Forecast of Healthcare Facilities and Health Workforce Requirements for the Public Sector in Ghana, 2016–2026

Document Type: Original Article

Authors

1 Human Resources Division, Ghana Health Service, Accra, Ghana

2 Health Economics Unit, University of Birmingham, Birmingham, UK

3 World Health Organization (WHO), Accra, Ghana

4 Ministry of Health, Accra, Ghana

Abstract

Background
Ghana is implementing activities towards universal health coverage (UHC) as well as the attainment of the health-related Sustainable Development Goals (SDGs) by the health sector by the year 2030. Aside lack of empirical forecast of the required healthcare facilities to achieve these mandates, health workforce deficits are also a major threat. We therefore modelled the needed healthcare facilities in Ghana and translated it into year-by-year staffing requirements based on established staffing standards.

 
Methods
Two levels of modelling were used. First, a predictive model based on Markov processes was used to estimate the future healthcare facilities needed in Ghana. Second, the projected healthcare facilities were translated into aggregate staffing requirements using staffing standards developed by Ghana’s Ministry of Health (MoH).

 
Results
The forecast shows a need to expand the number/capacity of healthcare facilities in order to attain UHC. All things being equal, the requisite healthcare infrastructure for UHC would be attainable from 2023. The forecast also shows wide variations in staffing-need-availability rate, ranging from 15% to 94% (average being 68%) across the various staff types. Thus, there are serious shortages of staff which are worse amongst specialists.

 
Conclusion
Ghana needs to expand and/or increase the number of healthcare facilities to facilitate the attainment of UHC. Also, only about 68% of the health workforce (HWF) requirements are employed and available for service delivery, leaving serious shortages of the essential health professionals. Immediate recruitment of unemployed but qualified health workers is therefore imperative. Also, addressing health worker productivity, equitable distribution of existing workers, and attrition may be the immediate steps to take whilst a long-term commitment to comprehensively address HWF challenges, including recruitments, expansion and streamlining of HWF training, is pursued.

Highlights

Supplementary File 1 (Download)

Keywords

Main Subjects


  1. Nino FS. Sustainable development goals - United Nations. United Nations Sustainable Development. http://www.un.org/sustainabledevelopment/sustainable-development-goals/. Published 2015. Accessed July 9, 2016.
  2. Lopes MA, Almeida AS, Almada-Lobo B. Handling healthcare workforce planning with care: where do we stand? Hum Resour Health. 2015;13:38. doi:10.1186/s12960-015-0028-0
  3. World Health Organization. Global Strategy on Human Resources for Health: Workforce 2030. Geneva: World Health Organization; 2016.
  4. O'Brien-Pallas L, Baumann A, Donner G, Murphy GT, Lochhaas-Gerlach J, Luba M. Forecasting models for human resources in health care. J Adv Nurs. 2001;33(1):120-129.
  5. Hornby P, Ray DK, Shipp PJ, Hall TL. Guidelines for health manpower planning: a course book. Geneva, Switzerland: World Health Organization; 1980.
  6. Sharma K, Zodpey SP, Gaidhane A, Quazi SZ. Methodological issues in estimating and forecasting health manpower requirement. J Public Adm Policy Res. 2014;6(2):25-33. doi:10.5897/JPAPR2011.067
  7. Kolehmainen-Aitken RL. Human resources planning: issues and methods. Data for Decision Making Project, Department of Population and International Health, Harvard School of Public Health; 1993. http://www.harvardschoolofpublichealth.com/ihsg/publications/pdf/No-1.PDF. Accessed June 3, 2016.
  8. Roberfroid D, Leonard C, Stordeur S. Physician supply forecast: better than peering in a crystal ball? Hum Resour Health. 2009;7:10. doi:10.1186/1478-4491-7-10
  9. Chilvers R. Planning Framework for Human Resources for Health for Maternal and Newborn Care. London School of Hygiene & Tropical Medicine; 2014.
  10. Wichit Srisuphan RN, Sirikanokwilai N. Supply and Requirement Projection of Professional Nurses in Thailand over the Next Two Decades (1995-2015 AD). http://www.who.int/entity/hrh/en/HRDJ_2_3_05.pdf?ua=1. Published 1995. Accessed June 23, 2016.
  11. Hall TL, Mejia A. Health manpower planning: principles, methods, issues. Geneva: World Health Organization; 1978.
  12. Fakhri A, Seyedin H, Daviaud E. A Combined Approach for Estimating Health Staff Requirements. Iran J Public Health. 2014;43(1):107-115.
  13. Labelle R, Stoddart G, Rice T. A re-examination of the meaning and importance of supplier-induced demand. J Health Econ. 1994;13(3):347-368. doi:10.1016/0167-6296(94)90036-1
  14. Ministry of Health. National Community-Based Health Planning and Services (CHPS) Policy: Accelerating attainment of Universal Health Coverage and bridging the access inequity gap. Ghana: Ministry of Health; 2015.
  15. Ministry of Health. The Health Sector Medium-Term Development Plan, 2014 -2017. Ghana: Ministry of Health; 2014.
  16. Ministry of Health. National Health Policy: Creating Wealth Through Health. Ghana: Ministry of Health; 2007.
  17. Saleh K. The Health Sector in Ghana: A Comprehensive Assessment. Washington, DC: World Bank Publications; 2013.
  18. World Health Organization. Equitable Access to Functional Health Workforce and Community Health Workers in the Africa Region [Internet]. Windhoek, Namibia: WHO Regional Forum on Strengthening Health Systems for the SDGs and UHC; 2016. http://www.afro.who.int/index.
  19. African Health Workforce Observatory. Human Resources for Health Country Profile. Ghana: African Health Workforce Observatory; 2010.
  20. Asamani JA, Naab F, Ansah-Ofei AM. Leadership styles in nursing management: implications for staff outcomes. J Health Sci. 2016;6(1):23-36. doi:10.17532/jhsci.2016.266
  21. Scheffler RM, Mahoney CB, Fulton BD, Dal Poz MR, Preker AS. Estimates of health care professional shortages in sub-Saharan Africa by 2015. Health Aff (Millwood). 2009;28(5):w849-862. doi:10.1377/hlthaff.28.5.w849
  22. Ministry of Health. Holistic Assessment of the Health Sector Programme of Work 2015. Accra: Ministry of Health, Ghana; 2016.
  23. Ministry of Health. Health Sector Holistic Assessment of the Health Sector Performance - 2015. Ghana; Ministry of Health; 2016.
  24. Ministry of Health. Holistic Assessment of the Health Sector Programme of Work 2013. Accra: Ministry of Health, Ghana; 2014.
  25. Ministry of Health. National Assessment for Emergency Obstetric and Newborn Care. Ghana: Ministry of Health; 2011.
  26. Ministry of Health. Staffing Norms for the Health Sector of Ghana (Volume 1). Ghana: Ministry of Health; 2015.
  27. World Health Organization. Workload Indicators of Staffing Need (WISN): Selected Country Implementation Experiences. Human Resources for Health Observer Series. 2016. http://apps.who.int/iris/bitstream/10665/205943/1/9789241510059_eng.pdf. Accessed June 12, 2016.
  28. Barton P, Bryan S, Robinson S. Modelling in the economic evaluation of health care: selecting the appropriate approach. J Health Serv Res Policy. 2004;9(2):110-118. doi:10.1258/135581904322987535
  29. Briggs A, Sculpher M, Claxton K. Decision Modelling for Health Economic Evaluation. Oxford: Oxford University Press; 2006.
  30. Ghana Health Service. Ghana Health Service Strategic Plan 2015 -2025 (Final Draft). Ghana Health Service; 2016.
  31. Ministry of Health. District Health Information System 2. Centre for Health Information Management (CHIM) -Ministry of Health; 2016. https://dhims.chimgh.org/dhims/dhis-web-commons/security/login.action.  Accessed May 25, 2016.
  32. Barton P. Modelling for Health Economics. University of Birmingham; 2016.
  33. Drummond MF, Sculpher MJ, Torrance GW, Stoddart GL. Methods for the Economic Evaluation of Health Care Programmes. 4th ed. Oxford: Oxford University Press; 2015.
  34. Ghana Health Service. Annual Report - 2015. Accra: Ghana Health Service; 2016.
  35. Ministry of Finance. The Budget Statement and Economic Policy of the Government of Ghana for the 2016 Financial Year Presented to Parliament. Government of Ghana: Ministry of Finance; 2015.
  36. McPake B, Scott A, Edoka I. Analyzing Markets for Health Workers: Insights from Labor and Health Economics. Washington, DC: The World Bank; 2014.
  37. Savelli S, Joslyn S. The Advantages of Predictive Interval Forecasts for Non-Expert Users and the Impact of Visualizations. Appl Cogn Psychol. 2013;27(4):527-541. doi:10.1002/acp.2932
  38. Kieny MP, Evans DB. Universal health coverage. East Mediterr Health J. 2013;19(4):305-306.
  39. Garshong B, Akazili J. Universal Health Coverage Assessment Ghana. http://funsalud.org.mx/gnhe/Documentos/UHCDay/GNHE%20UHC%20assessment_Ghana.pdf. Published 2015. Accessed August 3, 2016.
  40. World Health Organization. The Abuja declaration: ten years on. Geneva: World Health Organization. 2011;53.
  41. Ministry of Health. End-Year Report on the Budget Statement and Economic Policy of the Republic of Ghana for The 2015 Financial Year. Government of Ghana: Ministry of Health; 2016.
  42. Ministry of Health. Capital Investment Report. In Holistic Assement of Annual Programme of Work - 2015. Ghana: Ministry of Health; 2016.
  43. Ministry of Health. Human Resource Policies and Strategies for the Health Sector, 2007-2011. Ghana: Ministry of Health; 2007.
  44. Appiah-Denkyira E, Herbst CH. Towards Interventions in Human Resources for Health in Ghana: Evidence for Health Workforce Planning and Results. Washington, DC: World Bank; 2013.
  45. Cherry B, Jacob SR. Contemporary Nursing: Issues, Trends & Management. 4th ed. St. Louis: Mosby Elsevier; 2008.
  46. Barber P, Lopez-Valcarcel BG. Forecasting the need for medical specialists in Spain: application of a system dynamics model. Hum Resour Health. 2010;8:24. doi:10.1186/1478-4491-8-24
  47. Mitka M. Looming shortage of physicians raises concerns about access to care. JAMA. 2007;297(10):1045-1046. doi:10.1001/jama.297.10.1045
  48. Suwannakij T, Sirikanokwilai N, Wibulpolprasert S. Supply projection for physician in Thailand over the next 25 years (1996-2020 AD). Hum Resour Health. 1998;2:117-128.
  49. Ferrinho P, Siziya S, Goma F, Dussault G. The human resource for health situation in Zambia: deficit and maldistribution. Hum Resour Health. 2011;9:30. doi:10.1186/1478-4491-9-30
  50. Addai E, Bosomprah S. Health Workforce Productivity. Accra: Present Ministry of Health; 2007.
  51. Asabir K, Witter S, Herbst CH, Dedzo KM. The Performance of Health Workers. In: Appiah-Denkyira E, Herbst CH, eds. Towards Interventions in Human Resources for Health in Ghana: Evidence for Health Workforce Planning and Results. Washington, DC: World Bank; 2013.
  52. Birch S, Kephart G, Tomblin-Murphy G, O'Brien-Pallas L, Alder R, MacKenzie A. Human Resources Planning and the Production of Health: A Needs-Based Analytical Framework. Can Public Policy. 2007;33(1 Suppl ):S1-16. doi:10.3138/9R62-Q0V1-L188-1406
  53. Amporfu E. Private hospital accreditation and inducement of care under the Ghanaian national insurance scheme. Health Econ Rev. 2011;1(1):13. doi:10.1186/2191-1991-1-13