Managing uncertainty in forecasting health workforce demand using the Robust Workforce Planning Framework: the example of midwives in Belgium

Benahmed et al. Human Resources for Health https://doi.org/10.1186/s12960-023-00861-1 (2023) 21:75 Human Resources for Health Open Access RESEARCH Managing uncertainty in forecasting health workforce demand using the Robust Workforce Planning Framework: the example of midwives in Belgium Nadia Benahmed1* , Mélanie Lefèvre1   and Sabine Stordeur1    Abstract Background In Belgium, the Planning Commission for Medical Supply is responsible for monitoring human resources for health (HRH) and ultimately proposing workforce quotas. It is supported by the Planning Unit for the Supply of the Health Professions. This Unit quantifies and forecasts the workforce in the healthcare professions on the basis of a stock and flow model, based on trends observed in the past. In 2019, the Planning Unit asked the KCE (Belgian Health Care Knowledge Centre) to develop additional forecasting scenarios for the midwifery workforce, to complement the standard historical trend approach. The aim of this paper is to present the development of such forecasting scenarios. Methods The Robust Workforce Planning Framework, developed by the Centre for Workforce Intelligence in the UK was used to develop alternative midwifery workforce scenarios. The framework consists of four steps (Horizon scanning, Scenario generation, Workforce modelling, and Policy analysis), the first two of which were undertaken by KCE, using two online surveys and five workshops with stakeholders. Results Three alternative scenarios are proposed. The first scenario (close to the current situation) envisages pregnancy and maternity care centred on gynaecologists working either in a hospital or in private practice. The second scenario describes an organisation of midwife-led care in hospitals. In the third scenario, care is primarily organised by primary care practitioners (midwives and general practitioners) in outpatient settings. Conclusions The Robust Workforce Planning Framework provides an opportunity to adjust the modelling of the health workforce and inform decision-makers about the impact of their future decisions on the health workforce. Keywords Midwifery, Human resources for health, Midwifery services, Scenario planning, Belgium *Correspondence: Nadia Benahmed 1 Belgian Health Care Knowledge Centre, Boulevard du Jardin Botanique, 55, 1000 Brussels, Belgium © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Benahmed et al. Human Resources for Health (2023) 21:75 Background Midwifery in Belgium In Belgium, the training and practice of midwives are regulated by the Law of 10 May 2015 on the practice of health professions. Although the minimum content requirements for midwifery training are described in this law, each linguistic community may define the duration of the training needed to acquire the required skills, i.e. 3 years in the Flemish Community and 4 years in the French Community. The law distinguishes between activities performed by midwives with complete autonomy and those that require medical supervision. Autonomous midwifery activities are listed in the law and include pregnancy diagnosis, follow-up of low-risk pregnancies (maternal and child risk assessment, birth preparation, and parent education), eutocic deliveries (including amniotomy, episiotomy, perineal suturing), postnatal care, care of healthy newborns, preventive measures, and emergency procedures. They also have the right to prescribe a limited number of drugs listed in the law. The management of fertility problems, high-risk pregnancies, high-risk deliveries, and newborns with life-threatening conditions requires medical supervision. In addition, the law describes procedures that are explicitly prohibited for midwives, namely: artificial dilation of the cervix; use of forceps and vacuum; administration of anaesthesia (except local anaesthesia for performing or suturing episiotomy); and inducing abortion. Except in emergencies, midwives are also prohibited from performing the following procedures: internal version, breech extraction, manual removal of the placenta and manual exploration of the uterus. In Belgium, patients are free to choose their care provider and the setting of care. Antenatal care can be provided in a variety of settings, including hospitals, private practices and other centres. The majority of women give birth in hospital while the number of outpatient deliveries (at home, in a birth centre, or in a one-day hospitalisation) has remained fairly stable over time, accounting for about one per cent of the total number of deliveries [1–3]. Early postnatal care is usually provided in hospital, while postnatal care can be provided at home or in other settings (hospital, private practice, etc.). In 2019, 12 088 midwives were licensed to practise [4], of whom 57% worked in the healthcare sector (7 175 FTEs) [5]. With more than 9 out of 10 births taking place in hospital [1–3], the majority of midwifery activity took place in hospitals. As a result, less than 10% of the midwives worked in an outpatient setting [5]. Planning for healthcare professionals in Belgium In Belgium, the planning of healthcare professionals is a responsibility shared by the federal state and the federated entities [6]. Page 2 of 12 The Planning Commission for Medical Supply, under the authority of the Federal Minister of Health, is responsible for monitoring human resources for health (HRH) and proposing the regulation of the workforce through a system of federal quotas. Recently, besides this commission, two commissions have been set up in the federated entities to monitor HRH in their territories. The authorities of the federated entities regulate the candidates for training in order to meet the federal quotas. The Planning Commission for Medical Supply is supported by the Planning Unit for the Supply of the Healthcare Professions. This Unit quantifies and forecasts the supply of health professionals, including midwives, on the basi (...truncated)