Using modeling and analyses to inform targeted investments in human resources for health.
A strong and well-distributed health workforce is essential to providing quality health services. However, too often, the health workforce is often insufficient to meet the need, particularly in low- and middle-income countries. Human resource costs often represent a large portion of public sector spending on health care, forcing governments with limited budgets to make difficult decisions about what types of health workers to train and employ and where to place them.
CHAI collaborated with the government of Malawi to conduct three modeling exercises to inform the country’s Human Resources for Health Strategic Plan (HRH SP) 2018-2022 which outlines planning, education, and management interventions for the country’s health workforce. The Malawian government uses a facility-based staffing standard which designates a targeted number of staff that should be employed in each health facility type in the country; these positions are known as established posts. Modelling for the HRH SP provided a new way of thinking about staffing targets based on demand for services and how to meet them by: 1) comparing the current number of staff to established posts to calculate vacancy rates; 2) estimating the immediate need for additional health workers based on current demand for services at each facility in the country; and, 3) forecasting the future available workforce under various scenarios for interventions to the training pipeline. Estimating health worker needs based on demand can provide countries with more responsive and attainable workforce estimates than facility-based standards as this target-setting approach considers variation in use of services across geographies and how services are delivered by different cadres of health workers.
Analyses for the HRH SP found that as of 2018, 55 percent of established posts were filled, with an average of 1.49 health professional staff per 1,000 population; however, there were significant variations in staffing at the sub-national level. The demand-based model shows an immediate gap of 7,374 health workers to optimally deliver services at current utilization rates, with the largest gaps among nursing and midwifery officers and pharmacists. Under current trends in health worker training, Malawi is projected to meet its establishment targets in 2030 but will not meet the World Health Organization (WHO) standard of 4.45 health workers per 1,000 population by 2040. These results are presented in and informed the interventions and investments prioritized in the HRH SP.
This work is documented and described in a recent publication in the journal Human Resources for Health, as the approach and experience of Malawi could be applicable to other countries. CHAI is now supporting the government of Malawi to update and adapt these modeling tools for the Health Sector Strategic Plan 2022-2030.