models for health workforce planning and projections | 8 august 2011 1 |1 | models for health...

Models for health workforce planning and projections | 8 August 20111 |

Models for health workforce planning and projections

Models for health workforce planning and projections

Department of Human Resources for Health

World Health Organization, Geneva


HRH planning and projectionsHRH planning and projections

The purpose of workforce planning projections is to contribute to evidence-based, rationalize decisions in the formulation of

national HRH policies and strategies . rationalize policy options based on a (financially) feasible picture of the

future in which the expected supply of HRH matches the requirements for staff within the overall health service plans

identify short and longer term actions for achieving longer-term objectives.

Making projections is a policy-making necessity, and needs regular re-evaluation and adjustment


conceitosconceitos

Projeções da força de trabalho pode ser definido como estimativas do que vai acontecer no futuro utilizando cálculos baseados em suposições.

Necessidade da força de trabalho pode ser definido como o número e tipos de pessoal necessários (em relação à procura – demanda ou necessidade).


Uncertainties with projectionsUncertainties with projections

Country situation changes (demographic, epidemiological, economic, etc.)

The capacity (both current and projected) for implementing the proposed interventions

Conflicting priorities for different stakeholdersleadership turnover Actions of stakeholders that can impact on health

systems development


Linking health workforce requirements and supply projectionsLinking health workforce requirements and supply projections

Source: Hornby 2007


Factors affecting HRH SupplyFactors affecting HRH Supply

Health Workers Supply– HRH production / training capacity– human capital stock– other resources– global, regional, local exit and entry forces, labor market conditions

Health Workers Attrition / Loss– death, out-migration– career change


Methods of supply projectionMethods of supply projection

Trend projectionIn- and out- moves method

– Stock and flow projection

Cohort method, based on cohort retention rates


Trend projectionProjeção da densidade per capita de médicos por 1000 habitantes, Brasil 1970-2030

Trend projectionProjeção da densidade per capita de médicos por 1000 habitantes, Brasil 1970-2030

0

0.5

1

1.5

2

2.5

3

3.5

1970

1976

1978

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

2006

2008

2010

2012

2014

2016

2018

2020

2022

2024

2026

2028

2030

De

ns

ida

de

de

me

dic

os

pe

r 1

00

0 p

op

médicos per capita _DATASUS médicos per capita _census+PNAD

Projeção de oferta medicos per capita_datasus Projeção de oferta medicos per capita_census+PNAD


In and out move methodIn and out move method

InflowEducation In-migration

OutflowRetirementDisability/DeathOut-migration

Stock ofStock ofHealth WorkersHealth Workers


"Inflow" and "outflow" of nurses from the UK, 1993-2010"Inflow" and "outflow" of nurses from the UK, 1993-2010

Buchan, J & Seccombe, I. Planning for Retirement? The 2011 UK Nursing Labour Market Review. 2011. in print.


Cohort methodCohort method

Estimate approximate percentage of each cohort of graduates who remain in active workforce over time

– Cohort refers to a group of persons followed through time as, for example, male doctors who graduated during the five-year period 1980-84, or female nurses during the period, 1990-94

Use observed or assumed cohort retention rates to project numbers of each cohort of graduates who will be active in future years

– For example, 98% remain active 5 years after graduation, 96% remain active 10 years after graduation, 92% remain active 15 years after graduation


Ageing nurses in the United States of AmericaAgeing nurses in the United States of America

- - - - - - - -


Factors affecting HRH demandFactors affecting HRH demand

Demand for health services:– Population demographic characteristics: population size, age

structure– Epidemiological factors: disease patterns– Socio-economic factors: income, education– Behavioral factors: utilization patterns

Health service policy and resources:– Technology & service provision patterns – Finance / budgets


Requirements projectionsRequirements projections

Workforce to population ratio method

Service demands method

Service targets method

Health needs method


HRH per population approachHRH per population approach

Current Population Level

Future Population Level

Current level ofHRH Density

HRH HRH RequirementsRequirements

Desired level of HRH Density

Population Growth Trends

*Regional/Global standard* Geographical comparisons *Economic and social status

*Historical trends *Expert opinions


Population density of health care professionalsrequired to ensure skilled attendance at births

Population density of health care professionalsrequired to ensure skilled attendance at births

Source: WHR 2006


Health Worker Density in European CountriesNumber of Health Workers per 10,000 Population for Selected HRH Categories

Health Worker Density in European CountriesNumber of Health Workers per 10,000 Population for Selected HRH Categories

Comparison Group

PhysiciansNursesMidwivesPharmacistsDentists

Armenia34,541,74,10,53,9

Ukraine30,878,35,04,84,1

EU32,174,53,67,16,0

WHO-EURO33,972,24,45,25,1

Source: WHO HFA database, 2006 data


Service demand approachService demand approach

Population characteristics

age, income, sex, education

Current Health care utilization

(Survey)

Population and socio-

economic trends HRH HRH

RequirementRequirementss

Future health service

requirements

HR Productivity

Future Population Characteristics

Using current demand make assumptions about how that will change over time


Service target approachService target approach

•Current and projected facilities

•Current and projected staffing patterns

•Vacancy and attrition rates

Future health systems scenario and health

service requirements

HR Productivit

y

HRH HRH RequirementRequirement

ss

Policy Makers

*Experts*Planners


HRH demand for ART in Mozambique (scenario 1)8 000 starting ART by the end of year 1,

ending with 58 000 starting ART by the end of year

HRH demand for ART in Mozambique (scenario 1)8 000 starting ART by the end of year 1,

ending with 58 000 starting ART by the end of year

Source: Hagopian, A., Micek, M., Vio, F., Gimbel-Sherr, K., Montoya, P. What if we decided to take care of everyone who needed treatment? Workforce planning in Mozambique using simulation of demand for HIV/AIDS care. Human Resources for Health 2008, 6:3


Health needs approachHealth needs approach

Population characteristics

*age *income *sex *education

Current Health Needs

Population and socio-economic

trends HRH HRH RequirementRequirement

ss

Future health service requirements

HR Productivity

Future Health Needs

Future Pop Characteristics

Detailed study of health status targets

Models for health workforce planning and projections | 8 August 201122 |22

Each approach has limitationsProblems in securing data Degree of precision of some variables are subjectivePrivate sector characteristics and projecting demandConverting full-time equivalents (FTEs) into ‘persons’Potentially wide errors regarding loss estimatesDifficulty maintaining relevant policies over timeLack of data about deployment, productivity, location, costs,

specialization Lack of data about the ‘inactive’ supply and what policies might help

bring them back to active status22

Key problems with requirements projectionsKey problems with requirements projections


Special studies and applicationsSpecial studies and applications

Econometric analysis: a statistical techniques on market factors that influence labour participation and health service utilization, such as access to services and preferences of health consumers

Regression analysis: This is a technique for the modelling and analysis of numerical data consisting of values of a dependent variable (response variable) and of one or more independent variables (explanatory variables).

Meta analysis: A technique to assess and reconcile potential variances in coverage, classification and reporting of data, by means of amalgamating, summarizing and assessing all available information on a specific dimension and applying statistical techniques to measure outcomes on a common scale.

Simple models: Specialized analysis of a given issue for consideration of other health aspects, such as the impact of HIV on the workforce: used by aid decision-makers to take to address HW situation to mitigate potential future scenarios

WISN

Models for health workforce planning and projections | 8 August 201124 |24

Factors influencing choice of method (1)Factors influencing choice of method (1)

Magnitude of system and HRH changes sought– Nature and urgency of the HR problem (s)

• Projections <10 years permit only minor changes in the health system, supply, or deployment

• 20+ years allow significant changes in type of health system, personnel numbers and ratios

Number of cadres to be projectedData availability, especially on staffing patterns, costs,

productivity, and on geographic and functional distribution


Factors influencing choice of method (2)Factors influencing choice of method (2)

Passive or active government health policies– Passive: Seeks to anticipate likely future developments based on

observable and likely trends

– Active: Seeks to intervene to shape future developments, eg, changes in ratios, numbers, types of health facilities, public/private sector balance, geographic distribution, task allocations, level of performance

– But, governments are never entirely passive, or active

Level of ‘precision’ sought

25


Developing scenariosDeveloping scenarios

The requirements models develop alternative scenarios of a future health care system

– Scenarios are different visions of what might take place based on specified assumptions

– Scenarios are never wrong — they say what would result if input estimates are valid and assumptions come true. However...

• Base year data estimates may be wrong• Planning assumptions may be unrealistic or impossible


Developing scenarios (2) Developing scenarios (2)

Scenario characteristics….– Scenarios assist planning process by showing the potential

consequences of alternative assumptions about the future

– Scenarios do not predict the future

– No scenario projection model can result in a human resources plan!

A plan is the result of human choices regarding the future evolution of the health system


Concluding remarksConcluding remarks

Projecting requirements is much more challenging, and controversial, than supply

Supply and requirements projections are two sides of a single coin, without the other, is of little use

Match method to country needs, characteristics, and data Develop array of projection options using different plausible assumptions Involve stakeholders at appropriate points and seek consensus as to key

assumptionsPlan long (10-30 years), act short (3-5 years), update often (every 3-4

years)

models for health workforce planning and projections | 8 august 2011 1 |1 | models for health...

Documents

health workforce planning

health workforce requirements

hrh planning

active workforce

supply projections source

geneva slide

adjustment slide

overall health service