An assessment of staffing needs at a HIV clinic in a Western Kenya using the WHO workload indicators of staffing need WISN, 2011

Burmen et al. Human Resources for Health (2017) 15:9 DOI 10.1186/s12960-017-0186-3 CASE STUDY Open Access An assessment of staffing needs at a HIV clinic in a Western Kenya using the WHO workload indicators of staffing need WISN, 2011 B. Burmen1* , N. Owuor1 and P. Mitei2 Abstract Background: An optimal number of health workers, who are appropriately allocated across different occupations and geographical regions, are required to ensure population coverage of health interventions. Health worker shortages in HIV care provision are highest in areas that are worst hit by the HIV epidemic. Kenya is listed among countries that experience health worker shortages (<2.5 health workers per 1000 population) and have a high HIV burden (HIV prevalence 5.6 with 15.2% in Nyanza province). We set out to determine the optimum number of clinicians required to provide quality consultancy HIV care services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, JOOTRH, HIV Clinic, the premier HIV clinic in Nyanza province with a cumulative client enrolment of PLHIV of over 20,000 persons. Case presentation: The World Health’s Organization’s Workload Indicators of Staffing Needs (WISN) was used to compute the staffing needs and sufficiency of staffing needs at the JOOTRH HIV clinic in Kisumu, Kenya, between January and December 2011. All people living with HIV (PLHIV) who received HIV care services at the HIV clinic at JOOTRH and all the clinicians attending to them were included in this analysis. The actual staffing was divided by the optimal staff requirement to give ratios of staffing excesses or shortages. A ratio of 1.0 indicated optimal staffing, less than 1.0 indicated suboptimal staffing, and more than 1 indicated supra optimal staffing. The HIV clinic is served by 56 staff of various cadres. Clinicians (doctors and clinical officers) comprise approximately one fifth of this population (n = 12). All clinicians (excluding the clinic manager, who is engaged in administrative duties and supervisory roles that consumes approximately one third of his time) provide full-time consultancy services. To operate at maximum efficiency, the clinic therefore requires 19 clinicians. The clinic therefore operates with only 60% of its staffing requirements. Conclusions: Our assessment revealed a severe shortage of clinicians providing consultation services at the HIV clinic. Human resources managers should oversee the rational planning, training, retention, and management of human resources for health using the WISN which is an objective and reliable means of estimating staffing needs. Keywords: Adequacy of human resources, Staffing needs, HIV/AIDS health services * Correspondence: 1 Kenya Medical Research Institute Center for Global Health Research, P.O. Box 1578-40100, Kisumu, Kenya Full list of author information is available at the end of the article © The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. 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. Burmen et al. Human Resources for Health (2017) 15:9 Background A health worker density exceeding 2.5 per 1000 population (or 23 health workers—doctors, nurses, and midwives—per 10,000 populations) is required to achieve the Sustainable Development Goal (SDG) of ensuring healthy lives and promoting well-being for all at all ages [1]. However, there is a global health worker shortage in 57 developing countries, 36 of which are in Africa [2]. With the advent and scale-up of antiretroviral therapy (ART), and drastic reductions in the costs of ART, there has been a decline in morbidity and mortality due to HIV. However, health worker shortages continue to pose a formidable challenge in ART provision. HIV programs in countries with the highest HIV burden in 2004 (Malawi, Zimbabwe, South Africa, and Mozambique) continue to cite health worker shortage as a major impediment to achieving their goals [3, 4]. Kenya, with a population of 40 million and a HIV prevalence of 6.2% among persons aged 15–49 years of age, had only attained 13 of the minimum requirement of 23 health workers per 10,000 populations in 2010 [5]. Nyanza province of Kenya had the highest HIV prevalence in the country: 15.6% against the country’s average of 5.1% according to the Kenya AIDS Indicator Survey of 2012 [6]. To address the global health workforce crisis, tactical information on human resources for health should be provided to guide policy making [2]. This implies that we need information to forecast the number of health workers required. For this reason, the Kenya National AIDS strategic plan III 2009–2013 directed that adequacy of human resources for health be assessed using staff audits [7]. To compute optimal allocations and deployment of staff, population ratios, standard staffing schedules, or the Workload Indicators of Staffing Needs (WISN) can be used. Population ratios are based on the World Health Organization (WHO) recommendations of number of health workers per a catchment population. However, population ratios do not consider that workloads may differ in different localities; hospitals with the same bed capacity may not have same morbidities, health seeking habits, and facility workloads. Additionally, health requirements will vary with population density, demographic and socioeconomic characteristics, morbidity and mortality, geographical features, utilization patterns, and ease of access [8]. Standard staffing schedules, similar to benchmarking, are based on a predetermined number of health workers who should be attached to a given hospital [9]. Fixed staffing norms in health facilities in Uganda have been shown to fall short of WISN staffing requirements [10]. Majority of staffing norms are usually located somewhere between the two. Subsequently, unadjusted staff loads lead to overstating staffing needs or underestimating workloads Page 2 of 8 [9, 11]. Other methods to assess staffing needs include using informal managerial judgments [12]. An ideal method would be to use the WISN, developed by the WHO. The WISN includes activities done by common cadres, the annual workload, time taken to do particular activities, available working time, and associated activities that are not core to the job description of a person [11]. WISN takes into account the indigenous epidemiology and specific sets of services; therefore, its results are precise and more useful for planning and policy implementation [13]. WISN carried out to assess health worker requirements (...truncated)