iHRIS:Workforce Projection and Modeling
Excerpted from "An Overview of Human Resources for Health (HRH) Projection Models", a technical brief written by Dr. Pamela McQuide and published by the Capacity Project (2008).
Health workforce planning is necessary in order to ensure that trained and knowledgeable health workers are available to deliver health care services when and where they are needed. Ensuring adequate human resources for health (HRH) is crucial in order to continue progressing toward the realization of the Millennium Development Goals (MDGs). The purpose of workforce planning is to determine the most appropriate balance among the mix, distribution and number of health workers. As Thomas Hall has noted, workforce surpluses or shortages can decrease productivity and efficiency, deplete scarce resources and squander worker capabilities. Training health workers requires a significant investment of time and resources; therefore, restoring balance to a system in which the health workforce supply is out of sync with the demand for health services can be a lengthy process. In this context, health workforce projections can be very useful.
iHRIS Plan is intended to support and provide an interface to a standard, internationally accepted model for workforce planning. Initial iterations of the software will adopt the WHO HRH Projection Model, as recommended by an advisory group of health workforce planning experts at the HRH Workforce Planning Workshop held by the Capacity Project in December 2007. The first iteration uses a simplified version of the model, with the goal of enabling users to quickly enter data and produce projections. Subsequent iterations will introduce more complexity to the modeling. These future versions will also provide extensive help with understanding the concepts behind the model, the meaning of different data inputs and how to make assumptions when projecting requirements or modeling interventions.
The first iteration of iHRIS Plan projects health workforce needs based on a health worker-to-population ratio. This model estimates the current ratio as well as the desired future ratio of doctors-to-population and of other health professionals-to-population. This method uses a base year ratio using the targeted number of health worker positions required in each cadre for that year and the current population, and estimates annual changes in future numbers of health workers. Projected future health worker supply is compared with projected need, and projected costs are compared with projected available funds. Assumptions about growth rates are adjusted until desired ratios are reached.
Using a health workforce-to-population ratio assumes that the relative proportion of health workers in a given area is the most important determinant of ability to deliver health services. Additionally, this approach assumes that reasonable decisions can be made about the preferred doctor-to-population and health worker-to doctor ratios. Assumptions about desired ratios may be based on the ratio of a region or reference country selected as a comparator.
This approach is quick, relatively simple and may be satisfactory if realistic assumptions are made about growth rates. However, the health workforce-to-population ratio does not take into account the effects of changes in health services utilization or changes in health workforce mix, productivity, task-shifting, etc. Furthermore, disparities in health worker distribution that exist in the base year will likely continue through the target year.
In order to take steps to address the demands on the future health workforce, decision makers must be able to understand and analyze current workforce capacity. Projections provide insight into possible future scenarios, enabling decision makers to take action today in order to address tomorrow's needs. Nevertheless, planners should remember that projections are only estimations of what is to come and that the process of HRH planning should be iterative. To remain useful, projections should be updated regularly to incorporate higher quality data and to reflect developments in population trends and health services utilization. Additionally, historical projections should be compared with outcomes in order to improve the accuracy of forecasting techniques and models. Finally, although projection models should anticipate health sector developments for 10 to 30 years into the future, policies based on projections should look no more than three years ahead.
For more information, please see the Health Workforce Planning Resources in iHRIS Plan.
