrete choice experiment surveys, costing surveys, and cost-benefit analysis methods may be replicated by other developing countries to calculate whether health worker incentive packages are viable policy options.

Differences in Preferences for Rural Job Postings between Nursing Students and Practicing Nurses: Evidence from a Discrete Choice Experiment in Lao People’s Democratic Republic

A discrete choice experiment was conducted to investigate preferences for job characteristics among nursing students and practicing nurses to understand whether differing policies may be appropriate for each group. Data were collected from 256 nursing students and 249 practicing nurses. For both groups, choice of job posting was strongly influenced by salary and direct promotion to permanent staff. As compared to nursing students, practicing nurses had significantly lower preference for housing allowance and housing provision as well as lower preference for provision of transportation for work and personal use. Findings suggest that it may be important to differentiate between recruitment and retention policies when addressing human resources for health challenges in developing countries, such as Lao PDR.

Why Would I Go There? Motivating Workers to Take and Keep Jobs in Rural Areas

Given the complexity of the social, professional, and economic factors that influence motivation, how do institutions make rural job postings more attractive? While many recognize that salary is an important factor, other characteristics of a job—such as better living or working conditions, supportive supervision, opportunities for continuing professional development, career advancement, networking, and even public recognition—can improve a worker’s sense of purpose and productivity. Identifying and offering the right incentive package to workers can result in a win-win situation, with benefits for both the worker and the community served. To address this issue of job attraction and retention in the health sector, CapacityPlus has helped ministries of health and NGOs answer these questions by using a rapid discrete choice experiment, a rigorous survey method that identifies the trade-offs that workers would be willing to make between specific job characteristics. Garnering statistical evidence of what motivates workers provides policy-makers with the needed information to develop more cost-effective job incentive strategies. This article originally appeared in the December 2012 issue of Monthly Developments Magazine (www.monthlydevelopments.org).