Health Officials Tap into Powerful Data to Expand HIV Services in Namibia

Health officials in Namibia are using data from the first-ever national Workforce Indicators of Staffing Needs (WISN) assessment to expand access to antiretroviral therapy (ART), update national health policies, and inform their budgets as they shape the future of Namibia’s health workforce.

The WISN method, developed by the World Health Organization, assesses workload pressure on health workers—including what kinds of tasks they perform, how long those tasks take, how many times they must perform them throughout the day, and more. Based on those workloads, WISN helps calculate exactly how many health workers of a particular cadre are required in a given health facility.

The data revealed severe staff shortages.

Namibia’s Ministry of Health and Social Services teamed up with IntraHealth International to undertake the assessment on a national scale—including every public health facility—in 2013. The data revealed severe staff shortages, particularly of doctors and pharmacists, and a tendency for nurses to be clustered in hospitals, leaving smaller health centers with too few nurses.

Early in the analysis, it became clear that requiring clients to see a physician for all ART services was creating a major bottleneck that delayed services for many Namibians living with HIV. The number of staff required for these services was generally about a 50/50 distribution of doctors and nurses.

So after analyzing the data and working with IntraHealth’s USAID HIV Clinical Services Technical Assistance Project to demonstrate that nurses could safely and effectively deliver ART services, the ministry changed its policies and procedures. Now, nurses who undergo a new ART certification are authorized to provide ongoing ART services to clients who are already enrolled.

After instituting this new task-sharing practice, the ratio of staff needed for ART services changed to about 80% nurses and 20% doctors. Physicians were freed up to focus on the more complex task of enrolling new clients in ART. This change in skill mix had a significant impact on costs.

After analyzing the data, the ministry changed its policies and procedures.

But the changes didn’t stop there. Using the WISN results, the ministry found that adding ART services to the nurses’ already-full workloads would mean that some of the busiest facilities needed more nurses on staff. As a result, the project has hired 69 additional nurses for the facilities with highest demand to help the ministry achieve epidemic control.

Officials are using WISN results to make other decisions about health policies, health worker training and deployment, and changes within the health system, based on IntraHealth’s recommendations. These include:

  • Increasing the number of positions for the cadres in shortest supply
  • Redistributing existing staff to address inequalities
  • Reviewing health facility classifications
  • Considering task-sharing based on scope of practice and competency
  • Creating new cadres or specialized tracks within existing cadres
  • Introducing competency-based training
  • Consolidating and improving health information systems

Health and finance officials have found the results to be so valuable when drafting budgets for the health sector for the past three fiscal years that they are now considering a second assessment to update the data. They’ve also used WISN data to inform their restructuring decisions.

Namibia’s government is working to increase the number of trained doctors, pharmacists, and other health workers in the country in part to eventually achieve the UNAIDS 90-90-90 targets for HIV. This would mean that 90% of all people living with HIV know their status; 90% of those diagnosed with HIV receive antiretroviral treatment; and 90% of the people on treatment are living healthy lives with suppressed viral loads. To reach that target, Namibia will have to put an additional 42,000 patients on ART.

IntraHealth International’s USAID HIV Clinical Services Technical Assistance Project is funded by the US Agency for International Development through the President’s Emergency Plan for AIDS Relief (PEPFAR).