With the declaration of the 1977 constitution, the health sector has re-aligned its policy and strategic plans. A Health Policy and Health Sector Strategic Plan have been developed, which outline the health sector long, and medium term strategic intents respectively.
Maximizing the potential of the health workforce is one of the policy directions specified in the Health Policy. Specifically, the sector intends to ensure there is adequate and equitable distribution of human resources for health at all levels. To achieve this, the health sector has to review, and apply evidence based health workforce norms and standards for the different tiers of health care levels.
In line with the need to attain this goal, the Health Sector Strategic Plan has committed to deploy all health facilities with at least one skilled health personnel with particular focus on primary level based on expected services to be delivered as defined in the Essential Health care package. A staffing norm has been defined for each level, to outline the appropriate number of health workers, by cadre and skill mix needed to assure provision of the EHCP. During the period of the HSSP V, the sector efforts shall be geared towards assuring this calculated number of staff. Once this is assured, additional funds would be used to provide additional human resources to attain optimum norms that facilities, regions and national levels will have elaborated.
To facilitate the implementation of the HSSP V, the health service delivery systems are categorized around the following four tiers:
- Community services focused on demand creation
- Primary care services (comprising dispensaries, health centers and District services of both public and private providers).
- Regional services—government, and private.
- The zonal, specialized and national services will include the service units providing tertiary / highly specialized services including high level specialist medical care, laboratory support, blood product services, and research.
1.2 Rationale and objectives for developing HRH Staffing levels
The need for a rational and evidence based method of setting the correct staffing levels has been a challenge for the health sector. In the past, the health sector based staffing requirements on fixed patterns of staff for different levels of care. The previous staffing requirement (2014) brought these requirements into one document, and also introduced population ratios for critical staff. These two approaches have been quite useful in assessing overall staffing requirements at a national, regional and facility level, and so guiding HRH policy and planning. However, they have had challenges in their adaptation in the Country:
i.The fixed patterns of staff, and population based norms were based on critical staff, not all staff available for health service provision. Different levels have different workload depending on number of patients and clients served. Thus makes the HRH requirement to differ as well.
ii.While the 2021 staffing requirements were based on expected workload, the workload used was for essential health care package and factor the many new interventions introduced for health workers.
iii.The 2021 staffing requirement considered actual staffing needs emanated from specific health facilities and an average number was taken across facilities of the same type as standard norms.
These staffing levels are a guide as to the required staff that different levels of the health sector need to work towards having, for effective delivery of the EHCP. They have therefore considered three factors:
i.Human Resources for Health norms by facility type, and population for adequate and equitable efficient and sustainable delivery of the EHCP
ii.Appropriate staffing needs required for each level to deliver the EHCP based on the derived norms
iii.Workload components for different EHCP services
The staffing levels therefore are useful in guiding HRH planning, management and development decisions at the Primary, Region and National levels. They are also useful for monitoring how close different implementation levels are to the attainment of required HRH for delivery of the EHCP.