Introduction: With reducing number of health workers amidst increasing disease burden, ever incre... more Introduction: With reducing number of health workers amidst increasing disease burden, ever increasing population and limited resources, health systems are faced with challenges of providing adequate and quality health care globally. The application of provider-population ratio or fixed staff establishments have overtime, not matched the changing human resource needs of health care organizations. This study aimed to estimate human resource requirements of Mityana hospital basing on workload as an alternative to the existing approaches. Methodology: We employed descriptive cross-sectional design and the Workload Indicator of Staffing Needs (WISN) methodology. We utilized focus group discussion, observation and document review to obtain information from key informants; generated annual service statistics from the hospital’s records. The quantitative data were analyzed using the WISN software and spread sheet. Results:All the cadres studied had the same hours of work in a year (1,664), except nursing assistants whose annual available working time was1,696 hours. All the cadres were experiencing additional workload due to use of their time for activities other than their primary duties. Medical officers used more than 50% of their time for such (non-primary) activities compared to the laboratory staff (15%). As a result, the calculated WISN staff requirements were very high compared to the existing staff levels. Mityana hospital had 44% of the posts filled for the studied cadres. The nurses and midwives had the highest calculated requirements (72 and 45 respectively) and the highest staff positions filled (57% and 84% respectively) making them experience the lowest work pressure (49% each). The highest work pressure was experienced by medical officers and medical clinical officers (82% each). Conclusion: The study reveals shortages in health workforce in Mityana hospital. Non-primary activities contributed to work pressure in different units of the hospital, resulting into long hours of shifts which could have compromised quality of health care. This method (WISN) estimates staffing requirements based on actual service provision. Stakeholders facing human resource challenges and scarcity can employ it in prioritizing health cadres for recruitment and deployment based on existing work pressure.
There is a growing concern that the traditional-budget-based financing of health services does no... more There is a growing concern that the traditional-budget-based financing of health services does not have adequate incentive to stimulate health sector performance improvement in terms of outputs and quality. Despite increased development aid towards health over the years, most of the low-income countries remain far from attaining the health-related Millennium Development Goals (MDGs). Performance based financing (PBF) has slowly gained favor as one of the provider payment mechanism that can partly address current performance challenges in the health sector. Cordaid piloted PBF in level IIIs primary health care facilities of Jinja diocese for 3 years (from 2009/10 to 2011/12). We conducted this study to assess the effects of PBF on the performance of the HCIIIs. The descriptive, cross-sectional study with a comparative component was carried out in 4 HC IIIs of Jinja diocese from 12th June to 22nd July 2012. We collected and analyzed annual performance data from health facility records on selected outputs for the 2 years before and after roll-out of PBF – comparing the study health facilities with an equal number of controls of the same level. We also analyzed data on selected quality indicators. After start of PBF, there was a positive trend in performance of the PBF- implementing health facilities relative to the controls. Human resource as a proxy marker of quality of inputs stood lower in the study health facilities than controls. We concluded that there was a positive trend in performance in the selected indicators in the PBF H/Cs. To create credibility to the observed performance, there is need to have a rigorous, regular and independent data verification plan built within the implementation process. We recommend piloting of this PBF approach in more health facilities and of bigger coverage like level IV health facilities and hospitals so as to gain more insight on what effect it can have on Uganda’s health system and related contexts.
Introduction: With reducing number of health workers amidst increasing disease burden, ever incre... more Introduction: With reducing number of health workers amidst increasing disease burden, ever increasing population and limited resources, health systems are faced with challenges of providing adequate and quality health care globally. The application of provider-population ratio or fixed staff establishments have overtime, not matched the changing human resource needs of health care organizations. This study aimed to estimate human resource requirements of Mityana hospital basing on workload as an alternative to the existing approaches. Methodology: We employed descriptive cross-sectional design and the Workload Indicator of Staffing Needs (WISN) methodology. We utilized focus group discussion, observation and document review to obtain information from key informants; generated annual service statistics from the hospital’s records. The quantitative data were analyzed using the WISN software and spread sheet. Results:All the cadres studied had the same hours of work in a year (1,664), except nursing assistants whose annual available working time was1,696 hours. All the cadres were experiencing additional workload due to use of their time for activities other than their primary duties. Medical officers used more than 50% of their time for such (non-primary) activities compared to the laboratory staff (15%). As a result, the calculated WISN staff requirements were very high compared to the existing staff levels. Mityana hospital had 44% of the posts filled for the studied cadres. The nurses and midwives had the highest calculated requirements (72 and 45 respectively) and the highest staff positions filled (57% and 84% respectively) making them experience the lowest work pressure (49% each). The highest work pressure was experienced by medical officers and medical clinical officers (82% each). Conclusion: The study reveals shortages in health workforce in Mityana hospital. Non-primary activities contributed to work pressure in different units of the hospital, resulting into long hours of shifts which could have compromised quality of health care. This method (WISN) estimates staffing requirements based on actual service provision. Stakeholders facing human resource challenges and scarcity can employ it in prioritizing health cadres for recruitment and deployment based on existing work pressure.
There is a growing concern that the traditional-budget-based financing of health services does no... more There is a growing concern that the traditional-budget-based financing of health services does not have adequate incentive to stimulate health sector performance improvement in terms of outputs and quality. Despite increased development aid towards health over the years, most of the low-income countries remain far from attaining the health-related Millennium Development Goals (MDGs). Performance based financing (PBF) has slowly gained favor as one of the provider payment mechanism that can partly address current performance challenges in the health sector. Cordaid piloted PBF in level IIIs primary health care facilities of Jinja diocese for 3 years (from 2009/10 to 2011/12). We conducted this study to assess the effects of PBF on the performance of the HCIIIs. The descriptive, cross-sectional study with a comparative component was carried out in 4 HC IIIs of Jinja diocese from 12th June to 22nd July 2012. We collected and analyzed annual performance data from health facility records on selected outputs for the 2 years before and after roll-out of PBF – comparing the study health facilities with an equal number of controls of the same level. We also analyzed data on selected quality indicators. After start of PBF, there was a positive trend in performance of the PBF- implementing health facilities relative to the controls. Human resource as a proxy marker of quality of inputs stood lower in the study health facilities than controls. We concluded that there was a positive trend in performance in the selected indicators in the PBF H/Cs. To create credibility to the observed performance, there is need to have a rigorous, regular and independent data verification plan built within the implementation process. We recommend piloting of this PBF approach in more health facilities and of bigger coverage like level IV health facilities and hospitals so as to gain more insight on what effect it can have on Uganda’s health system and related contexts.
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it can have on Uganda’s health system and related contexts.
it can have on Uganda’s health system and related contexts.