Developing a National Health Workforce Plan for Nepal: A Report

This report provides a detailed analysis of Nepal's health workforce, addressing critical issues and proposing a comprehensive 5-year plan. It begins with an executive summary highlighting the significant human resource challenges in Nepal's healthcare sector, particularly in comparison to developed nations. The report includes an environmental scan, evaluating various political, environmental, and social factors influencing the development and execution of a national health workforce plan. It examines workforce distribution, entry rates, and other key parameters. The report also outlines a potential framework, aligning with WHO guidelines, and discusses issues within the framework, offering recommendations for improvement. The report emphasizes the need for job creation, gender equality, and transformative education to enhance the health workforce. It also addresses challenges related to funding, coordination, and workplace practices, offering strategies to overcome these obstacles and improve workforce performance.

EXECUTIVE SUMMARY
This report addresses existing issues that exist in case of a low-income country as reported by
WHO. The low-income country chosen for this report is Nepal, which has significant Human
Resources issues in the healthcare sector. This report goes on to show the expected minimal
workforce plan required for developed countries and Nepal as a part of the developing nations
lag behind the expected guideline. It further addresses that the country has failed to meet the
National Health Policy of 1991 and how the current workforce plan for the country is unable to
attend the necessary demands. The potential framework for the workforce plan has been
provided for the next five years. This report also addresses issues that exist within the workforce
plan and ways to overcome such challenges. Recommendations have been provided keeping in
mind the guidelines provided by WHO which also takes into account multiple factors for
addressing key issues that exist in the framework for every nation.

Table of Contents
INTRODUCTION...........................................................................................................................................3
Environmental Scan of the country.............................................................................................................3
Characteristics to be considered while evaluating the environmental scan for Nepal............................4
Potential Framework for Nepal.........................................................................................................................6
RECOMMENDATIONS.........................................................................................................................................9
CONCLUSION.................................................................................................................................................11
REFERENCES..............................................................................................................................................12

INTRODUCTION
This report addresses one of the low-income countries, mentioned by the WHO (World Health
Organization) in terms of developing a National Health Workforce Plan, Nepal. It looks forward
to explaining the environmental scans for the country with the aspect of the multiple political,
environmental, social factors that can influence to development and execution of the health
workforce plan. This report also takes into account the desired goal of health care professionals
to be made available in the country and makes a close comparison with developed nations with
recommendations to address existing issues with the current infrastructure, the existing
workforce, the delivery of services, issues and multiple others.
Human Resource is an integral part of the healthcare system. Human Resource for Health (HRH)
is one of the very important building blocks of the health care system. This includes multiple
categories of health care experts like doctors, nurses, mid-level professionals, paramedics,
specialists, public health professionals as well as researchers. This report chose Nepal, as one of
the low-income countries, to develop a national workforce plan for the next 5 years. Nepal was
chosen for this report as the Human Resource situation for the country is a key issue in providing
proper healthcare to the citizens due to multiple challenges faced in terms of shortage of
workforce as well as the inappropriate distribution of the existing workforce.
Environmental Scan of the country
Environmental Scanning is early on warning theframework with strategies- it enables
associations to distinguish key chances and dangers sufficiently first so that the beneficiary can
profit by circumstances and alleviate dangers genius effectively, as opposed to responsively. It's
a basic contribution to situation arranging and a key apparatus in prospects considering or
connected foreknowledge (Grimes et al., 2014).
Environmental Scanning is utilized to resolve issues taught insufficiency - the idea that
concernes individuals have complete knowledge of our association and industry, that we are
frequently the last to know when it is being changed (Hanlon et al., 2014). History is covered
with associations who botched the chance to react nimbly in the reality of outside circumstances.
Blockbuster, as well as Kodak, is oft-referred to models. A progressively contemporary model is

the cab business, which - in spite of being a directed imposing business model in basically every
ward in which they work far and wide - have been on a very basic level upset in only a couple of
years since 2009, when Uber was an endeavor supported application with only $200,000 in seed
subsidizing (Gordon, 2013).
For Strategic Planning of the workforce, Environment Scanning is a crucial process to find the
vital factors that may impact the workforce of the country in the future. These factors may be
external or internal coming due to the demand within or outside the country.
Characteristics to be considered while evaluating the environmental scan of Nepal
Age and Sex of the Workforce: In economically backward countries like Nepal, the number of
male nurses is low. Equal wage is still a question in such countries. The target would be to
achieve equally proportioned ratios of male to the female workforce within the range of 20-45
for both.
Classification levels- There has to be categorized a list of the medical workforce including
dentists, paramedics, registered nurses, midwives, medical professionals, nursing assistants,
pharmacists, medical imaging workers. These are only some of the crucial roles to be focused on
for Nepal.
Occupational Categories- For occupational categories, the kind of job profile every individual for
the workforce has is vital. This would mean recruiting trained staff or offering training to
enrolled individuals in universities and colleges.
Staffing Mix- Financial crisis is often an issue in low-income countries, to deal with this, it
would be beneficial to hire part-time workers along with full-time ones. There is also the need to
consider temporary staff and permanent staff.
Turnover Rates- The number of workers leaving the organization or the workforce has to be
replaced by new ones. That would be the only option to balance the turnover rates and increase
the rate over time.
Growth, Stability or decline in headcount and FTE- Growth of the workforce would be possible
only through countering internal and external parameters that are holding back the country from
developing the workforce required. Stability would be achievable once the minimum number of

workforce required in every field is achieved and has a positive turnover rate. With the FTE, it is
normal for every individual to have 8 work hours per day, hence breaking the day down in 3
shifts with every category would help to determine the number of workforces necessary for a
particular branch.
Workforce Distribution- Nepal has a terrible workforce distribution coupled with the minimal
workforce. It is a country prone to earthquakes and other calamities, where a strong workforce is
required besides the regular needs of healthcare services. The workforce distribution here would
be such that a sufficient number of people from each category of the medical field is made
available depending on the population of a region to rural and town areas.
Entry Rates- Although in the case of Nepal immigration leading to unemployment is not a big
issue but the number of graduate or initial supply rates is quite poor due to the lack of a basic
education system. This leads the unemployed youth in medical fields to opt for jobs outside in
countries like India, China, and other neighbours (Düerkop&Huth, 2017). It would be necessary
to work up the infrastructure to increase these rates.
Average hours worker and Overtime hours- Doctors and physicians tend to have a busy schedule
all over the world but in case of Nepal, its more difficult a situation as the entry rates for these
positions are low. Log work hours like 14-24 hour shifts are considered normal here. It is
necessary to equip each medical facility with sufficient staffing to cut out long work hours and
hire temporary staff(Kayastha, 2014).
Sick Leave and other Leave- Getting a leave is a fruit of labor that every human being deserves.
Due to the long work hours of a small workforce, it is hard to have leave granted here. Increasing
the number of workforces and granting leaves for reasonable causes is to be determined only
when the sufficient workforce is present.
Productivity Data- This is a crucial point to address when assessing the current workforce. It is
necessary to look at the benefits of having part-time workers here as that would only increase
productivity unlike a single individual doing 24-hour rounds every following day(Saunders,
2015)..

Performance Data- It would be equally necessary to assess the performance data of the
workforce and strategies to increase it in the future. This assessment will help develop
techniques to make the most out of the existing workforce while helping with the recruitment
process as well(Dole, 2013).
Potential Framework for Nepal
Parameters Number of Workers
in 2001
Proportion of health
workforce
Percentage change
between 1996 and
2001
000 Per cent
Registered
Nurses/Midwives
174 38.7 7.3
Enrolled Nurses 19 4.3 2.7
Nursing
assistants/personal
carers
51 11.2 18.8
Medical Professionals 52 11.5 12.6
Dentists 8 1.9 7.9
Dental
Technicians/assistant
s
18 3.9 12.5
Pharmacists 14 3 13.0
Allied Health
Workers
39 8.6 26.5
Complementary
Health Workers
9 1.9 29.6

Medical Imaging
Workers
8 1.8 25.0
Medical Scientists 11 2.6 11.8
Ambulance
Workers/Paramedics
7 1.5 12.5
Others 41 9.1 30.2
Total 451 100 11.6
Fig. 1 Minimal workforce plan for developed countries
Source: https://www.pc.gov.au/inquiries/completed/health-workforce/report/
healthworkforce.pdf
This is the desired workforce plan for a developing country in and around the demographics of Nepal, keeping in mind
the epidemiology. There are around 450 000 paid wellbeing experts in Developed Nations, of whom simply finished 350
000 areas of now utilized in wellbeing administration businesses. Over half are medical caretakers, with restorative
experts and unified wellbeing experts representing a further 12 percent and 9 percent of the workforce individually (see
table 1) (Khanal et al., 2014).
The principles of the NHWSF (National Health Workforce Strategy Framework) for the next five years focus on
promoting/achieving:
• National self-sufficiency in workforce supply keeping in mind Nepal is nonetheless an integral part of the world market
• Proper distribution of workforce depending on demographics, concentrating more in readily inaccessible regions, in
case of natural crisis so that the health care needs of the all the citizens are met
• Creating a healthy workplace environment for the professionals to work in
• Skilled and competent workforce with the ability to be available at any moment required

• The workforce has to be adaptable to the current infrastructure while the government plans to expand and upgrade the
infrastructure with optimal use of existing skills of the workforce
• Proper analysis of available services and creating a health workforce policy that adheres to the basic framework of
health care services
• All stakeholders would need to collaborate to outline the framework and develop potential strategies depending on the
PESTLE analysis for the country for sustainable development of the healthcare services including the expansion of
workforce (Karkeeetal., 2014).
Issues with the framework
In the same way as the remainder of the human services framework and frameworks abroad, Nepal's wellbeing workforce
plans are exceptionally mind-boggling and reliant.
• The Nepal, State, and Territory Governments are associated with the majority of the key portions of the wellbeing
workforce framework, and regularly at a few dimensions.
• There are more than 20 bodies engaged with certifying wellbeing workforce instruction and preparing, and more than
90 enrolment sheets.
• A large group of expert bodies regulates sets of accepted rules which supplement formal guideline or accommodate
self-guideline. The enormous number of elements and the subsequent discontinuity of duties result in expense and accuse
moving and different wasteful aspects (Thapa&Niehof, 2013).
• Coordination isn't constantly successful, in spite of Principle 7 of the National HealthWorkforce Strategic Framework
(NHWSF), which advances the collective quest for its destinations by all partners.
• Current administrative courses of action are frequently inflexible and subject to extensive impact from the expert
gatherings concerned. This hinders changes to workforce jobs that could more readily meet changing social insurance
needs (Hoyler et al., 2014).
• Funding and installment plans cheapen effective results. For model, the focal point of Medicare Benefits Schedule
(MBS) sponsorships on administrations given by therapeutic professionals can prompt wasteful utilization of the
workforce, as can the predisposition in MBS discounts for procedural administrations (Bajunirwe et al., 2013).

• Entrenched working environment practices can expand protection from advantageous advancement, and social
dispositions can fortify thoughts of 'high status' and 'low status' work zones, fuelling the enlistment and maintenance
troubles confronted by psychological wellness, inability administrations and matured consideration. The unyielding
emergency clinic, the board rehearses likewise influence work environment profitability.
RECOMMENDATIONS
Job creation
While advantageous development is happening, it frequently stays at the neighborhood level. For sure, late encounters
give sufficient proof of the issues of accomplishing real occupation upgrade inside the present routine. For instance, the
presentation of attendant experts to Nepal — a calling which has existed in some different nations for a long time — has
been a drawn-out procedure is as yet experiencing opposition from parts of the medicinal calling. Primarily, challenging
issues in connection to the jobs of physiotherapists, radiographers, and the different dimensions of the nursing calling
appear to probably stay obstinate without institutional change (Adhikari&Grigulis, 2013).
Gender and Women’s Rights
Women’s rights are one such instance which is highly neglected similar in comparison to other third world countries.
With the growing health sector, the employment of women would contribute more to the call and cause of gender
equality in workplaces. This would be a great place to start with the healthcare workforce in Nepal (Bhandari et al.,
2013).
Education, Training, and Skills
More investment would have to go into education, instead of the traditional methods of specializations, it would need to
adhere to locally relevant issues and provide wholesome education to each. There may be geographical barriers in the
case of Nepal; this is an issue that must be overcome to achieve the desired outcome and develop a knowledgeable
workforce (Adhikari, 2014).
Health Service Delivery and Organization

In terms of service delivery and organization, as Nepal is quite a small country in comparison to its neighboring
developing countries, it would be easier to create a framework for service delivery that would not involve discrimination
based on demographics as there are parts which are not easily reachable (Bogren et al., 2013).
Technology
With the rapid advancement of technologies, Nepal still lags behind quite a lot, and it has to be upgraded for instance in
terms of information and technology and the provision of the use of internet all over the country despite natural barriers.
As this would help share information and make the entire process of service delivery and organization easier for the
country (Kong & Kong, 2013).
Crisis and Humanitarian Settings
Multiple public health crises have hit Nepal previously. It is necessary to detect the existing issues and address them one
by one. Humanitarian settings must be developed on an urgent basis to counter naturally caused crisis and challenges.
Financing and Fiscal Space
The government must also be willing to provide private sectors the fiscal measures to ensure several other types of
healthcare services can emerge that the public can have access to (Sherchand, 2013).
Partnership and Co-operation
Partnering with other countries or corporate sectors to work on the development of the workforce and health care service
planning would also be an efficient strategy for Nepal. This would help the country take some of the load off the
government and address further issues (Khanal et al., 2016).
International Migration
Although international migration is not one of Nepal’s main issues, mainly due to the lack of resources available in the
country, people tend to emigrate out of the country in search of employment and enjoy health care benefits. It would be
necessary to ensure healthcare services along with the unemployment crisis existing in the country are addressed to
rectify this issue further (Knevel et al., 2015).
Data Information and Accountability

Accountability is an essential part of developing an efficient workforce framework. The data information available can be
used with upgraded infrastructure in terms of technology to be able to access all necessary health care information, such
as strategies, policies as and when required for Nepal.
CONCLUSION
In comparison to the developed countries in the world, Nepal is yet to reach the same level of healthcare services by
developing a proper workforce plan. But with the use of the currently available resources and services, it is possible to
look at the before mentioned plan for the next five years while ensuring the up gradation of infrastructure are also in
order. This would help the country get a hold of its current policy of facilitating services to its citizens all around the
country. This report with the recommendations and the framework strategy provides an overall outlook of how Nepal can
make use of the existing resources to build on and to the framework of developing a health care workforce

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