Health Workforce Plan Report: Challenges and Recommendations for Nepal

This report provides a comprehensive overview of Nepal's health workforce plan, examining the country's healthcare system, challenges, and potential solutions. It begins with an executive summary and proceeds to an environmental scan, data profile, and critical issues analysis. The report highlights issues such as workforce migration, financial constraints, and the need for improved health literacy. It examines the density of healthcare professionals, mortality rates, and government expenditure on health. The report outlines the health workforce planning, including the recruitment rate of healthcare personnel, equity, new interventions, continuity in treatment, and new treatment policies. The critical issues discussed include the work efficiency of the staffs in the health care system, the productivity rate and availability of the staff, competency level of the staffs, human resource for health management planning is fragmented, and the financial factor. The report concludes with recommendations for addressing these challenges and improving the overall health workforce in Nepal, emphasizing the need for financial investment and better workforce management planning to decrease the mortality rate of adults and infants in the country.

Running head: HEALTH WORK FORCE PLAN
HEALTH WORK FORCE PLAN
Name of the Student
Name of the University
Author Note

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Executive Summary
The primary focus of the following report is to develop a workforce planning overview of Nepal
on the basis of their development of plan, addressing the plans and the issues of the country in
this context. As a lower-middle income country Nepal faces many problems in terms of the
human resource for health and the financial aspect mainly. The plan of health workforce is
mainly focusing on the improving the human resource for health and the quality of care
development. However, the attraction to the better income and the opportunity are the factors
which lead to the migration of skilled professionals or joining the private sectors. All these issues
should be checked and better workforce management plan should develop. In order to develop a
better plan fitting recommendation for addressing the problem would be outlined as well in the
following report.

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Table of Contents
Introduction......................................................................................................................................3
Environmental Scan.........................................................................................................................4
Data Profile......................................................................................................................................6
Critical Issue....................................................................................................................................9
Recommendation...........................................................................................................................10
Conclusion.....................................................................................................................................13
References......................................................................................................................................14

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Introduction
Health workforce is a common term which refers to the human resource management in
the health care field. According to World Health Organisation the health workforce is the
phenomenon that defines the factor of the skilled, knowledgeable and motivated workers that
includes the nurses and the physicians along with doctors of a country in order to provide
universal level of care and cover a large area (Who.int, 2019). On the basis of this definition it
can be stated that the workforce management is one of the most important aspect of the health
care of a country. World Health Organisation also provides support for the human resource
management for low income countries and low-middle income countries. In this perspective in
Nepal it has been found that the country showed advancement in the human resource
development for the health workforce and on the basis of the document it has been seen that in
2010 Nepal ranked in top 10 countries which showed most advancement in the workforce
management (World Health Organization, 2015). However, there are several issues also found in
terms of the health workforce of the country such as education, quality, availability, financing
and others. In order to address all these issues World Health Organisation also recommended
several management plans along with provided the country with financial and other human
resource management supports. The purpose of the following report is to develop a workforce
planning overview of Nepal on the basis of their development of plan, addressing the plans and
the issues of the country in this context. Finally the fitting recommendation for addressing the
problem would be outlined as well.

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Environmental Scan
Nepal is a small country in Asian continent with population of approximately 29.3
million people in 2017 and this population rate has risen exponentially after 1980 (Who.int,
2019). This would be the reason of the migration of people from other neighbouring countries
and also the less education about the family planning. However, on the basis of the average
income of the country per capita which is $1120 approximately it can be classified as a lower-
middle income country (World Health Organization, 2015). On the basis of these data the human
resource in the health care or the health workforce can be calculated as well which shows that
nurses, physicians, doctors, midwives and care professional density in compared to the total
population is lower than expected. It has been that 7 people per 10,000 people are nurse,
midwife, physician and doctor (Who.int, 2019). However, the country develops in a manner that
let it enter the top 10 developing country in the field of health workforce management as
mentioned in the World Health Organisation report. On the contrary, the condition of the country
shows that the health professionals prefer the private setup of the health care facility in the urban
areas more than the rural governmental setups (Pozo-Martin et al., 2017). Other than this the
factor of migrating to foreign countries for the practice and health care profession adaptation by
the doctors and physicians along with the nurses puts stress on the health workforce of the
country (Baral et al., 2018). As a lower-middle income country the appointment of experts of
health care from other countries is a costly aspect which cannot be sustained by the country. The
world Health Organisation invests in the health workforce development of the country but the
condition of the lower human resource is the factor that affects the workforce. On the other hand
the hospital bed limit in the country is 50 for every 10,000 person which is also a factor that

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affects the health care providence of the country (Who.int, 2019). On this context it is also found
that the health literacy rate of the country is 56.5 percent (Who.int, 2019). The effect of the
health literacy rate is also a factor that affects the health work force in the country. Over all these
factors the main factor that affects the workforce in health care field is the human resource for
health that shows the rate of physicians in the country among every 10,000 people is 6.7 and the
nurse rate among every 10,000 is 2.1 (Who.int, 2019). On the basis of this data it can be found
that the mortality rate in the country is higher in the adults that are 380 per 10,000 people. In
order to address these issues and the problems government of Nepal invested 39.7 percent of the
total health expenditure and the total of government expenditure in the field of health is 10.9
percent (Who.int, 2019). Based on this data it can be said that the health care environment is a
factor which is not that much improved however, the country working on the health workforce
build up for the betterment in the process of health care and decrease the rate of the mortality
among the country people.

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Table: Country description
Source: (Who.int, 2019)
Figure 1: Population
Source: (Google.com, 2019)
Data Profile
The MoHP and the World Health Organisation data describe the condition of the Nepal
health workforce condition. The factor of the workforce in the health care sector depends on the
human resource for health and the assessment shows that approximately 55,000 people are
working in the health care sector of the country and among them 32,809 in public sector and
21,368 people are in the private sector of health (Nhsp.org.np, 2019). The plan of workforce of
the country showed that in the time period of 2012 to 2030 the rate of recruitment of the health

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care personnel would be low up to 1 percent whereas the people who would leave the post would
also be high up to 2 percent (Nhsp.org.np, 2019). On the other hand in terms of the global factor
the health care provider rate will be decreased by 18 million within 2030 (Limb, 2016). The
scenario is grave in terms of the global context however, in terms of Nepal one of the developing
country in the health workforce according to World Health Organisation it is lower in amount.
On the contrary the rate of human resource for health is focused on the private sectors and the
urban areas more which indicate the negative effect of the workforce in the health care sector.
On the other hand the health workforce exit in the country shows the rate of 5 percent every year
in a five year time frame (Nhsp.org.np, 2019). The workforce planning stated that equity, new
interventions, continuity in treatment and new treatment policies would be incorporated. The
remote and backward areas or communities of the country would be addressed by upgrading
1000 sub health posts to health posts in different areas of the country (Nhsp.org.np, 2019). In
addition with the health post up gradation 150 health institutions would also be developed within
2030 in order address or check the mortality rate of the country and providing more health
workforce as well (Nhsp.org.np, 2019). According to a survey it can be seen that in Nepal the
most effective cause of death is road accidents as in 2016 to 2017 the mortality rate from
accident was 2385 among 10,178 road accidents which was higher than the former year as that
was 2006 among 10,013 accidents (The Himalayan Times, 2017).In order to address this
condition the health workforce of the country should be able to develop the human resource with
the help of the World Health Organization. However, the factor of the declining of the health
care professional is a factor that should be assessed and on the basis of the assessment the proper
planning should be made and for that the proper financial investment in the health sector would
be needed as well. As the rate of physicians in the country among every 10,000 people is 6.7 and

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the nurse rate among every 10,000 are 2.1 (Who.int, 2019). Hence, the infant and adult mortality
rate in the country is high and infant mortality rate is 41 per 1000 birth (Who.int, 2019).
According to World Health Organisation data the workforce progress in terms of human resource
for health functioning system 64 percent, program of workforce production 86 percent and retain
workforce in underserved areas 50 percent (Who.int, 2019).
Figure 1: Workforce graph
Source: (Who.int, 2019)

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Figure 2: Workforce progress
Source: (Who.int, 2019)
Critical Issue
According to the World Health Organisation data on the workforce planning of Nepal
showed the progress in the workforce in health sector of the country and also described the
development in terms of developing ranking of the country in the same context. However, there
are several critical issues in the context as well which are found during the assessment. The
primary issue is the work efficiency of the staffs in the health care system as their quality of
work is not at per (Luitel et al., 2015). On the other hand the productivity rate and availability of
the staff are lesser as the number of staff in comparison to the population of the country is in a
minimal limit. Thus the competency level of the staffs is lesser than the requirement as well
(Filby, McConville & Portela, 2016). On the contrary the human resource for health management

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is planning is fragmented and thus the proper planning cannot be implemented (Singh, Thakur &
Anwar, 2018). The factor of the implementation of the planning is also threatened by the
financing for the human resource for health as well. The financial factor is affected as Nepal is a
lower middle income country (Leslie et al., 2017). The affection of the health care professionals
to the private sector along with the migration of these professionals to the foreign countries also
plays a key role in the financial and the human resourcing sector and this is a critical issue in the
workforce planning as well. The migration of health workers can be termed as the “brain drain”
phenomenon as the attraction and affection towards more facility and opportunity (Kadel &
Bhandari, 2019). All these issues are the primary threats for the context of the workforce
management of the health care sector of Nepal. However, the factors can be assessed and needed
to be addressed in order to sustain the proper workforce plan for the country along with
preventing the mortality rate of adults and infants in the country (Khanal et al., 2016). The issue
of the human resourcing for health care is affected in the country as the health literacy rate in the
country is in average rate and the factor of the health care professionalism among the people is a
lesser concern. However, the other aspect is the financial part which should be mitigated with the
help of World Health Organisation and the UN. As a developing country Nepal showed great
progress in terms of the workforce management in health care and in order to address the
declining rate of the health care workforce the country should be able to change several aspects
as well (Gauchan et al., 2018). The changes should be done with the help of the World Health
Organisation recommendations and the process should be cost friendly as well in order to be
more effective in the implementation of the planning.

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Recommendation
In order to address all the human resource for health issues World Health Organisation
recommended several new policies. The policies would be counted to at least ten
recommendations (Raven et al., 2018). The following policies are the factors that needed to be
considered in the development of the better workforce plan that can be helpful in the betterment
and the retention of the health workforce:
1. Job Creation: According World Health Organisation creating better job opportunities in
the health sector would be a positive aspect that can be helpful in the gaining more staffs
in the field. The primary focus would be on the women and youth population who have
proper skills. Their involvement in the right place is recommended for the retention for
their employment in the health sector (Apps.who.int, 2016).
2. Gender and Women Rights: By proper empowerment to the women with proper
economic participation in certain institution is the factor of women involvement (Rijal &
Wasti, 2018). The factor of leadership, gender inequity and proper education is the
primary focus for the workforce development by means of involving women in the sector
(Apps.who.int, 2016).
3. Education, Training and Skills: High quality education and training would be the helpful
in addressing the aspects of the proper of need of health care for the population. Lifelong
learning would be the key factor for the quality improvement of the health care
(Apps.who.int, 2016).
4. Health Service Delivery and Organisation: Reformation of service models focusing on
the hospital care would be a positive change that impact on the quality of care. High

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quality, community based and affordable care providing is the primary aim of the service
reformation. The basic idea of the reform of the care service is to provide proper care to
the underserved areas (Apps.who.int, 2016).
5. Crises and Humanitarian Setting: Investment in national and international health
regulation capacities including skill development and humanitarian setting for the public
health emergencies (Ranabhat et al., 2019). The investment in the setting development
would be helpful in both acute and protracted care. The setting development need to
focus on the safety of the health workers as well (Apps.who.int, 2016).
6. Technology: In order to address the high quality care it is also needed to invest in the cost
effective information and communication technology. It is helpful in the enhancement of
the health education, person centred care and high quality health care service
(Apps.who.int, 2016).
7. Financing: It is also needed to raise funds for the development of the better workforce
and high quality care. The funding should be sourced from the domestic and the
international sources. The financing can be divided into private and the public services
for the betterment of the care service and also development of the proper skills, better
working condition and other aspects of the service as well (Apps.who.int, 2016).
8. Partnership and Cooperation: Incorporating unions, civil societies and the collaboration
of the national, international and regional sectors are the most positive aspect in the
investment of the proper workforce development and high quality of care (Apps.who.int,
2016).
9. International Migration: Recognition of advanced international qualification of workers
could be the crucial factor in the retention and preventing migration of skilled health

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workers. It would reduce the negative effects of the health worker migration and also
induce the care quality (Apps.who.int, 2016).
10. Data, Information and Accountability: Research and analyse the health labour market
with harmonised market research methods would be helpful in the accountability
development of the health care professional skills and evidence collection of the human
resource for health (Apps.who.int, 2016).
All these factors would be recommended for addressing all the human resource for health
and financial issues along with quality of care. The recommendations are based on the
consent of the World Health Organisation.
Conclusion
Based on the above discussion it can be concluded that the health care quality and the
amount would be solely dependent on the health workforce of a country. In case of Nepal a
lower-middle income country the factor of health workforce is developing however, the factor of
migration and better opportunity seeking are the threats of the workforce planning of the country.
The financial aspect and the health care quality and the health education are the factors that
affect the workforce planning of the country most. The World Health Organization is on the
other hand observes the factors of the development and the faults of the workforce planning of
the country. The organization also invests in the health sector of the country. The factors of
technological adaptation, better appraisal to the skilled professionals, developing better health
care setting are the common recommendation to address the adverse condition of the workforce
maintenance of Nepal. The key issues on the other hand for the workforce planning of Nepal are
the quality, education and the human resource for health and these are needed to be addressed for

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the betterment of the health care quality and the proper care to the large amount of people of the
country especially the underrated people and areas of the country.

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