Developing a Health Workforce Management Plan for Sri Lanka

This report focuses on developing a health workforce management plan for Sri Lanka, selected due to its low-to-medium income status and healthcare workforce challenges. It begins with an executive summary and an introduction highlighting the importance of workforce adequacy in healthcare. The report then justifies the country selection, providing rationale based on WHO data and existing literature. An environmental scan analyzes the current healthcare workforce, including the number of physicians, nurses, and other healthcare professionals, along with an examination of the labor market trends. The report identifies critical issues such as a shortage of nursing staff and lack of investment in healthcare education and recruitment. A strategic framework is proposed, addressing these issues through strategies like increasing wages, improving work-hour management, and enhancing educational opportunities. The report concludes with recommendations and an implementation plan, emphasizing stakeholder engagement and evaluation procedures to ensure effective workforce improvement. References from various sources support the analysis and recommendations.

Running head: HEALTH WORKFORCE MANAGEMENT
Health Workforce Management
Name of the Student
Name of the University
Author note

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Executive Summary
The purpose of this paper is to select a country from the who health-stat report 2015 that
belongs to low to medium income range and analysing the existing health workforce status to
develop a health workforce management plan. This paper consists of a set of
recommendations for chosen countries as well. Healthcare service is one of these crucial
services in any country that holds the quality of life of common people. Therefore, for such
an essential service, workforce adequacy is a necessary criterion.

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Table of Continent
1. Introduction............................................................................................................................3
2. Selection of the country and Rationale..................................................................................3
3. Environmental scan................................................................................................................4
4. Health workforce plan for Sri Lanka.....................................................................................8
4.1 Critical issues to be addressed..........................................................................................8
4.2 Framework for strategies..................................................................................................9
4.3 Implementation and Activity Plan.................................................................................10
5. Conclusions..........................................................................................................................11
6. Recommendations................................................................................................................12
References:...............................................................................................................................13

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1. Introduction
Workforce is one of the major pillars of any service that yields the quality,
effectiveness and other parameters of efficiency measurement. When it comes to the public
services like education, healthcare and law enforcement, the inefficiency of the service not
only affects the authority, rather it also changes the quality citizens’ life. Healthcare service is
one of these crucial services in any country that holds the quality of life of common people.
Therefore, for such an essential service, workforce adequacy is a necessary criterion.
According to the health-stats report published in 2015 by World Health Organisation or
WHO, there are numerous low income and even meddle to low income countries that have
very poor healthcare workforce strength. The purpose of this paper is to select a country from
WHO health-stat report 2015 that belongs to low to medium income range and analysing the
existing health workforce status to develop a health workforce management plan. In Situation
analysis section this paper will analyse the current progress and limitation of healthcare
workforce of the chosen countries considering the direct and indirect factors that could
influence the further growth as well. The workforce development plan also consists a
strategic framework to achieve the target objectives and the activity plan for practical
implementation. This paper consists of a set of recommendations for chosen countries as
well.
2. Selection of the country and Rationale
As discussed in the introductory section there are many countries in health-stat report
of WHO that belong to middle to lower income range. According to this statistical report the
healthcare development of south-east Asian countries are significantly low compared to other
section of the globe. Amongst the south-east Asian countries, Sri Lanka is a low to middle
income country which also has very poor growth in healthcare in past 10 years. According to

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Aluwihare-Samaranayake et al. (2017), the major reason behind this poor healthcare service
growth in spite of having many private funding is the lack of healthcare workforce that could
support the healthcare provisions to be strengthened. As discussed earlier, poor workforce has
a huge impact on service quality, and therefore the consequence of having poor workforce
strength in healthcare services in highly distinguishable in Sri Lanka. Sri Lanka has utilized
standard health workforce per population ratios as the preferred staffing indicator to assess
the availability of health staff of the country at national and sub-national levels. However, Sri
Lankan Ministry of Health have not achieved even one fourth of their target in the recent
years. As presented by Whosrilanka.org. (2016), the educational infrastructure is also
responsible for this lack of healthcare workforce in Sri Lanka. Surprisingly among other
labour markets the labour market of healthcare service is significantly low in Sri Lanka.
Hence, Sri Lanka has been chosen for this report for environmental analysis as well as for
healthcare workforce management plan.
3. Environmental scan
The environmental scan consists the exiting workforce strength analysis, finding
opportunities The environment of healthcare workforce consists the government policies,
number of physicians, number of medical specialist, number nurses, number of
pharmaceutical personnel, current health education provisions and others. According to the
published report by WHO, the number of Physicians are only 6.8 per 10000 population. At
the same time, there are only 16.4 nurses per 10000 people (World Health Statistics. , 2015).
The dentistry personnel count is also very low. Only 0.6 licensed personnel are currently
engaged in dentistry practice in Sri Lanka. Along with only 0.4 pharmaceutical personnel per
1000 population the number of psychiatrists is also extremely low in Sri Lanka (Who.int.,
2019). Less than 0.05 psychiatrists are currently practicing across the Sri Lanka, which is the

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major cause of radical increase of the population with mental illness in last 3 years (World
Health Statistics., 2015).
In order to anticipate the possible cause of this poor healthcare workforce strength and
poor development as well, the labour market of overall Sri Lanka has to examine. According
to the projected results on national workforce by Ministry of National Policies and Economic
Affairs in 2016 the following table has been developed to visually analyse the difference and
trends in labour market of Sri Lanka
Health and social work Education Public administration and
defence
0
100000
200000
300000
400000
500000
600000
700000
Employment growth in the service sector 2013–2016
Labour force
Figure: Employment growth in the service sector 2013–2016
Source: (Ministry of National Policies and Economic Affairs., 2016)
From the above table it can be clearly found that the employment growth in service
sector of Sri Lanka is more biased towards the public administration and defence. On the
other hand, the workforce growth of the health and social work is significantly low, where in

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2016 the projected growth of the workforce is almost zero compared to other service sectors.
In Sri Lanka health and social work jobs comprised only 1.8% of all employment in 2016
compared to 4.1% in education and 7.7% in public administration and defense (Ministry of
National Policies and Economic Affairs, 2016). According to the Librarian (2015), the
national authority of health has initiated a new set of activities to improve the healthcare
education in mainstream and vocational training by at least 35% within one year. Sri Lanka
has utilized standard health workforce per population ratios as the preferred staffing indicator
to assess the availability of health staff of the country at national and sub-national levels.
However, Sri Lankan Ministry of Health have not achieved even one fourth of their target in
the following years. Mujeeb (2013), argued that the poor growth of healthcare related
educational provision is a result of lack of national and regional level funding and the lack of
public and private service collaborative activities. However, only this issue could not be the
only cause behind these devastating results. In the following graph the annual rate of
graduating nurses from 2006 to 2015 has been presented to find any possible trend in
statistical change.
2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
0
500
1000
1500
2000
2500
3000
3500
1120
2580
1260
2360
3180
2000
1570
1820
1420
1760
Annual output of nurses in Sri Lanka, 2006–2015
Number of nursing graduates

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Figure: Annual output of nurses in Sri Lanka, 2006–2015
Source: (Whosrilanka.org., 2016)
According to the above data chart published by Ministry of Health in 2017, it could be
clearly found that the data trend of average total number of graduate nurse output is creasing
in each year from 2010. From 20067 to 2015, 2014 has experienced that least number of
graduate nurse outputs nationally. From 2014 to 2015 this number has not been increase
considerably. Therefore, the dearth of nursing staffs is noticeable in Sri Lanka. Not on the
annual output of graduate nurses, the number of annual output of medical officer in Sri Lanka
is also poor. In the following graph the annual rate of graduating medical officers from 2006
to 2015 has been presented to find any possible trend in statistical change. At the same time,
Ministry of Foreign Employment is promoting the migration of skilled workers notably
health workers. There is a lack of data to assess the exact scope of migration of health
workers from Sri Lanka.

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2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
0
200
400
600
800
1000
1200
1400
800
900 970 950
792
1070 1025
548
1205 1150
Annual output of medical officers in Sri Lanka, 2006–2015
Number of medical graduates
Figure: Annual output of medical officers in Sri Lanka, 2006–2015
From the above data chart it can be said that the number of Annual output of medical
officers in Sri Lanka is comparatively better than the nurses and midwives. At the same time,
from the data trend line of average calculation, it can be found that from 2013 to 2015 the
number of annual output of medical practitioners has been increased. According to
Wijeyaratne et al. (2016), the major challenges that the Ministry of Health of Sri Lanka is
going to face in upcoming years are the increasing number of domestically trained health
workers and Sri Lankan, the medical students who are studying abroad and returning to Sri
Lanka to work as medical doctors, the PHC reform, changes in private sector dynamics and
increasing health worker emigration. The lack of medium and long-term planning has
resulted in large volatility in the recruitment cycles, especially for nurses (Mujeeb 2013).

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4. Health workforce plan for Sri Lanka
4.1 Critical issues to be addressed
There are many critical issues that should be address in the following healthcare
workforce management plan for Sri Lanka. These critical issues are:
 Less number of nursing and midwifery staffs output than medical practitioners
 Poor number of service workforce growth in healthcare industry
 Lack of proper planning and implementation for healthcare educational improvement
 Lack of investment for healthcare related recruitment across Sri Lanka especially in
the public service organisations
 Lack of collaborative investment within government and private organisation
 Poor integrity within the Ministry of Health and Ministry of education in Sri Lanka
 Coordinating the health worker migration
In the following section all these points are addressed through proper strategic framework
and activity plan.
4.2 Framework for strategies
The strategic framework for the development of health services aimed to strengthen
the human resource development considering the opportunities and the assets. The following
table presents the critical issues and the relevant strategies to be taken.
Major Issues Effective Strategies
Lack of recruitment  The wage policies of the government healthcare service to be
increased to attract more workforce for national level service
providing
 Locating the nearest labour market and increasing the effective
communication between the healthcare service organisation and
the recruiters (Rosskam et al., 2013)

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Poor Staff enjoyment and
high turnover
 Strengthening the work-hours management policies to reduce the
stress level of worker
 Enforcing new policies in HRH, for more training and
development
 Ensuring work environment and workforce safety
Lack of nursing graduates
and midwife candidates
 Increasing the educational subsidy in vocational, diploma and
graduate level nursing courses
 Ensuring collaborative approach between Ministry of Health and
Ministry of Education
Coordinating health
worker immigration
 Implementing multi-sectoral common policy on health workforce
migration with the Ministry of Health, Ministry of Education and
Ministry of Foreign Employment, based on the principles of the
WHO Global Code of Practice
 Strengthening the political and economical relationships with
foreign countries
Rising adequate funding  Conducting collaborative investment with the national and
international level private healthcare and financial organisations
(Dawson, Wijewardena & Black, 2013)
 Increasing Market share by allowing foreign investors to invest in
national labour market, educational sectors and health services
 Strengthening coordination and collaboration between ministry
of health and ministry of finance
4.3 Implementation and Activity Plan
Implementing the strategies is more essential than forming the proper strategies for
healthcare workforce improvement. There are two major aspect of this implementation
process namely the stakeholder engagement and the evaluation procedure. The stakeholder
engagement depends on the stakeholder’s responsibility, power and interest. With this
regards it has to be remembered that in this case the private and foreign organisations have
lower power with higher interest. Therefore converting their interests to their responsibilities

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could be a major challenge. On the other hand, evaluation of effectiveness requires
monitoring, assessment and improvement that could be only achieved by proper coordination
and cooperation (Lopes Cardozo et al., 2013). Considering all these factors the major
activities that have to be conducted to ensure the health service workforce improvement are
presented bellow
 Policy assessment and reformation through taking help from WHO and Global Level
Policy Formation Guidelines
 Communicating with global and national level private investors for funding
 Conducting a joint policy development with Ministry of education to ensure
educational provision
 Investing and developing new educational provisions for vocational, diploma and
graduation courses of nursing
 Encouraging youth to be a part of the healthcare service for national integrity through
government promotions
 Preparing periodic national level healthcare workforce and educational improvement
audit plan
 Ensuring the safety and engagement of workforce from regional to national level
through forming a more tangible health and safety workforce plan
5. Conclusions
From the above discussion it can be found workforce is one of the major pillars of any
service that yields the quality, effectiveness and other parameters of efficiency measurement.
Amongst the lower to middle income countries Sri Lanka has been chosen for this report for
environmental analysis as well as for healthcare workforce management plan. It has been
also found that the major reason behind this poor healthcare service growth in spite of having
many private funding is the lack of healthcare workforce that could support the healthcare

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provisions to be strengthened. According to the projected results on national workforce by
Ministry of National Policies and Economic Affairs in 2016 the number of health workers,
specially nurses and midwives are significantly low. It has been also found that poor growth
of healthcare related educational provision is a result of lack of national and regional level
funding and the lack of public and private service collaborative activities. It has been found
that the major challenges that the Ministry of Health of Sri Lanka is going to face in
upcoming years are the increasing number of domestically trained health workers and Sri
Lankan, the medical students who are studying abroad and returning to Sri Lanka to work as
medical doctors, the PHC reform, changes in private sector dynamics and increasing health
worker emigration. In this situation the above strategic framework and activity plan could be
helpful to successfully improve the healthcare workforce across the Sri Lanka. There are two
major aspect of this implementation process namely the stakeholder engagement and the
evaluation procedure.
6. Recommendations
From the above strategic framework and intervention activity plan some major
recommendations can be found from Sri Lanka that will increase the sustainability of their
healthcare workforce related improvement, These recommendations are are presented in the
following section:
 Most of the stakeholders including government and private investors should invest in the
process of job creation in the health sector to increase inclusive economic growth while at
the same time to meet the growing need for health workers nationwide (Mujeeb, 2013).
 The Ministry of Healthcare and Ministry of Education should improve oversight in the
private sector and coordination between the public and private sectors through
appropriate regulation and data monitoring systems that will allow them more effective
implementation of new policies and interventions.

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 The Ministry of Health and the Ministry of Education of Sri Lanka should develop a
health workforce strategy and action plan for the period 2019–2030 with an emphasis on
PHC and using multisectoral consultations, so that it could guide them to ultimate success
(Aluwihare-Samaranayake et al., 2017).
 Considering the workforce migration factors, the government of Sri Lanka should also
develop a multi-sectoral common policy on health workforce migration with the Ministry
of Health, Ministry of Education and Ministry of Foreign Employment, based on the
principles of the WHO Global Code of Practice to utilise the the emigrations for
collective benefit and growth.
 The Ministry of Health, Ministry of Education, Ministry of Finance, Ministry of Foreign
Employment should work collaboratively with proper coordination and communication
from the start of improvement activities to the end of the improvement, to make the
growth of healthcare service of Sri Lanka flawless.
References:
Aluwihare-Samaranayake, D., Ogilvie, L., Cummings, G. G., & Gellatly, I. R. (2017). The
nursing profession in Sri Lanka: time for policy changes. International nursing
review, 64(3), 363-370.
Dawson, A. J., Wijewardena, K., & Black, E. (2013). Health and education provider
collaboration to deliver adolescent sexual and reproductive health in Sri Lanka. South
East Asia Journal of Public Health, 3(1), 42-49.
Librarian, I. (2015). Human Resources for Health Strategic Plan 2009 - 2018: Situation
Analysis (Sri Lanka) | HRH Global Resource Center. Retrieved from
https://www.hrhresourcecenter.org/node/4204.html

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Lopes Cardozo, B., Sivilli, T. I., Crawford, C., Scholte, W. F., Petit, P., Ghitis, F., ... &
Eriksson, C. (2013). Factors affecting mental health of local staff working in the
Vanni region, Sri Lanka. Psychological Trauma: Theory, Research, Practice, and
Policy, 5(6), 581.
Ministry of National Policies and Economic Affairs. (2016). Retrieved from
http://www.mnpea.gov.lk/web/index.php/en/15-downloads.html
Mujeeb, L. M. (2013). Importance of best Human Resource Management Practices and the
need for a Human Resource Information System (HRIS) for the Public Health Sector
in Sri Lanka. Sri Lanka Journal of Bio-Medical Informatics, 3(2).
Rosskam, E., Pariyo, G., Hounton, S., & Aiga, H. (2013). Increasing skilled birth attendance
through midwifery workforce management. The International journal of health
planning and management, 28(1), e62-e71.
Who.int. (2019). Health Labour Market Analysis in Sri Lanka: A Call to Action. Retrieved
from https://www.who.int/hrh/news/2018/18168_SriLankaLabourMarketflyer.pdf?
ua=1
Whosrilanka.org. (2016). Human Resources for Health. Retrieved from
http://www.whosrilanka.org/EN/Section31_91.htm
Wijeyaratne, C., Arambepola, C., Karunapema, P., Periyasamy, K., Hemachandra, N.,
Ponnamperuma, G., ... & de Alwis, S. (2016). Capacity-building of the allied health
workforce to prevent and control diabetes: lessons learnt from the National Initiative
to Reinforce and Organize General Diabetes Care in Sri Lanka (NIROGI Lanka)
project. WHO South-East Asia journal of public health, 5(1), 34.

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World Health Statistics. (2016). World Health Statistics 2015. Retrieved from
https://www.who.int/gho/publications/world_health_statistics/2015/en/