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The imperative of evidence-based health workforce planning and implementation: lessons from nurses and midwives unemployment crisis in Ghana.

ABSTRACT: Following periods of health workforce crisis characterised by a severe shortage of nurses, midwives and doctors due to low production rates and excessive out-migration, the Government of Ghana through the Ministry of Health (MOH) responded by expanding training and allowing private sector involvement in the training of health workers especially nurses and midwives. This resulted in substantial increases in the production levels of nurses and midwives even above the projections of the MOH. In this paper, we discuss how a strategy that was seemingly well planned suffered a decade of uncorrected implementation lapses resulting in a lingering need-based shortage of nurses and midwives at service delivery points whilst thousands of trained nurses and midwives remained unemployed for up to 4?years and constantly protesting for jobs. In the short term, we argue that the Government of Ghana would need to increase investment to recruit trained and unemployed nurses and midwives whilst a comprehensive health labour market analysis is conducted to provide robust evidence towards the development of a long-term health workforce plan that would guide future production of nurses and midwives. The Government of Ghana may also explore the option of a managed migration programme to export nurses/midwives to countries that are already destinations to individual migration initiatives in a bid to mitigate the potential skill loss associated with long periods of unemployment after training, especially for those who trained from the private institutions.

SUBMITTER: Asamani JA

PROVIDER: S-EPMC7059310 | biostudies-literature | 2020 Mar

REPOSITORIES: biostudies-literature

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The imperative of evidence-based health workforce planning and implementation: lessons from nurses and midwives unemployment crisis in Ghana.

Asamani James Avoka JA Amertil Ninon P NP Ismaila Hamza H Akugri Francis Abande FA Nabyonga-Orem Juliet J

Human resources for health 20200306 1

Following periods of health workforce crisis characterised by a severe shortage of nurses, midwives and doctors due to low production rates and excessive out-migration, the Government of Ghana through the Ministry of Health (MOH) responded by expanding training and allowing private sector involvement in the training of health workers especially nurses and midwives. This resulted in substantial increases in the production levels of nurses and midwives even above the projections of the MOH. In thi ...[more]

PMID: 32143724

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Project description:BackgroundImplementation of evidence-based practice in clinical practice is crucial. Nurses and midwives play a vital role in using updated evidence. However, limited support and barriers to implementing evidence-based practice hamper the use of up-to-date evidence in clinical decision-making practice. Therefore, this study aimed to explore the implementation of evidence-based practice of nurses and midwives working in public hospitals.MethodsA qualitative descriptive study was conducted to explore the experience of implementing evidence-based practice among nurses and midwives working in public hospitals. A total of 86 participants, of which, 25 in-depth interviews, 5 FGDs having 47 participants and 14 participants were involved during observations, were considered in Amhara Region public hospitals from November 17, 2019 to April 25, 2020. The observational data, interview and FGD transcripts were imported into NVivo 12 plus to manage and analyze the data using the Computer-Assisted Data Analysis Software Program (CAQDAS). The data were analyzed through thematic content analysis.ResultsNurses and midwives perceived that implementation of evidence-based practice is the use of research findings, guidelines, hospital protocols, books, and expert experience in clinical decision-making practice. However, there was limited support for the implementation of evidence-based practice by nurses and midwives. The lack of knowledge and skill to use evidence like research findings, time mismanagement, the lack of motivation, the lack of resources and training were the perceived barriers to the implementation of evidence-based practice. Stick to the traditional practice due to lack of incentive and unclear job description between diploma and BSc nurses and midwives were the perceived causes of the lack of motivation.ConclusionsThe experience of evidence-based practice of nurses and midwives indicated that there was limited support for the implementation of evidence-based practice. However, research findings were rarely used in clinical decision-making practice The Knowledge, attitude towards implementing evidence-based practice, lack of resources and training, time mismanagement and lack of motivation were the barriers to the implementation of evidence-based practice. Therefore, the promotion of adopting the implementation of evidence-based practice and training on the identified barriers are mandatory.

Project description:BackgroundThis study was a retrospective evaluation of an unsuccessfully implemented team-based, chronic disease management program, with an aim to understand more about implementation barriers. The program, the Chronic Disease Management Initiative (CDMI) was a new collaborative model of care for patients with COPD. It utilized customized health information and interactive tools, mainly smartphones, for ongoing disease management. The program's goal was to demonstrate that integrated team-based models of care could improve patient care, as well as reduce readmission rates and emergency department visits. The program planning for CDMI began in 2017, followed by the implementation and evaluation period in 2018. After a 10-month implementation period, the program was unable to enroll a sufficient number of patients to examine if there was an improvement in patient outcomes.MethodsA retrospective case-study design using multiple data sources was used to gather feedback from participants involved in CDMI. Data collection occurred throughout planning and implementation and continued into early 2019. Semi-structured interviews were conducted, and transcripts were analyzed using NVivo 10 software. This was followed by content analysis.ResultsAnalysis revealed four key themes as barriers to CDMI's implementation: 1) lack of a needs assessment with key stakeholders; 2) lack of buy-in from medical staff; 3) inadequate patient engagement and; 4) contextual barriers. Planners did not conduct a proper needs assessment, nor include patients in the study design. In addition, there was insufficient consideration for how CDMI should be integrated into the usual COPD care plan, leading to confusion in roles and responsibilities. Poor communication between the implementation team and healthcare providers implementing the program, led to a lack of buy-in and engagement.ConclusionThe key themes resonate with what is already known in the literature. This study supports the importance of using a theoretically grounded plan for implementation. Using a model only in the planning stages is insufficient even when an intervention is based on evidence to support higher quality care. It is imperative to consider practical and contextual factors of program implementation and their interactions. By detailing the 'failed implementation' of this intervention, we hope to share important lessons about the need to plan implementation processes early in program planning.

Project description:BackgroundDespite tremendous health workforce efforts which have resulted in increases in the density of physicians, nurses and midwives from 1.07 per 1000 population in 2005 to 2.65 per 1000 population in 2017, Ghana continues to face shortages of health workforce alongside inefficient distribution. The Ministry of Health and its agencies in Ghana used the Workload Indicators of Staffing Needs (WISN) approach to develop staffing norms and standards for all health facilities, which is being used as an operational planning tool for equitable health workforce distribution. Using the nationally agreed staffing norms and standards, the aim of this paper is to quantify the inequitable distribution of health workforce and the associated cost implications. It also reports on how the findings are being used to shape health workforce policy, planning and management.MethodsWe conducted a health workforce gap analysis for all health facilities of the Ghana Health Service in 2018 in which we compared a nationally agreed evidence-based staffing standard with the prevailing staffing situation to identify need-based gaps and inequitable distribution. The cost of the prevailing staffing levels was also compared with the stipulated standard, and the staffing cost related to inequitable distribution was estimated.ResultsIt was found that the Ghana Health Service needed 105,440 health workers to meet its minimum staffing requirements as at May 2018 vis-à-vis its prevailing staff at post of 61,756 thereby leaving unfilled vacancies of 47,758 (a vacancy rate of 41%) albeit significant variations across geographical regions, levels of service and occupational groups. Of note, the crude equity index showed that in aggregate, the best-staffed region was 2.17 times better off than the worst-staffed region. The estimated cost (comprising basic salaries, market premium and other allowances paid from central government) of meeting the minimum staffing requirements was estimated to be GH¢2,358,346,472 (US$521,758,069) while the current cost of staff at post was GH¢1,424,331,400 (US$315,117,566.37), resulting in a net budgetary deficit of 57% (~ US$295.4 million) to meet the minimum requirement of staffing for primary and secondary health services. Whilst the prevailing staffing expenditure was generally below the required levels, an average of 28% (range 14-50%) across the levels of primary and secondary healthcare was spent on staff deemed to have been inequitably distributed, thus providing scope for rationalisation. We estimate that the net budgetary deficit of meeting the minimum staffing requirement could be drastically reduced by some 30% just by redistributing the inequitably distributed staff.Policy implicationsEfficiency gains could be made by redistributing the 14,142 staff deemed to be inequitably distributed, thereby narrowing the existing staffing gaps by 30% to 33,616, which could, in turn, be filled by leveraging synergistic strategy of task-sharing and/or new recruitments. The results of the analysis provided insights that have shaped and continue to influence important policy decisions in health workforce planning and management in the Ghana Health Service.

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The imperative of evidence-based health workforce planning and implementation: lessons from nurses and midwives unemployment crisis in Ghana.

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The imperative of evidence-based health workforce planning and implementation: lessons from nurses and midwives unemployment crisis in Ghana.

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