Namibia Case Study: WHO Tool Provides Data Countries Need to Achieve Universal Access to Health Care

A new analysis illustrates exactly how the World Health Organization’s Workforce Indicators of Staffing Needs (WISN) tool can provide the data that health systems managers and policymakers need to promote universal access to health care within their own countries. The analysis appears in a special issue of World Health & Population, the theme of which is “The Global Health Workforce: Striving for Equity Tackling Challenges on the Ground.” IntraHealth International board member Marilyn DeLuca served as guest editor.

The WISN method, which is available free from the WHO, estimates the numbers and types of staff each health facility needs based on actual workload. Managers can use the resulting data to assess workload pressures and make staffing decisions, and the ministry can use them to determine what types of health workers and how many a region or facility may need based on the real demand for services and the time it takes to provide different types of care.

Data like these will be vital to reaching the new Sustainable Development Goals—which include achieving universal health coverage by 2030—and to combatting the global shortage of health workers. According to WHO estimates, the world needs an additional 7.2 million doctors, nurses, and midwives in order to meet global demand for health services.

Namibia Case Study

As part of its commitment to achieving universal access to health care in Namibia, the Ministry of Health and Social Services worked with IntraHealth to apply WISN to the country’s public health sector regionally and nationally. The results revealed severe shortages of physicians and pharmacists, that nurses are not distributed effectively throughout the country, and that staffing norms were inflexible.

The new data have raised awareness among policy-makers and are now informing more evidence-based decisions regarding the health sector among government officials.

In their paper published in the journal World Health & Population last month, authors from IntraHealth and Namibia’s Ministry of Health and Social Services outline several innovative ways to use WISN results to influence health policy, planning, management, and practice, using Namibia as an example. These include:

  • Staff redeployment: For example, grape farms in Southern Namibia attract influxes of seasonal workers during harvesting periods, which led one local clinic to become overwhelmed with clients while another nearby was not. District managers used WISN results to recommend a staffing adjustment between the two facilities in their strategic plans.
  • Scarce skill allocation: WISN results showed that one region of Namibia needed 131 pharmacist assistants, but had only three. While there is no quick fix for a staff shortage of this magnitude, regional decision-makers in Namibia can redeploy staff based on where the needs are greatest, plan for greater preservice education, and prioritize future staffing decisions based on these data.
  • Staffing norms: Namibia’s staffing norms, which are now about 10 years old, state that each of the country’s 278 clinics should have two nurses. But based on WISN results about the workload at each clinic, 13% of facilities need five to nine nurses, and 8% need nine or more. These data make it clear that using just one staffing norm for each facility type is insufficient.
  • Task sharing: Official policy in Namibia states that only physicians are allowed to enroll clients living with HIV in antiretroviral therapies, and that nurses then provide subsequent care and treatment for most clients. But expanding nurses’ professional scopes of practice to include more HIV care could allow nurses to practice at the top of their education and training while also freeing up physicians’ time for other tasks that are solely within their purview.

Read more: “Improving Access to Care among Underserved Populations: The Role of Health Workforce Data in Health Workforce Policy, Planning, and Practice.”

IntraHealth authors of the analysis include Jennifer Wesson, senior monitoring, evaluation, and research technical advisor; Pamela McQuide, Namibia country director; Claire Viadro, technical writer and editor; Maritza Titus, senior human resources for health advisor; Daren Trudeau, senior program manager; and Maureen Corbett, vice president of programs. Norbert Forster, deputy permanent secretary in Namibia’s Ministry of Health and Social Services, was also an author.

IntraHealth’s work in Namibia is funded by the US Agency for International Development.