Analysis of Demand, Need and Requirement of Health

Manpower at Real Situation

Nava Raj KandelPratik Khanal

BPH 22nd BatchMaharajgunj Medical Campus

CONTENTS

1. Health manpower production/exercise a. Concept of manpower production - Demand - Need - Requirement - Manpower projection b. Identify the important issues with a specific

emphasis on the differing view points of the peoples and service providers.

CONCEPT OF

HEALTH MANPOWER PRODUCTION

Reshaping the health manpower so that it is responsive to a nation’s requirement for health care is essentially a triple process involving planning, production and management.

• Manpower production is concerned with the provision of learning opportunities in order to improve individual, team and organizational performance.

• It includes educational programs which produce health professionals.

• Production of health manpower is one of the elements of health manpower development.

In Nepal, the production of health manpower is mainly carrying out through two sectors:

Educational Sector- Five universities(TU, KU,

PU, NSU, Pokhara University), 3 deemed universities of health sciences(BPKIHS, NAMS, PAHS) and CTEVT and,

Health Service Sector- National Health Training

Centre under MoHP

CONCEPT OF

DEMAND, NEED AND REQUIREMENT OF

HEALTH MANPOWER PRODUCTION

Without a clear understanding of the variables that influence the demand for health care and of the ways they may change with time, even sophisticated analyses of manpower characteristics, distribution, productivity and costs can contribute relatively little to policy formulation.

Demand and Supply of health workers

• Local and global labour market dynamics that reflect economic, socio-demographic, political and scientific developments in addition to health needs influence both demand and supply of health workers.

Demand

• Demand is a measure of the quantities of goods or services that buyers take at alternative prices.

• As applied to health sector, a demand curve shows how the use of a given health workers services varies with the price of such services, for each price level there is different utilization level of effective demand.

FACTORS INFLUENCING DEMAND FOR HEALTH MANPOWER

Demographic factors- Size, distribution, density, growth rate, composition of

population (age, sex) Economic factors- At any given price, a strong correlation usually exists between

income and the demand for health care.- In the absence of a price variable, as in government financed

health care system , the waiting time for services and other such variables will tend to replace the price between supply and demand

FACTORS INFLUENCING DEMAND FOR HEALTH MANPOWER (CONT.)

Social and cultural factors- Educational level, level of health

consciousness, awareness about availability of health care

Health Status- Morbidity, mortality, disease pattern

FACTORS INFLUENCING DEMAND FOR HEALTH MANPOWER (CONT.)

Accessibility- Travel time, waiting time, convenience of time

for services, social and cultural barriers to receiving services

Resource availability- Manpower, hospital beds, other accessory

resources

FACTORS INFLUENCING DEMAND FOR HEALTH MANPOWER (CONT.)

Resource productivity- If resource productivity is increased, the

output of services will be greater and a higher level of demand can be satisfied

Health care technology- Availability of new and efficient technology

Need

• Need represents estimation of the number of workers or amount of services necessary to provide an optimum standard of health care based on professional judgment and current medical technology.

• The humanistic ethic has often caused planners to regard health services as of such positive value that they should be made available to all citizens regardless of their social or economic situation.

• As a result, much health planning has been based on professionally determined estimates of the presumed need for health services.

Requirements

• Requirement refers to the amount of services, manpower etc required to satisfy a given sets of assumptions about how the health sector does, could or should function.

Analysis of demand, need and requirement of health manpower is one of the must difficult task confronting the health manpower planner, but an essential one.

The word demand, need and requirement of manpower make semantic confusions regarding their meaning.

In summary, Demand refers the sum of the amount of the

various types of health services that the population of the given area will seek at prevailing price in a given time period

Need is an estimation based on professional judgment

Requirement refers to the amount of services, manpower etc. required satisfy a given set of assumption

Manpower projection

Manpower projection

• There are varieties of manpower requirement projection method. These are:

1 Supply side projectionThis is done by cohort analysis and annual loss rate of manpower

2 Demand side projectionIn this following methods are used:

Health need methodHealth services target methodHealth (or economic) demand methodManpower/ population ratio method

• Health need method: This method seeks to determine what health services people

actually require to keep them healthy.

The determination are made by health professionals with or without the involvement of the consuming public and are based primarily on medical and technological consideration.

Other issues such as cost, the capacity to deliver the services needed and the degree to which people are seeking health services may be important but are secondary concern

It is especially useful in planning, preventive and public health programs and in countries with a strong data base, a reasonably adequate health system infrastructure and a strong commitment to planned change.

Health service target method:

In this method the primary focus is on setting targets for the production and delivery of health services. The targets are established by the health authorities and may be based on a wide variety of inputs including health needs, economic demands, consumer wants and manpower ratios.

This method usually presupposes a health system that takes an active role in shaping sectoral development.

Its advantages includes flexibility, potential for disaggregating the several components of demand and less stringent data required than for the health need method.

Its limitation includes the risk that unrealistic targets will be set and that the degree of control over sectoral change will be overestimated.

Health (or economic) demand method:This method asks what number and kinds of health

services people will actually use at the anticipated monetary and other cost of obtaining these services.

Current health service utilization rates are a good measure of the met demand for health services and the planner may also want to take into account the unmet demand for services, given certain assumption about their cost and accessibility.

It is chiefly applicable to private sector planning and to countries whose government policies are more concerned with anticipating than with actively shaping future sectoral development and in which there are no large inequalities in access to care.

HR/ Population relation method: This method uses an observed or desired

manpower/ population ratio as the basis for deriving manpower requirement. This method has been a favorite method in many countries, primarily because of its simplicity and easy to carry out.

The appropriate population to health workers ratio usually depends on the level of economic development and the type of health care system management in each country.

• Demographic trend• NPC

• Affordability• Demand

– International comparison– Recommended standard– Ratios in favored areas– Past trends/ expert opinionsFig: Recruitment projection by HRH/ Popn ratio method

Current Population Projected population

Required future HRH/ population

ratioCurrent HRH/

Population ratio

Projected future HRH Requirement

Projected Changes in Staffing Requirement

Occupation Supply in 2003 Requirement in 2017

New posts % change

Medical Specialist

1544 2347 793 51

Medical Officer 1186 3459 2273 192%

SN 1585 7432 5847 369%

ANM 1820 15611 13791 758%

Manager 245 418 173 71%

Total 34,917 72,582 37,665 108%

Projected Requirement for new recruitsStaff type

MOH Staff in 2003 (A)

Estimated leaves in 14 years (B)

Transfer to private secTor (C)

Estimated lossD=B-C

Private sector(E)

Estimated leAves(F)

Estimated totalG=D+F

Additional staff required (H)

Total recruits requiredI+G+H

MS 371 208 104 104 1173 328 432 793 1225

MO 747 261 209 52 439 123 175 2273 2448

SN 967 338 271 68 618 173 241 5847 6088

ANM 1365 478 382 96 455 127 223 13791 14014

Manager

172 60 48 12 74 21 33 173 206

Total 26643 9761 7460 2301 8275 2317 4619 37665 42283

• The selection of an appropriate method or methods for requirement projection should take into account:

- The degree of government involvement in planning and health care delivery

- The quality of available data base and of planning expertise

- The degree to which the assessment result will be consonant with the general political, social and economic context of the country and

- Take into account past experiences in the production and utilization of health manpower.

Differing view

• Equity in access to health• Decentralized delivery of health care• Greater socio-economic inclusion and improved

outcomes for the poor.• Community participation• Accountability

Performance in terms of quantity and quality, responsiveness that essentially means addressing the issue or concern with appropriate measure and in time.

• Nepal’s health system is facing imbalances in the skill mix of staffs at the district level and also practical problems in geographical distribution

• Issues of role definition and job description has yet to be improved and a formal monitoring and supervising process is yet to be fully implemented.

• HRH , a component of HMIS should be utilized for comprehensive proactive management rather than confining only on personnel administration.

• The main challenge in Nepal is also the retention of health workers that has resulted in shortage of health infrastructure which are commonly aggravated by skewed distribution, movement from rural to urban areas, from public to private sectors.

• Contributing factors also include insufficient investment in pre-service training, migration, work overload, unattractive remuneration and work-environment issues.

• The public sector work setting can now be characterized by vacant posts, high turnover and loss to the private sector or abroad.

• Paradoxically, the country has higher number of health worker unemployment.

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References

• HRH Strategic Plan 2003-2017• Sagric C, Radulovic O, Bogdanovic M. Health needs. Acta Medica

Medianae 2007,Vol.46(1), P no. 36- 40• Cavanagh S, Chadwick K. Health Development Agency Health

Need Assessment, 2005• Hooper J, Longworth P. Health needs assessment workbook,

2002• Hall T L, Mejia A. Health Manpower Planning: Principles,

Methods , Issues, WHO 1978• Dreesch N et al. An approach to estimating human resource

requirements to achieve the Millennium Development Goals, Oxford University Press, 2005

Thank you