National Health Workforce Plan, the Case of Sri Lanka

This paper discusses the National Health Workforce Plan in Sri Lanka, addressing the nursing shortage and proposing strategies to close the gap. It explores the current health workforce profile, the future workforce profile, and the external and internal environment. The paper also includes a gap analysis and closing strategies.

Running Head: NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 1
National Health Workforce Plan, the Case of Sri Lanka
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NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 2
Table of Contents
Health Workforce Plan, Case Study of Sri Lanka........................................................................................4
Context and Environment............................................................................................................................5
External Environment..................................................................................................................................7
Internal Environment...................................................................................................................................8
The Current Health Workforce Profile in Sri Lanka....................................................................................9
Future Workforce Profile in Sri Lanka......................................................................................................10
Gap Analysis and Closing Strategies.........................................................................................................10
Conclusion, Review, Evaluation Strategy and Next Steps.........................................................................12
References.................................................................................................................................................13

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 3
Executive summary
Based on the World Health Organization (WHO) statistics, this paper has identified Sri Lanka
as a low-middle income country whose health sector has a lot to be done. For improvement
purposes, the paper has come up with a workforce plan. The outlined workforce place solves
the issue of nursing shortage faced by the country. In the first subtitle, context, and
environment, it has been revealed that Sri Lanka has been surviving under a deficit of 30,000
nurses which has made it challenging for this country to meet its health goals. The second
subtitle, the external environment, has presented health worker shortage as a big problem in
the whole country which has made it very hard for them to achieve universal healthcare. In
the current workforce profile of Sri Lanka, the paper has revealed that the country has enough
institutions which can accommodate enough healthcare workers for its market. To close the
gap on healthcare worker shortage, the paper has proposed that the government of Sri Lanka
should invest in its education system to encourage more learners in the healthcare sector

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 4
Introduction
In any country, the backbone of the healthcare system lies on the shoulders of the nurses
whose workload has proved to be multifaceted and highly complicated. The shortage of nurses
has however been reported all over the world. The shortage has had adverse impacts on global
healthcare systems. The nursing shortage is defined as the existing imbalance between the supply
and demand of nurses which can be attributed to qualifications, demographics, availability, and
willingness to execute nursing duties (Pozo-Martin et al, 2017). Generally, when a health system
has inadequate nurses who can provide quality nursing care it’s perceived as a shortage of
nurses. In the economic field, the shortage of nurses has been defined as the condition where a
health system has insufficient health workers who can provide high-quality health services.
The consequences attributed to the shortage of nurses, particularly the uneven healthcare
quality have deteriorated the general well-being in most countries. Healthcare administrators are
therefore supposed to work together to come up with sustainable ways of providing health
services among the growing population of Sri Lanka. Health workload approaches have been
categorized into four levels: the unit, the job, the patient and situation levels (World Health
Organization., 2016). Both the patient and situation levels fall under the job level, which falls
under the unit level. Under the clinical unit, nurses work in collaboration but in shifts. Also, a
nurse’s workload depends on the unit and the specialty. For instance, a nurse under intensive
care unit has a high amount of workload compared to a general floor nurse. When in their line of
duty, nurses come across different patients under different conditions, which are the determinants
of patient and situation level workloads. The healthcare workload depends on the patient’s health
status and the patient’s nursing care needs as well as the severity of his or her symptoms. There
are different approaches to determine whether the composition and scale of nurse staffing

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 5
adequately meet patient needs (Gosling, 2016). In general, the approaches entail factors such as
the time required for nursing interventions, the number of nurses in each ward and patient safety.
The nursing workload has also been defined as the time spent by a patient in a nursing ward and
the average length of hospital stay. Mainly, most of the research papers on nursing workload
have used the nurse-patient ratio to determine the nursing workload (Addicott, Maguire,
Honeyman & Jabbal, 2015). The nursing workload is, however, a complex construct which
cannot be determined by the nurse-patient ratio alone. Some of the activities which increase
nursing workload include the increased patient turnover, increased admission, and discharge of
patients, general organizational and nursing duties and the movement of patients within the
hospital wards. This paper scrutinizes the nursing workload in Sri Lanka and proposes a
workforce plan which can solve the shortage of nurses in the country.
Context and Environment
Sri Lanka’s healthcare system is free with a number of services which are based on
both western and indigenous medications. Mainly, the delivery of healthcare services in the
country is achieved through primary and tertiary centers, dispensaries, and hospitals. The
network has improved the overall health status of the country under low annual expenditure
(Aluwihare‐Samaranayake, Ogilvie, Cummings & Gellatly, 2017). Over the last few years,
the healthcare system in Sri Lanka has experienced major changes, especially as it regards to
the safety and quality of the country’s health system as a result of the limited resources. The
recent South East Asian Summit held by WHO applauded Sri Lanka as a good example in the
region following its excellent hospital administration, patient care and medical services
(Shukri, 2019). Sri Lanka’s healthcare system has nursing approaches which value patient
care against illnesses and assisting the advancement of health status within the country.

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 6
Nurses in Sri Lanka perform a number of roles which include the provision of care to patients,
coordination of paramedical services, administration of medications and supervision of
assistant staff members.
Nurses in Sri Lanka don’t work independently but work in groups. They are often the
first contact points when a patient attends a hospital for treatment and also the last contact
points for patients upon discharge. Nurses are therefore very critical workers to the healthcare
system of a country (Aluwihare‐Samaranayake, Gellatly, Cummings & Ogilvie, 2018).
Despite their critical roles in Sri Lanka’s healthcare system, the shortage of nurses has
continued to be a major concern in the country. Considering the retirement of nurses to be 60
years, around 23% of professional health workers in Sri Lanka will have retired in the next
five years. Also, considering the fact that 11% of Sri Lanka’s professional nurses are over the
age of 60 years, the healthcare system of this country requires more nurses to take care of the
nurses who may not be available for practice in the next few years (Mudihanselage &
Chamaru, 2015). In consideration to the analysis and the fact that Sri Lanka’s government has
cut back the posting on nursing students and closed down several nursing colleges, a gap in
the healthcare workforce has been introduced, leading to increased pressure and workload for
nursing staff.
The demand for nurses in Sri Lanka has been increasing because of its aging
population. In 2012, statistics indicated that the population of Sri Lanka was 20.3 million and
those who had healthcare needs were more than 1.3 million. According to Central Bank
Annual report in the same year, the number of those who had extensive healthcare needs was
expected to grow by 20% by the year 2030 (Samarasooriya, Park, Yoon, Oh & Baek, 2019).).
Secondly, the number of nurses has not been enough to meet the needs of the suffering

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 7
population, and the shortage was projected to keep growing as the health demands kept
increasing and nursing colleges unable to cope with the increasing demand. Currently, the
nursing workforce in Sri Lanka is 30,000 which is not able to meet the health demands of the
country. Because of the shortage, the nursing workload has increased for the remaining
nurses. Also, in response to the increased healthcare costs, hospitals had reduced the number
of nursing staffs and implemented an overtime policy which has also increased the nursing
workloads (Gunn, Muntaner, Villeneuve, Chung & Gea‐Sanchez, 2019). These statistics give
a picture of a nation which can not satisfy the health needs of its population, a gap which is
expected to keep widening as the population increases and more nurses retire. The main goal
of the workforce is to minimize the wide gap in Sri Lanka’s healthcare system. The plan will
encourage the enrollment of nursing students in the countries higher learning institutions.
External Environment
Shortage of nurses is currently a world problem regardless of whether the country is a
developed or underdeveloped. The United States and Australia are good examples. However,
the implementation of planned strategies in those countries has enabled them to minimize
their health workforce gaps. For instance, the senior population in the U.S has been growing
for the last five years (Kumari & De Alwis, 2015). This has been attributed to its aging
population. This growth and the implementation of an Affordable Care Act have had both
opportunities and challenges in the US health sector. There has been an increased demand for
healthcare services in the country, which is expected to exceed the current healthcare
workforce in the country. The same case applies to Australia and the United Kingdom.
To close the nursing shortage gaps, most of the developed countries have put different
strategies towards workforce planning. Most of them have invested in health education

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 8
programs like Medicaid and Medicare. Through these programs, the government subsidizes
healthcare education to encourage potential nursing students to enroll. Although the strategy
has worked for a number of developed countries to achieve sustainable health workforce,
some of the countries are facing different challenges. The American Hospital Association
Committee on Performance Improvement (AHACPI) has revealed that training of the
potential practitioners among the rural communities has remained a major challenge in most
of the countries. In addition, the AHACPI indicated that the partnership and educational
pipeline between the medical and academic institutions has not been fully strengthened.
Internal Environment
Currently, Sri Lanka’s nursing shortage has hit 24,000 which will require a nursing
cadre of 48000 for the gap to be filled (Kumari & De Alwis, 2015). According to a report
published by the country’s Ministry of Health, the nursing shortage is expected to worsen and
possibly hit the mark of 40,000 nurse shortage by the year 2025. In regard to these statistics,
two questions have hit the headlines; (1) will the already overwhelmed healthcare system be
able to provide safe and quality healthcare services for patient support and healthy working
environments? (2) Will the already burdened nursing workforce be able to satisfy the health
needs of the fast-growing population? Research by (Nayomi, 2016) demonstrated that the
shortage of nurses in Sri Lanka had increased mortality and morbidity of patients under acute
care units. According to this research, the results were attributed to increased nurse workload,
work-related stress, and low job satisfaction. It proposed the assessment of nursing job
outcomes to ensure that nurses are optimally utilized.

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 9
The Current Health Workforce Profile in Sri Lanka
As pointed in the subsections above, Sri Lanka has adequate learning institutions
which can produce enough nurses for the country’s health needs. This is because the country
has enough universities and other institutions of higher learning. Also, the country has enough
students who can fill those positions to come out as experienced nurses (World Health
Organization, 2018). However, the institutions lack enough facilities to enable them to
accommodate enough nursing students who can fill the nursing shortage gap in the country.
Resources such as labs and enough tutors who can support the high intakes are also lacking in
most of the nursing institutions. This has forced the institutions to take a small number of
nursing students which can be supported by the available resources. The cost of nursing
courses is also very expensive to the extent that it scares away students from poor families
who are potential nurses.
In addition, Sri Lanka has been listed among the countries with underpaid nurses and
other healthcare practitioners. The fact that nurses are underpaid and work under unhealthy
conditions has made it appear as a doomed profession has discouraged many potential nursing
students. Therefore, the Sri Lanka government should strive to fund the nursing institutions
offering medical related courses in order to make it possible for them to accommodate a large
number of nursing students (Smith, 2018). The first priority should be given to the institutions
through enough human resources and enough facilities which can accommodate a large
number of nursing students. The second priority will be geared to reduce the cost of nursing
courses in the country’s public institutions. Reducing the cost will enable more students to
venture into the nursing field (Munasinghe & Matsui, 2019). This will be achieved through

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 10
government subsidies for health-related courses. The third priority will be based on welfare
improvement. Nurses and other healthcare workers must be compensated handsomely to
make it attractive to the potential students.
Future Workforce Profile in Sri Lanka
Through Sri Lanka’s ministry of health, strategic objectives have been tabled to
increase its work density. The government will be forced to heavily invest in the health care
sector through the support of nursing institutions which offer nursing courses to be able to
accommodate a large number of potential nursing students (Saha, Gunaratnam, Patil, Choo,
Bagchi, Jhaveri & Herman, 2018). To implement the workforce plan, the government will
incur additional costs because it will entail supporting the institutions. The government will
also need to compensate health workers handsomely in order to attract more learners into the
field. This will in turn raise issues in regard to government expenditure because citizens will
have to be taxed heavily for the government to be able to support the initiatives.
Gap Analysis and Closing Strategies
From the subsections above, it comes out clearly that Sri Lanka is currently facing a
shortage of nurses in its healthcare system. This can be seen from its nursing density, which is
far below the set standards outlined by the World Health Organization (WHO). According to
WHO, a country with an adequate number of nurses should have 23 nurses for every 10000
people. The shortage of nurses in Sri Lanka has been linked with a number of factors. The
first factor is the high cost of pursuing health-related courses in the country. The high cost
makes it hard for some of the potential health care students to afford. The second factor
touches on the welfare of the nurses within the country (Wijeyaratne, Arambepola,

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 11
Karunapema, Periyasamy, Hemachandra, Ponnamperuma, & de Alwis, 2016). The nursing
profession is perceived as a doomed profession compared to other professions such as
engineering and teaching. This is based on the fact that nurses have low salaries than most of
the civil servants in the country.
To bridge the gap, the paper has proposed that the government should invest in
healthcare training in order to produce enough nurses for its fast-growing population. To
achieve this objective, Sri Lanka’s government must support the public institutions offering
health-related courses in the country. This will be achieved through fees subsidies to enable
all potential students regardless of the financial backgrounds (Fernando, Suveendran & de
Silva, 2017). This will also be achieved by supporting the institutions offering nursing courses
with resources to make it possible for them to accommodate enough nursing students.
Harnessing the power of information technology in nursing education is the second approach
to enhance health education within the country (Altschul et al, 2018).
Conclusion, Review, Evaluation Strategy and Next Steps
Based on the outlined workforce plan, the main approach to bridging the nursing
shortage gap will be based entirely on the provision of affordable nursing education in Sri
Lanka (Opalek & Greenberg, 2017). Through this approach, potential nursing students will be
able to undertake nursing courses regardless of their financial backgrounds. The action plan
will also advocate for attractive and competitive wages based on the nursing roles in order to
entice potential students to pursue nursing related courses (Lopes, Almeida & Almada-Lobo,
2015). Evaluation of this plan will be based on the perceived changes in regard to the number
of students joining nursing institutions. The workforce plan will be marked effective based on
the number of student with interest in pursuing nursing courses as well as the overage number

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 12
of those who join the nursing institutions. Finally, there will be coordination of health-related
courses in order to make sure that the students get quality education based on the market
demands.

NATIONAL HEALTH WORKFORCE PLAN, THE CASE OF SRI LANKA 13
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