How is KHHRAC developing standards for health facility staffing?

Health systems only deliver value when human resources for health (HRH) are deployed, managed and remunerated optimally. Planning for HRH is important because it helps in dealing with the persistent HRH problems, such as shortages, unequal distribution, and non-productivity, among others. Planning for HRH requires objective estimation of staff that is efficient and effective to achieve national health goals.

In the past, health facility staffing was determined using volume-based ratios (like nurse-to-patient ratios), standard staffing norms and headcount, all of which are now considered outdated. Modern thinking emphasizes using better estimates based on workload, patient classification and task-timing. However, these are only just starting to gain traction in Kenya and other low- and middle-income countries.

To strengthen staffing practices, the World Health Organisation (WHO) introduced the Workload Indicator of Staffing Need (WISN) methodology for its member states to consider. The WISN tool looks at actual work done by staff, factoring in both the clinical and non-clinical (administrative) tasks for a more complete picture. WISN moves away from volume-based models that overlook factors like the nature of illness. Instead of prescribing the number of clinicians required per 10,000 people, WISN asks questions like how many patients does the clinician see? What kind of services are they providing? How much time does it take them to perform specific tasks, and so on. The WISN approach is better able to map a health worker’s journey and quantify their tasks, thus ensuring they are optimally utilized, and protected from work-related stress and burnout.

The Kenya Health Human Resources Advisory Council (KHHRAC) is a Kenyan state corporation mandated with reviewing policies and establishing uniform norms and standards to improve health workforce welfare and performance.

To achieve its mandate, KHHRAC is working closely with the parent Ministry of Health and WHO, KHHRAC has developed a national WISN roadmap. WISN-adoption activities being done include training healthcare managers on WISN and establishing workload components and activity standards to enable accurate and context-specific workload measurement. KHHRAC and MOH are presently conducting WISN assessments at selected (sampled) facilities across 20 counties to generate evidence needed to establish accurate HRH staffing norms and standards for Kenya. Once completed, KHHRAC will be able to forecast staffing needs that will guide decision makers when planning and budgeting for HRH.

KHHRAC is partnering with other stakeholders, including Strathmore University and the University of Nairobi, to strengthen health workforce information to enable it to achieve its statutory mandate of maintaining an up-to-date register of all health workers in the country. Having accurate HRH data will enable the MOH to better forecast, plan and budget for future HRH needs whilst balancing across key factors like production (supply) and absorption (demand).