1. THE WORLD HEALTH ORGANISATION
EXPLORING THE USE OF
THE WORLD HEALTH ORGANISATION
HUMAN RESOURCES
FOR HEALTH
PROJECTION MODEL
Peter Hornby
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

2. Changing Style Of Human Resource Planning
Traditional H.R. Planning
Staff roles and functions changing little,
little attention to costs or efficiency
Finance Limited H.R. Planning
Staff numbers and mix determined or
limited by finance
Performance Driven H.R. Planning
Staffing driven not simply by
finance limits but also by demands
for efficient use of resources
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

3. Purpose of Manpower- Human Resource – Work Force Planning
To Achieve and Sustain :
Right number of people
In the right place
with the right skills
at the right time
1960’s Concept
Right number of people
In the right place
with the right skills
at the right time
with the right attitudes
and motivation
1970’s Concept
Right number of people
In the right place
with the right skills
at the right time
with the right attitudes
and motivation
at the right cost
1980’s Concept
Right number of people
In the right place
with the right skills
at the right time
with the right attitudes
and motivation
at the right cost
doing the right work
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT
1990’s Concept

4. The ideal for the workforce (2000s concept),
in human resource terms, is to have:
The right number of people,
With the right skills,
In the right place,
At the right time,
With right attitudes/
commitment,
Doing the right work,
At the right cost,
With the right productivity.
This ideal is never achieved or at best minimally, because
the workforce and the workforce environment is an
extremely complex and dynamic system.
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

5. Classical View of Human Resource Planning Process
Current Health
Needs & Demands
Existing
Services
Future Health
Needs & Demands
Future Health &
Health Care Goals
Leavers
Current Staff
Future
Services
Types of Staff
Required
Trained Staff
Returning
Projected
Skill Mix
New Graduates
Total Staff
Available In
The Future
Total Staff Needed
In The Future
Equal ?
YES NO
Change Goals,
Services and/or
Staff Requirements
Change Type &
Scale of
Recruitment, Losses
Affordable ?
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT NO
YES
Implement
Plan

6. STAFF The Variables Impacting on Future Staff Requirements
SERVICES
POPULATION
GROWTH AND CHANGE
AVAILABLE
FINANCE
TECHNOLOGY
CHANGE
PUBLIC
EXPECTATIONS
STAFF
REQUIREMENTS
HEALTH
PROBLEMS
STAFF
UTILISATION
QUALITY
STANDARDS
SKILL MIX
ORGANISATIONAL
EFFICIENCY
INDIVIDUAL
PERFORMANCE
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

7. Conceptual Model - Linking Health Needs,
Care Provision & the Health Workforce.
FIRST STAGE --- Determine Current Situation
Current Health
Needs and
Demands
Current Demographic
&
Epidemiology patterns
Health Services
Current Share of
National GNP
Current Public
Health Services
Provided
Current Socio-
Economic Status
of the population
Current
Service & HR
Policies
Current Public
Sector
Workforce Mix
Current Size
of the Private
Health Sector
Current
Workforce
Cost
Creates foundation for second stage
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

8. Conceptual Model - Linking Health Needs,
Care Provision & the Health Workforce.
FIRST STAGE --- Determine Current Situation
Current Health
Needs and
Demands
Current Demographic
&
Epidemiology patterns
Health Services
Current Share of
National GNP
Current Public
Health Services
Provided
Current Socio-
Economic Status
of the population
Current
Service & HR
Policies
Current Public
Sector
Workforce Mix
Current Size
of the Private
Health Sector
Current
Workforce
Cost
SECOND STAGE –Develop The Service Plan
Projected
Changes in
National GNP
Projected Future
Demographic &
Epidemiology patterns
Proposed
Future Service
Policies
Future Socio-
Economic Status
of the population
Future Health
Needs & Demands
Expected Future
Share in
National GNP
Proposed Future
Public Health
Services
Private Sector
Expansion
Provides Basis for Determining Future Workforce Requirements & Supply in Stage 3
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

9. Conceptual Model - Linking Health Needs,
Care Provision & the Health Workforce.
Current Health
Needs and
Demands
Current Demographic
&
Epidemiology patterns
Health Services
Current Share of
National GNP
Current Public
Health Services
Provided
Current Socio-
Economic Status
of the population
Current
Service & HR
Policies
Current Public
Sector
Workforce Mix
Current Size
of the Private
Health Sector
Current
Workforce
Cost
Projected
Changes in
National GNP
Projected Future
Demographic &
Epidemiology patterns
Proposed
Future Service
Policies
Future Socio-
Economic Status
of the population
Future Health
Needs & Demands
Expected Future
Share in
National GNP
Proposed Future
Public Health
Services
Private Sector
Expansion
Staffing
Standards/Norms
& Principles
Projected Future
Workforce
Supply
Available
Financing for
Workforce
Human
Resource
Policies
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT
Future
Workforce
Staffing Mix
Projected Future
Workforce
Requirements

10. The model software actually incorporates three different
There are an array of strategic HR projection models which include:
THE WHO HRH PROJECTION MODEL (Hall)
THE KEELE ZONAL HRH MODEL (Hornby)
THE SMALL STATE/DISTRICT HRH MODEL (Dewdney)
HEALTH SERVICE RESOURCE MODEL (UNDP in process)
INTEGRATED HEALTH CARE TECHNOLOGY PACKAGE
(IHTP) WHO
SERVICE TARGETS/REPROFILING MODEL (FOR UK)
The model software actually incorporates three different
projection models; a ratio method model which is now rarely used,
a service targets model for which few developing countries have
the necessary data and which has been largely superceded by more
sophisticated versions and a variant on the target method called
the locations method based on institutional development. It is this
method that is widely used in developing country situations
The Keele model was developed to link
electronically to the WHO model and provide a more detailed
breakdown of staff requirements (note: maybe job titles)
and more local (district) strategic projections. It proved too
cumbersome for districts but reasonable at zonal or regional level
with grouped districts
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

11. Flexibility of WHO model inputs
Models use individualized inputs regarding …
Duration of projection (any number of years)
Occupational categories used (up to 20 possible)
Training intake and loss assumptions
Post-graduation workforce loss assumptions including migration
Geographic distribution variables (urban/rural)
Economic, budget and demographic variables for age and gender
Up to 7 types each of hospitals and ambulatory facilities in both public and private sectors
Staff in non-clinical settings
Staffing norms for different types of facilities
All input/output tables electronically linked
providing easy production of alternate scenarios
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

12. Model Data tables (Locations method)
Data not
Required
(automatic)
Data
Required
Topic
Yes 1
DEMOGRAPHIC ESTIMATES AND ASSUMPTIONS
Yes 2
EXISTING HEALTH WORKFORCE
Yes 3
SUMMARY OF KEY PLANNING ASSUMPTIONS
Yes 4
PUBLIC SECTOR INCOME ESTIMATES AND ASSUMPTIONS
Yes 5
ECONOMIC FEASIBILITY TEST
Yes 5a
ECONO
MIC FEASIBILITY TEST, PRIVATE SECTOR
Yes 9
HOSPITAL REQUIREMENTS BY LOCATIONS METHOD 11
BASE YEAR & TARGET YEAR HOSPITAL STAFFING NORMS No 9a
PRIVATE HOSPITAL REQUIREMENTS BY LOCATIONS METHOD
Yes
11a
BASE YEAR & TARGET YEAR PRIVATE HOSPITAL ST
AFFING NORMS
Yes 10
AMBULATORY FACILITIES BY THE LOCATIONS METHOD
Yes
Yes 12
BASE YEAR & TARGET YEAR CLINIC STAFFING NORMS
Yes
10a
PRIVATE AMBULATORY FACILITIES BY THE LOCATIONS METHOD
Yes 13
BASE YEAR & TARGET YEAR PRIVATE CLINIC STAFFING NORMS Ye s 14
OTHER STAFF BY LOCATIONS METHOD 15
PROJECTION OF PRIVATE SECTOR STAFF AND SERVICES
Yes 16
SUMMARY REQUIREMENTS BY LOCATIONS METHOD
Yes 6
PROJECTED SUPPLY BASED ON TRAINING ASSUMPTIONS
Yes 6a
CALCULATING CHANGES BETWEEN BASE AND TARGET YE
ARS No
Yes 7
STUDENT ENROLMENT AND INSTRUCTOR ASSUMPTIONS No 17
SUPPLY -
REQUIREMENTS COMPARISON BY LOCATIONS METHOD No 18
ECONOMIC FEASIBILITY OF LOCATIONS METHOD PROJECTION No 19
SUMMARY OF KEY DATA BY LOCATIONS METHOD 20
SUMMARY OF KE
Y DATA IN ALTERNATE LANGUAGE No
Yes 8
TEN -
YEAR PROJECTION BY STOCK AND FLOW METHOD
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

13. Major model outputs HR requirements and supply projections
Urban/ rural distribution of staff & services
Number, size and staffing of all health sector facilities
Test of economic feasibility for public sector staff and staff production feasibility for all health sector
Intermediate year interpolation projections
Summary statement of key indices of
change sufficient to produce HRH plan document
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

14. AVAILABLE SUPPORT FOR THE MODEL
The model itself is freely available from WHO Geneva
on the tools website
There is a very comprehensive manual but it has not
been updated for new tables and is difficult to locate on
the WHO website
there is a short form manual from Keele which provides
guidance on how to run the model and what data is
required to complete the tables. It is freely available but
not routinely distributed
There is a manual from Keele which provides guidance
on how to analyse and interpret input data in the model
tables. It is freely available but not routinely distributed
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

15. Modelling and the Modelling process
Issues:
- participants in the projection making process
lose track of the relationship between tables
- the meaning of the numbers in the tables is
often not understood among non-planners
- the connection between health, HRH policy and
growth proposals is only weakly made and applied
in the model
- there is frequently poor information on leavers
- the estimates of staff costs is often very difficult
to establish because of multiple funding sources
- participants unused to visioning
- original help tables now out of date and new
types of help data required
- the need for multiple iterations in the projection
process is generally not recognised
- difficult to find and maintain technical know-how
within ministry – need external(in country) support
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT

16. Fitting modelling into the Planning Process
Issues:
Operational environment becoming complicated with devolution of responsibilities in health sector reform.
Data collection, processing & analysis difficult and time consuming.
Service planning is sometimes not in place, sometimes mechanical or political & is always time consuming with little opportunity for testing resource (HR) implications.
Little incentive for managers (although this is changing under new pressures for efficiency) to meet plan objectives.
Planners not engaging with the Politics of planning
Mechanisms for implementation often not
In place.
KEELE
UNIVERSITY CENTRE FOR HEALTH PLANNING AND MANAGEMENT