Improving Access to Care among Underserved Populations: The Role of Health Workforce Data in Health Workforce Policy, Planning and Practice

Abstract

Universal health coverage (UHC) is central to the post-2015 development agenda. In Namibia, optimal organization of HIV and high-priority health services requires robust, policy-relevant health workforce evidence. This paper examines Namibia’s use of the Workload Indicators of Staffing Need (WISN) tool, which estimates staffing requirements based on health facility workload. Namibia’s public health sector applied WISN regionally and nationally. We analyzed four health workforce decisionmaking scenarios (staff redeployment, scarce skill allocation, staffing norms and task sharing) and used spatial analytic techniques to consider facility under/overstaffing in association with regional HIV prevalence, finding significant staff shortages in densely populated regions with high HIV burdens. Innovative use of WISN results by health systems managers and policymakers can help rationalize staff deployment, provide concrete information on staffing needs and model the impact of potential policy changes. These examples illustrate WISN’s value for policy and practice decisions that can further global commitments to achieve UHC. Background Globally, efforts are underway to define the post-2015 development agenda. For the health-related goals, the cornerstone is country movement toward universal health coverage (UHC), which aims to ensure that all people obtain the health services they need without suffering financial hardship. The global community has also reached a “defining moment” in its response to HIV, as ending the epidemic becomes an attainable goal (WHO 2014a). The relationship between UHC and HIV is closely interconnected, according to the WHO (2014a), which notes that the global response to HIV has been a trailblazer for UHC (WHO 2014a). In settings where UHC or conditions approximating universal coverage are lacking, the uneven distribution of health services and resources will typically result in inequities and underserved populations. The UHC agenda requires attention to country-level human resources for health (HRH) needs (WHO 2014b). Nearly a decade ago, the WHO (2006a) suggested that 2.28 health workers (physicians, nurses and midwives) per 1,000 of the population represents the HRH threshold necessary to achieve 80% population coverage to provide attended childbirths and immunizations, which are core Millennium Development Goal health indicators. According to some, however, this “minimalist” threshold vastly underestimates meeting population health needs and required HRH stock, masks regional/national disparities and ignores shortages of other cadres (O’Brien and Gostin 2011). Health worker shortages and imbalances represent a particular challenge in Africa, where three-fifths (63%) of the WHO-designated HRH crisis countries are located (Mdege et al. 2012; Moosa et al. 2014;