Health Workforce Planning

This document discusses the concept of health workforce planning and its significance in healthcare systems. It explores the strategies and challenges involved in workforce planning for underprivileged populations, using Uganda as a case study. The document also covers the importance of environmental scanning and forecasting in effective workforce management. It provides insights into ethical and organizational issues in healthcare, management systems, and the availability of health services. The document concludes with a discussion on the role of strategic planning in health workforce management.

Running head: Health Work force Planning 1
HEALTH WORK FORCE PLANNING

Health work force planning 2
TABLE OF CONTENTS-
CONTENTS PAGE NUMBER
1. Introduction of workforce plan 3
2. Situation analysis 4
3. Health workforce plan for Uganda 5
4. Ethical and organisational issues 8
5. Management system 9
6. Environmental scanning and
forecasting
10
7. Recommendation for assessment
content
15
8. Conclusion 15
9. References 16

Health work force planning 3
INTRODUCTION OF WORK FORCE PLAN-
The Strategic Workforce Planning Tool prepared by the NHS for the Foundation Trusts (FT)
(NHS, 2014), defines workforce planning as: Long-term strategic , oriented planning which is
integrated with the organisation’s process and basically foccusses on the size and the
workforce quality.[1]
It mainly deals with-
 Preparing the work force
1. Planning
2. Education
3. Recruitment
 Enhancing the performance of the work force
1. Supervision
2. Compensation
3. System support
 Management of attrition
1. Choice of career
2. Health safety
3. Retirement
SITUATION ANALYSIS –

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This is a primary diagnostic tool used to process development of a proper strategic plan on
human resources for health [2]
It basically provide a rapid initial assessment of a longer term sustained process of human
resourcing planning. [3]
This tool-
1. Facilitates the effective regulation of the proper educational system and the job
availability towards an equitable distribution of health workers or workforce.
2. Management of health workforce and the working environment is improved.
3. Appropriate mix of health workers are achieved which are responsible for meeting the
needs of the population.
HEALTH WORKFORCE PLAN FOR UGANDA

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 Rationale for selecting the country-
1. Uganda lies below the poverty line.
2. Living conditions and working environment is poor.
3. Workload of healthcare is high.
THE WORKFORCE PLAN-
A competent team of around 250 field researchers were allocated to collect facts and
statistics from the healthcare workers in 200 facilities from seven selected underprivileged
zones. They were required to do the
1. Data entry both qualitative and quantitative.
2. Group transcription
3. Analysis
Health districts were divided into seven regions.
In all regions, a set of questionnaires were given to three major groups including-
1. Health care officials of the hospitals.
2. Administrator of the facility.
3. Health district directors and those who left the facility in the last year.
 Groups were checked thoroughly, one group comprised of doctors and nurses
 Other group consisted of allied health, pharmacy staff and paramedics.
These groups were dealt differently depending on logistics and their numbers.
 Overall satisfaction is rated and responses were evaluated on the basis of answers to
the questions asked,

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1. “Considering everything, I am satisfied with my job.”
Responses were made on a five-point scale:
“strongly agree,” “agree,” “neutral,” “disagree” or “strongly disagree.”
This question as a primary outcome variable to see which other measures best
predicted higher satisfaction.
2. Intent to stay is measured , ask- “Which of the following statements is true for you?”
responses about intention to quit the job -
“as soon as possible,” or within one month, six months , a year, two to three years , or
within three years to five years or willing to stay indefinitely.

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TABLE FOR QUALITATIVE ASPECTS OF HEALTH WORKFORCE PLAN-
TYPE OF
ANALYSIS
METHODOLOGY PROS CONS
Ratio trend analysis healthcare
workforce demand
estimates the ratio of
production level
divided by the
number of
workforce available
during that time.
Based on historical
data , and its easy to
calculate
It is an estimate , not
necessarily accurate
Regression analysis Determines the
relationship between
two variables and
changes one for
another .
Data driven Difficult application
Hrealth care
recruitment and
study
Total individuals
required in staff to
be present at a
stipulated period of
time
Excellent when the
workforce is
complete
Attendence is not
reliable
Strengths, weekness,
opportunities and
threats
Dimentions are
individually taken
care of to support
goals
Good tool to
understands a poor
countrys healthcare
work force .
Various gaps are
there to be filled in.

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ETHICAL AND ORGANISATIONAL ISSUES-
Include the following observations:
1. Few staff workers in the health facility are fraudulently charging money in the name
of fees .
2. Some doctors are being using medicines and surgical instruments illegaly from
government facilities for using in their private practices.
3. Many health workers are not trained and upgraded of the process and technology
being used which is a main reason for mal or unskilled practice.
4. Physicians running their own clinics at the time when they are supposed to be
working at the public sectors.
5. Administrators are also negligent of the malfunctioning as they are not taking any
appropriate action against these corrupt happening.
Health workforce demographic is an important characterstic to monitor during a policy
planning process. An appropriate balance between the worker and job is important for the
continuous presence in the facility, a substantial amount of workload , job security perceived
as stimulating or fun.
Majority of health workers are between age a group of 30-50 years and has many
dependents. Job satisfaction mainly include security apart from the basic satisfaction with the
salary, which is uniformly very low.
These situations could be addressed without the investment of a large amount of money.
Systems continuously tolerating incompetence , illegal practices, corruption, faulty decision
should be penalised as their work is not ethical and that’s why will not be valued.

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MANAGEMENT SYSTEMS
AVALILABILITY OF HEALTH SERVICES –
In the health service availability both must take into the type and level of health services
available to people are considered.
Each and every step is important in order to improve health outcomes for rural and
underprivileged population [4]
Primary, secondary and tertiay care and specialist care centers all contribute to the health care
sector [5]
Health workers usually perform a variety of roles at these different levels of the health care
system. Correct primary health care approaches are important as there is a the high burden of
chronic disease in underprivileged nations. Primary health centers includes services and care
facilities like -
 Emergency care services to serious patients which need treatment on an urgent basis.
 Cure of ambulatory patients.
 Chronic or severe illnesses management.
Population health programs –
 Vaccination programes
 Rehablitation programes [6]
Centers other than primary care units mainly provides a between different services that would
otherwise be unapproachable for the people, such as specialist medical care.[7]
Secondary and tertiary care services involves care at block level and if treatment is not
effective then reffereal to a higer level which is a specialised centre for cure . Some hospitals
use indigenous outreach workforce.
Primary care which is person -cantered is the key to bearable quality in the national
healthcare system.[8]
The health promoting influence of this model of care is mainly ideal for nations who are
below the poverty line .The World Health Report cited in Primary Health Care Reform in
(WHO, 2008, cited in 2009) outlined key elements in primary care which is mainly person-
centered and compared these to normal ambulatory medical care. [9]

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This mainly incorporated : -
1. Clear attention on health needs in contrast to attention on diseases and their definitive
treatments.
2. Strengthening personal relationships in contrast to relationship which is for a limited
period of consultation only.
3. Person cantered approach as it is more comprehensive.
4. Responsibility for the health for all in the desired or affected community .
5. Responsibility for managing the determinants of ill health incontrast to a
responsibility of effective advice to the patient at the time of consultation only.
ENVIRONMENTAL SCANNING AND FORECASTING -
With the help of better coordination, the primary care workforces can achieve basic
improvements in individual and population health care.
This can be achieved only when state health agencies must use assessments of needs to
understand the current senario and knowledge of the public health workforce and identify
loopholes in the training to better meet the demands of the changing healthcare climate.[10]
This report presents the results of an environmental scan of suitable practices for developing
and implementing these needs assessments. The scan consists of current researches and
interviews from organizations in the field.
A better and suitable way to both improve the care services and also to and cut down the
healthcare costs which is indeed the greatest burden is to better integrate public health and the
primary healthcare sector.[11]
The environmental scan has four aims: [12]
1. Assessment and understanding of needs of existing workforce in primary health care
as well as at corporate levels.
2. To identify and fix the loopholes and challenges in existing healthcare workforce .

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3. Assessment of opportunities for collaborating primary health care and workforces through
understanding needs.
4. Best practice implementation for developing a critical needs assessment to further
workforce development.
Most suitable way to monitor and analyse is to conduct external environmental scanning and
forecasting.
Environmental scanning or analysis process is a “kind of radar to scan the world sequentially
and systematically and thereby signal the new, the unexpected, the major, and the minor.” [13]
It includes:[14]
• Identification of environmental , scientific, technical, political and social interactions
critical to the organization.
• Analysing the serious threats to the organization caused by those events.
• Supporting continuous orientation programmes in health workforce management .
• Alerting workforce to trends that are parallel , converging, diverging, speeding up or
slowing down
Term strategic planning is well known and in regards to this higher education it is required
the first to identify the need for strategic healthcare planning in underprivileged populations,
for which it is important to ; [15]
1. Pay attention to the needs of the population and collection of exhaustive data on trends.
2. There needs to be competitive thinking about its strategic advantage and determine its
future needs.
3. Keep a balanced perspective on the need for appropriate hospital faculty and staff
participation and advisory input.
4. Link the strategic planning process with budget adjustments.
5. Risk-taking tendencies should be practiced.
6. Analyses the benefit risk ratio.
7. Planning process is to be converted into strategic decision making.
Taking into account the above points it is required that extensive researching of the external
environment is required for developing a strategic plan from the outside , involving
workforce in developing a plan, and then finally linking the strategic plan to budget and
strategic decision making. [16]

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The idea of strategic planning provided a clear knowledge of a planned systematic and
sequential activity which an organization uses to respond to major decisions facing it during a
three- to five-year period beyond the present.[17]
Strategic planning is:
 Foccused on the activities and responsibilities of the organisation.
 Directed externally
 Deals and solves the major planning issues
 Spans the boundaries for organisations.
 Process continuously affected by changes in the external environment occurring in an
irregular and haphazard time frame.
 Dealing with different uncertainities and possibilities.
 Evaluation of expert judgement.
The most reliable and common approach to strategic healthforce planning is an external
environmental scanning or analysis to identify the possibilities and threats facing the
organization, and internal scan to analyse the organization’s risk and upcoming opputunities.
[18]
EXTERNAl SCANNING- Core Environmental trends
1. Little population growth in a region since last 5 decades and this trend is likely to
continue
2. Population in the region is aging the younger population is leaving the region
3. Service sector employment especially in health care.
4. Government funding in health care needs
INTERNAL SCAN – SWOT analysis [19]
1. Strength-
 Excellent health care facility and staff with strong qualifications
 Energetic and innovative administration
 Affordable and accessible quality programs
2. Weekness-
 Funding
 Communication
 Teamwork

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3. Oppurtunities-
 Population aging or decreasing
 State funding
 More competition
4. Threats –
 Population aging and decreasing.
 No state funding
 Increasing competition

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Table - Report of the environmental scans and its analysis by methods and
outcomes.
Target population Method of
development
Method of
administration
Survey success
Primary care
workforce and
hospitals,
educational institutes
Exsisting public
healthcare data sets
Interview,
conversational and
assessment during
workforce planning
quantifiable
measures were used
according to the
needs of primary
healthcare services
in rural and
underprivileged
communities
More than 300
targeted individuals
and organizations
from Uganda
Group of workers
developed
workgroup
developed for the
better understanding
of the challenges ,
oppurtunities and
ongoing initiatives
of the workforce,
Electronic survey Reached to a larger
audience. Variety of
challenges like
financial challenges,
healthcare system
implementation, etc
were adressed
Exsiting healthcare
workforce or
healthcare providers
18 week study to
assess availability of
the existing
healthcare workforce
in area and
identification of the
areas where an
increase in the
healthcare workforce
is needed.
Tier 1 –
Physicians/Doctors
Tier 2 – Dentists,
Paramedics
Tier 3 –
Psychologist,
Optometrists,
Nurses, Midwifes.
Enabling
practitioners to
address effectively
the unmet healthcare
supply and analyse
the distribution of
midlevel workforce
in rural and
underprivileged
areas.

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Recommendations for Assessment Content:[20]
1) Rift between old workforce and new workforce to be assessed- It is essential to
evaluate knowledge differences between established employees and new employees. This can
be measured by use of new skills and technology which evaluates differences in workforce
2) Evaluation of the demand and supply of the workforce- It is crucial in order to
analyze workforce capacity.
3) Communication Barriers evaluation- In order to analyse that public health professionals
and primary care practitioners are fully aware of each other’s roles.
4) Evaluation of capacity of workforce- It is used to identify and assesess workforce needs
by looking individually at the public health workers, community health workers, physicians,
nurses etc.
Conclusion-
Environmental scan results revealed many good and ethical practices which are ongoing and
some malpractices limitations in the methodology also for assessing competency based needs
assessment and analysis. The current assessments provide a platform to build upon to the
changing healthcare environment. On the basis of the results gathered it is important to
implement a need assessment that acquires workforce capacity, diversity, training needs,
effectiveness, and basic demands .

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References
1. nhsemployers (2019) Retrieved from https://www.nhsemployers.org/your-workforce/plan
2. Skills for health https://www.skillsforhealth.org.uk/services/item/448-workforce-
planning
3. Strategy development plan (2014)
https://www.gov.uk/government/publications/strategy-development-a-toolkit-for-nhs-
providers
4. Rural health information hub https://www.ruralhealthinfo.org/topics/healthcare-access
5. Weisgrau, S. (2019). Issues in Rural Health: Access, Hospitals, and Reform. Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4193574/
6. Public health and medical care system
https://www.ncbi.nlm.nih.gov/books/NBK154484/
7. Primary secondary and tertiary health care http://www.arthapedia.in/index.php%3Ftitle
%3DPrimary,_Secondary_and_Tertiary_HealthCare
8. Person-centred care in primary care: the key to sustainable quality in the NHS? | The
Health Foundation. (2019). Retrieved from https://www.health.org.uk/blogs/person-
centred-care-in-primary-care-the-key-to-sustainable-quality-in-the-nhs
9. Robin Gauld, C. (2019). The World Health Report 2008 – Primary Healthcare: How Wide
Is the Gap between Its Agenda and Implementation in 12 High-Income Health Systems?.
Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3298021/
10. Williams, J., Walker, R., & Egede, L. (2019). Achieving Equity in an Evolving Healthcare
System: Opportunities and Challenges.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4724388/
11. Parker, R., Boulos, L., Visintini, S., Ritchie, K., & Hayden, J. (2019). Environmental scan
and evaluation of best practices for online systematic review resources.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5886503/
12. Paul Graham, R. (2019). Environmental scans: How useful are they for primary care
research?. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2464800/
13. Environmental Scanning. (2019). Retrieved from
http://horizon.unc.edu/courses/papers/enviroscan/

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14. (2019). Retrieved from
https://pdfs.semanticscholar.org/c1b6/642285d21137063b3aa7c0bf39644ac174fc.pdf
15. https://www.academia.edu/27102235/Implementing_the_Strategic_Plan
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entrepreneurship/entrepreneurship-creativity-and-innovation/environmental-
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