Influencing policy change: the experience of health think tanks in low- and middle-income countries

In recent years there has been a growth in the number of independent health policy analysis institutes in low- and middle-income countries which has occurred in response to the limitation of government analytical capacity and pressures associated with democratization. This study aimed to: (i) investigate the contribution made by health policy analysis institutes in low- and middle-income countries to health policy agenda setting, formulation, implementation and monitoring and evaluation; and (ii) assess which factors, including organizational form and structure, support the role of health policy analysis institutes in low- and middle-income countries in terms of positively contributing to health policy. Six case studies of health policy analysis institutes in Bangladesh, Ghana, India, South Africa, Uganda and Vietnam were conducted including two NGOs, two university and two government-owned policy analysis institutes. Case studies drew on document review, analysis of financial information, semi-structured interviews with staff and other stakeholders, and iterative feedback of draft findings. Some of the institutes had made major contributions to policy development in their respective countries. All of the institutes were actively engaged in providing policy advice and most undertook policy-relevant research. Relatively few were engaged in conducting policy dialogues, or systematic reviews, or commissioning research. Much of the work undertaken by institutes was driven by requests from government or donors, and the primary outputs for most institutes were research reports, frequently combined with verbal briefings. Several factors were critical in supporting effective policy engagement. These included a supportive policy environment, some degree of independence in governance and financing, and strong links to policy makers that facilitate trust and influence. While the formal relationship of the institute to government was not found to be critical, units within government faced considerable difficulties

'I believe that the staff have reduced their closeness to patients': an exploratory study on the impact of HIV/AIDS on staff in four rural hospitals in Uganda

<p>Abstract</p> <p>Background</p> <p>Staff shortages could harm the provision and quality of health care in Uganda, so staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed 'to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace'. Its results were to inform strategies to mitigate the impact of HIV/AIDS on hospital staff.</p> <p>Methods</p> <p>A cross-sectional study with qualitative and quantitative components was implemented during two weeks in September 2005. Data were collected in two government and two faith-based private not-for-profit hospitals purposively selected in rural districts in Uganda's Central Region. Researchers interviewed 237 people using a structured questionnaire and held four focus group discussions and 44 in-depth interviews.</p> <p>Results</p> <p>HIV/AIDS places both physical and, to some extent, emotional demands on health workers. Eighty-six per cent of respondents reported an increased workload, with 48 per cent regularly working overtime, while 83 per cent feared infection at work, and 36 per cent reported suffering an injury in the previous year. HIV-positive staff remained in hiding, and most staff did not want to get tested as they feared stigmatization. Organizational responses were implemented haphazardly and were limited to providing protective materials and the HIV/AIDS-related services offered to patients. Although most staff felt motivated to work, not being motivated was associated with a lack of daily supervision, a lack of awareness on the availability of HIV/AIDS counselling, using antiretrovirals and working overtime. The specific hospital context influenced staff perceptions and experiences.</p> <p>Conclusion</p> <p>HIV/AIDS is a crucially important contextual factor, impacting on working conditions in various ways. Therefore, organizational responses should be integrated into responses to other problematic working conditions and adapted to the local context. Opportunities already exist, such as better use of supervision, educational sessions and staff meetings. However, exchanges on interventions to improve staff motivation and address HIV/AIDS in the health sector are urgently required, including information on results and details of the context and implementation process.</p

DETERMINING STAFFING LEVELS AND MIX OF UCMB AFFILIATED HOSPITALS

Uganda Catholic Medical Bureau (UCMB) affiliated hospitals, like many other health institutions, are stressed by limited resources and increasing costs. This calls for a need to finance the increasing costs through efficiency gains on fixed inputs. Determining optimal staffing levels and skill mix would ensure efficiency gains on personnel whose costs account for 31-65% of UCMB's total recurrent expenditure. It would also match the staffing to the workload. A descriptive cross sectional study was carried out in four UCMB hospitals with the main objective of setting standard workloads for each staff category. The set standards would then be the basis for setting staffing norms. Results indicated a marked shortage of nursing aides, doctors and dispensers, but minimal shortage of nurses. The shortage of nursing aides resulted in both inappropriate use and increased work pressure on the nurses. Standard workloads per staff cadre per year were set as follows: 9,000 out patients to be seen by a clinician that is 37 patients per day and a dispenser to serve 10,667 out patients. On the wards, the standards were set at 8,000 inpatient days for a medical officer, 2,530 inpatient days for a nurse, 1,808 and 3,639 inpatient days for a midwife and nursing aide respectively

Learning from the Workload Indicator of Staffing Need Methodology Technical Implementation Experiences

This study was motivated by the fact that despite its numerous advantages, the use of the Workload Indicator of Staffing Need (WISN) methodology in Health Human Resource (HHR) planning and management is constrained. This is because some WISN users find the methodology especially, the implementation of its technical steps complex and laborious. Moreover, to date, the knowledge gained through the diverse WISN implementation experiences remains fragmented and untapped for peer learning and improvement of the WISN methodology. To promote peer and organizational learning, this study set out to use the direct experiences of the WISN users to obtain and document the lessons learned, innovations developed, and recommendations for WISN improvement. The traditional Delphi approach was used to collect data from 23 purposively selected WISN experts from 21 countries through a three-round Delphi online discussion. The WISN experts discussed and came to a consensus on the practicability of carrying out each of the WISN technical steps, key strategies and innovations that can be used to mitigate the common challenges encountered during WISN implementation. The experts also made recommendations of how to ease implementation of the WISN technical steps and to improve the WISN methodology as a whole. These included: revising the WISN User’s Manual, training, and Software; using a combined approach for setting activity standards; adapting the workforce optimization model’s approach to account for individual and category allowances; advocating for enabling policies for WISN implementation; establishing systems to facilitate benchmarking and peer learning; and establishing systems to ensure sustainable provision of WISN technical support to countries

Using The Workload Indicator Of Staffing Needs (WISN) Methodology To Assess Work Pressure Among The Nursing Staff Of Lacor Hospital

In their effort to provide adequate and quality health services, health systems in both developed and the developing countries have to confront the challenges of an ever increasing population with limited or diminishing resources. This includes the human resource which constitutes a major input in health care delivery and a key determinant of the cost and quality of care. There is an increasing need therefore for health organizations to identify the most appropriate staffing levels and skill mix to ensure efficient use of the limited health personnel. This paper demonstrates the use of the workload indicator of staffing needs (WISN) methodology in determining staffing requirements for the nursing staff in a hospital setting. It shows how the results can be used to assess overstaffing and understaffing as well as determine the work pressure among the different categories of nurses thus providing a basis for effective nurse redistribution to exploit efficiency gains without compromising the quality of services