Advancing the Population Needs-Based Health Workforce Planning Methodology: A Simulation Tool for Country Application

Methods for health workforce projection model: systematic review and recommended good practice reporting guideline

BACKGROUND

Health workforce projection models are integral components of a robust healthcare system. This research aims to review recent advancements in methodology and approaches for health workforce projection models and proposes a set of good practice reporting guidelines.

METHODS

We conducted a systematic review by searching medical and social science databases, including PubMed, EMBASE, Scopus, and EconLit, covering the period from 2010 to 2023. The inclusion criteria encompassed studies projecting the demand for and supply of the health workforce. PROSPERO registration: CRD 42023407858.

RESULTS

Our review identified 40 relevant studies, including 39 single countries analysis (in Australia, Canada, Germany, Ghana, Guinea, Ireland, Jamaica, Japan, Kazakhstan, Korea, Lesotho, Malawi, New Zealand, Portugal, Saudi Arabia, Serbia, Singapore, Spain, Thailand, UK, United States), and one multiple country analysis (in 32 OECD countries). Recent studies have increasingly embraced a complex systems approach in health workforce modelling, incorporating demand, supply, and demand-supply gap analyses. The review identified at least eight distinct types of health workforce projection models commonly used in recent literature: population-to-provider ratio models (n = 7), utilization models (n = 10), needs-based models (n = 25), skill-mixed models (n = 5), stock-and-flow models (n = 40), agent-based simulation models (n = 3), system dynamic models (n = 7), and budgetary models (n = 5). Each model has unique assumptions, strengths, and limitations, with practitioners often combining these models. Furthermore, we found seven statistical approaches used in health workforce projection models: arithmetic calculation, optimization, time-series analysis, econometrics regression modelling, microsimulation, cohort-based simulation, and feedback causal loop analysis. Workforce projection often relies on imperfect data with limited granularity at the local level. Existing studies lack standardization in reporting their methods. In response, we propose a good practice reporting guideline for health workforce projection models designed to accommodate various model types, emerging methodologies, and increased utilization of advanced statistical techniques to address uncertainties and data requirements.

CONCLUSIONS

This study underscores the significance of dynamic, multi-professional, team-based, refined demand, supply, and budget impact analyses supported by robust health workforce data intelligence. The suggested best-practice reporting guidelines aim to assist researchers who publish health workforce studies in peer-reviewed journals. Nevertheless, it is expected that these reporting standards will prove valuable for analysts when designing their own analysis, encouraging a more comprehensive and transparent approach to health workforce projection modelling.

Strategic workforce planning in health and social care - an international perspective: A scoping review

Effective strategic workforce planning for integrated and co-ordinated health and social care is essential if future services are to be resourced such that skill mix, clinical practice and productivity meet population health and social care needs in timely, safe and accessible ways globally. This review presents international literature to illustrate how strategic workforce planning in health and social care has been undertaken around the world with examples of planning frameworks, models and modelling approaches. The databases Business Source Premier, CINAHL, Embase, Health Management Information Consortium, Medline and Scopus were searched for full texts, from 2005 to 2022, detailing empirical research, models or methodologies to explain how strategic workforce planning (with at least a one-year horizon) in health and/or social care has been undertaken, yielding ultimately 101 included references. The supply/demand of a differentiated medical workforce was discussed in 25 references. Nursing and midwifery were characterised as undifferentiated labour, requiring urgent growth to meet demand. Unregistered workers were poorly represented as was the social care workforce. One reference considered planning for health and social care workers. Workforce modelling was illustrated in 66 references with predilection for quantifiable projections. Increasingly needs-based approaches were called for to better consider demography and epidemiological impacts. This review's findings advocate for whole-system needs-based approaches that consider the ecology of a co-produced health and social care workforce.

Methods and Tools Used to Estimate the Shortages of Medical Staff in European Countries-Scoping Review

Healthcare workforce (HWF) shortages are the biggest challenges today in healthcare systems. Therefore, it is crucial to forecast the future needs of HWFs in order to plan accordingly. The purpose of this study was to identify, map, and synthesize the tools, methods, and procedures for measuring medical staff deficits in Europe. We used the Arksey and O'Malley scoping review methodology. Based on predefined criteria, 38 publications that were retrieved from multiple scientific databases, hand-searched on the internet, from relevant organizations, and scanned from references were considered. They were published between 2002 and 2022. There were 25 empirical studies, 6 theoretical papers, 5 reports, 1 literature review, and 1 guidebook. The majority estimated or measured shortages of physicians (14/38) and nurses (7/38) or looked at HWF generally (10/38). Various methods were used, including projections, estimations, predictions, simulation models, and surveys, which used tools such as special computer software or customized indicators, i.e., the Workload Indicators of Staffing Need method. Researchers estimated HWF shortages at both national and regional levels. Such projections and estimations were often based on demand, supply, and/or need. These methods and tools are not always suited to the needs of a country or medical facility, which is why they need to be further developed and tested.

Proyección de brecha de especialistas en nefrología en Uruguay 2020-2050: aplicación de un modelo de dinámica de sistemas

Objetivo Estimar el equilibrio/desequilibrio entre la oferta y la necesidad de nefrólogos en Uruguay para el año 2020 así como la tendencia hacia el 2050. Métodos Se desarrolló un modelo de simulación, aplicando la metodología de dinámica de sistemas con dos componentes: el de oferta y el de necesidad. Se definió 2020 como el año base y un horizonte de proyección hasta 2050. Se comparó la oferta y la necesidad en el periodo de proyección para establecer la brecha tanto en términos absolutos como relativos. Resultados La proyección de brecha para todos los escenarios considerados es de superávit en la mayor parte del periodo analizado. Conclusiones El trabajo aporta insumos respecto de aquellos parámetros sobre los que se puede incidir y que afectan a la oferta de especialistas. El valor de las proyecciones radica en su utilidad para identificar la situación actual y las tendencias futuras a las que deben responder los responsables de la formulación de políticas.

The process of developing health workforce strategic plans in Africa: a document analysis

BACKGROUND

Many countries are faced with a multitude of health workforce-related challenges partly attributed to defective health workforce planning. Earlier efforts to guide the process and harmonise approaches to national health workforce policies and planning in the Africa Region included, among others, the development of the WHO Africa Regional Office (WHO/AFRO) Policies and Plans for Human Resources for Health Guidelines for Countries in the WHO African Region in 2006. Although this guideline has led to uniformity and rigour in developing human resources for health (HRH) policies and strategies in Africa, it has become imperative to synthesise the emerging evidence and best practices in the development of health workforce strategies.

METHODS

A document analysis was conducted using the READ ( R eadying materials; E xtracting data; A nalysing data and D istilling) approach.

RESULTS

Fourteen HRH policy/strategic plans were included in the study. The scope of the HRH strategic plans was described in three dimensions: the term of the strategy, sectors covered by the strategy and the health workforce considered in the projections. We found that HRH strategic plan development can be conceptualised as a cyclical, sequential multimethod project, with one phase feeding the subsequent phase with data or instructions. The process is very complex, with different interest groups and sectors that need to be satisfied. The HRH strategic plan development process comprises five main phases linked with external forces and national politics.

CONCLUSION

There is a need for accurate and comprehensive HRH data collection, astute HRH leadership, and broad base and multisectoral stakeholder consultation with technical support and guidance from experts and major external partners for effective HRH strategic plan development.

Health workforce supply, needs and financial feasibility in Lesotho: a labour market analysis

BACKGROUND

The Government of Lesotho has prioritised health investment that aims to improve the health and socioeconomic development of the country, including the scaling up of the health workforce (HWF) training and improving their working conditions. Following a health labour market analysis, the paper highlights the available stock of health workers in Lesotho's health labour market, 10-year projected supply versus needs and the financial implications.

METHODS

Multiple complementary approaches were used to collect data and analyse the HWF situation and labour market dynamics. These included a scooping assessment, desk review, triangulation of different data sources for descriptive analysis and modelling of the HWF supply, need and financial space.

FINDINGS

Lesotho had about 20 942 active health workers across 18 health occupations in 2020, mostly community health workers (69%), nurses and midwives (17.9%), while medical practitioners were 2%. Almost one out of three professional nurses and midwives (28.43%) were unemployed, and nearly 20% of associate nurse professionals, 13.26% of pharmacy technicians and 24.91% of laboratory technicians were also unemployed. There were 20.73 doctors, nurses and midwives per 10 000 population in Lesotho, and this could potentially increase to a density of 31.49 doctors, nurses and midwives per 10 000 population by 2030 compared with a need of 46.72 per 10 000 population by 2030 based on projected health service needs using disease burden and evolving population size and demographics. The existing stock of health workers covered only 47% of the needs and could improve to 55% in 2030. The financial space for the HWF employment was roughly US$40.94 million in 2020, increasing to about US$66.69 million by 2030. In comparison, the cost of employing all health workers already in the supply pipeline (in addition to the currently employed ones) was estimated to be US$61.48 million but could reach US$104.24 million by 2030. Thus, a 33% gap is apparent between the financial space and what is required to guarantee employment for all health workers in the supply pipeline.

CONCLUSION

Lesotho's HWF stock falls short of its population health need by 53%. The unemployment of some cadres is, however, apparent. Addressing the need requires increasing the HWF budget by at least 12.3% annually up to 2030 or prioritising at least 33% of its recurrent health expenditure to the HWF.

Modelling the supply and need for health professionals for primary health care in Ghana: Implications for health professions education and employment planning

Background

The health workforce (HWF) is critical in developing responsive health systems to address population health needs and respond to health emergencies, but defective planning have arguably resulted in underinvestment in health professions education and decent employment. Primary Health Care (PHC) has been the anchor of Ghana’s health system. As Ghana’s population increases and the disease burden doubles, it is imperative to estimate the potential supply and need for health professionals; and the level of investment in health professions education and employment that will be necessary to avert any mismatches.

Methods

Using a need-based health workforce planning framework, we triangulated data from multiple sources and systematically applied a previously published Microsoft® Excel-based model to conduct a fifteen-year projection of the HWF supply, needs, gaps and training requirements in the context of primary health care in Ghana.

Results

The projections show that based on the population (size and demographics), disease burden, the package of health services and the professional standards for delivering those services, Ghana needed about 221,593 health professionals across eleven categories in primary health care in 2020. At a rate of change between 3.2% and 10.7% (average: 5.5%) per annum, the aggregate need for health professionals is likely to reach 495,273 by 2035. By comparison, the current (2020) stock is estimated to grow from 148,390 to about 333,770 by 2035 at an average growth rate of 5.6%. The health professional’s stock is projected to meet 67% of the need but with huge supply imbalances. Specifically, the supply of six out of the 11 health professionals (~54.5%) cannot meet even 50% of the needs by 2035, but Midwives could potentially be overproduced by 32% in 2030.

Conclusion

Future health workforce strategy should endeavour to increase the intake of Pharmacy Technicians by more than seven-fold; General Practitioners by 110%; Registered general Nurses by 55% whilst Midwives scaled down by 15%. About US$ 480.39 million investment is required in health professions education to correct the need versus supply mismatches. By 2035, US$ 2.374 billion must be planned for the employment of those that would have to be trained to fill the need-based shortages and for sustaining the employment of those currently available.

Health Service Activity Standards and Standard Workloads for Primary Healthcare in Ghana: A Cross-Sectional Survey of Health Professionals

The attainment of health system goals is largely hinged on the health workforce availability and performance; hence, health workforce planning is central to the health policy agenda. This study sought to estimate health service activity standards and standard workloads at the primary health care level in Ghana and explore any differences across health facility types. A nationally representative cross-sectional survey was conducted among 503 health professionals across eight health professions who provided estimates of health service activity standards in Ghana's Primary Health Care (PHC) settings. Outpatient consultation time was 16 min, translating into an annual standard workload of 6030 consultations per year for General Practitioners. Routine nursing care activities take an average of 40 min (95% CI: 38-42 min) for low acuity patients; and 135 min (95% CI: 127-144 min) for high dependency patients per inpatient day. Availability of tools/equipment correlated with reduced time on clinical procedure. Physician Assistants in health centres spend more time with patients than in district hospitals. Midwives spend 78 min more during vaginal delivery in health centres/polyclinics than in district/primary hospital settings. We identified 18.9% (12 out of 67) of health service activities performed across eight health professional groups to differ between health centres/polyclinics and district/primary hospitals settings. The workload in the health facilities was rated 78.2%, but as the workload increased, and without a commensurate increase in staffing, health professionals reduced the time spent on individual patient care, which could have consequences for the quality of care and patient safety. Availability of tools and equipment at PHC was rated 56.6%, which suggests the need to retool these health facilities. The estimated standard workloads lay a foundation for evidence-based planning for the optimal number of health professionals needed in Ghana's PHC system and the consequent adjustments necessary in both health professions education and the budgetary allocation for their employment. Finally, given similarity in results with Workload Indicators of Staffing Need (WISN) methodology used in Ghana, this study demonstrates that cross-sectional surveys can estimate health service activity standards that is suitable for health workforce planning just as the consensus-based estimates advocated in WISN.