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The importance of planning and projections for HRH in health systems

Many factors which influence human resources for health (HRH) play a critical role in health system performance. This article details these factors.
A group of people in business attire talking while looking at a chart on a laptop screen.
© Nossal Institute for Global Health at the University of Melbourne

Managing human resources for health (HRH) involves understanding many factors including workforce densities and distribution; recruitment and retention, motivation and incentives. Good policy depends on good evidence about these factors, and reasonable projections of the needs and supplies of human resources in the future.

The WHO has developed a guide to models and tools for health workforce planning and projections, to encourage countries to develop strategic planning for human resources in health. The guide reviews a variety of existing tools for planning and making projections, discussing the advantages and challenges of the different methods. It is a good summary of both the reasons for doing strategic planning and the methods available for strategic planning exercises.

What are general problems with the current way governments tend to do planning and projections?

Many countries, especially low- and middle-income countries, fail to account for key elements like the education system, or strategic needs for changing current patterns of distribution. Planning is often only annual exercises that adjust the previous year’s plan, and not longer-term strategic plans that account for contextual changes and changing priorities.

What are some key human resource projection models?

  • Human resources to population ratio use targets for health professionals per population (eg 1 physician to 10,000 population) and projects growth of population and training capacity to identify the future gap. This is the easiest model but often misses the complexity of needs and performance.
  • Health needs focuses on epidemiological and demographic changes in the population using targets for coverage of priority health conditions, and is a more complex model.
  • Service demand uses utilisation rates for services and projected increases in demand for different population groups
  • Service target starts with projected types and numbers of facilities and staffing patterns for assuring that facilities have enough staff. This method is also relatively easy to implement.

Balancing HRH supply requirements with service provision plans

The above models usually focus on the public sector and relate HRH staff to budgets, public training capacities, private sector training, etc. They collect data on current staffing and on future projections of health needs and demographic projections which are often put into computer-based programs which can produce relatively simple consistent results or can simulate different changes in models. There are several available software packages freely available –some of them are reviewed with useful case studies, in the WHO guide.

Special studies

There are several more specific tools that can be useful as stand-alone analyses but also can feed into the broad human resources strategic plan. These include WISN (Workload Indicators of Service Need), a tool for assessing workload of staff to determine if workloads are too heavy or too light. Trend analysis is often used to project the role of the private sector, which is less predictable than public sector provision. Meta analyses are complex sophisticated techniques of using multiple data sets that can focus on specific HRH issues. Econometric analyses use sophisticated economic methods to address projections and relationships under different scenarios and assumptions.

Steps forward

The planning process requires involving top officials and other stakeholders and strong political, leadership and management skills and established commitments and responsibilities. Consensus on the objectives in short and long term is a starting point for the planning process. The first step in HRH strategic planning is establishing a steering committee of high-level officials representing important stakeholders to define objectives, supervise the process and take responsibility for presenting the draft plans. This committee will oversee a technical team of experts who will do the data collection and basic analysis.

Before moving on to the next step, take a moment to think about the differences in requirements for data and the assumptions implied in the four common approaches for projections. What are the advantages and disadvantages of each model? Which do you think is the best approach? Which is the most feasible for your country?

World Health Organization, 2010. ‘Models and tools for health workforce planning and projections’, Human Resources for Health Observer, no. 3.
© Nossal Institute for Global Health at the University of Melbourne
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