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Abbreviations Abbreviations CPH Chinhoyi Provincial Hospital DMO District Medical officer GMO Government Medical Officer HMO Hospital Medical Officer HCH Harare Central Hospital HRH Human Resources for Health HSB Health Service Board HTF Health Transition Fund MoHCC Ministry of Health and Child Care OI Opportunistic Infections PCN Primary Care Nurse RGN Registered General Nurse SCN State Certified Nurse SHO Senior House Officer SRMO Senior Resident Medical Officer WHO World Health Organization WISN Workload Indicators of Staffing Needs UBH United Bulawayo Hospital ZIMASSET Zimbabwe Agenda for Sustainable Socio Economic Transformation Written and Compiled by: Bernard Nkala (Health Service Board) Bernard Gotora (Health Service Board) Funded by: GoZ i Acknowledgements The Health Service Board (HSB) and Ministry of Health and Child Care (MoHCC) would like to extend its gratitude and appreciation to all representatives of various organisations and individuals who made invaluable contributions before, during and after the implementation of WISN in Zimbabwe. We are grateful to the Health Development Fund and Treasury for funding the WISN Study in Zimbabwe. The study was successful owing to the technical expertise and guidance provided by WHO Country Office working with the Afro Regional Technical Team. The WISN in Zimbabwe would not have been a success without the guidance and direction of the Steering Committee for implementing the WISN study in Zimbabwe and the WISN Expert Work- ing Group who developed the data collection tools. The Technical Taskforce immensely contribut- ed in coming with the WISN results for the studied facilities. The contribution of Messrs Nkala Bernard and Gotora Bernard in writing this study report would not go unnoticed. The Board and the Ministry would like to thank all the stakeholders who contributed in coming up with study report. The WISN Expert Working Group The implementation of WISN study in Zimbabwe was coordinated in the following structures outlined in the table below. Technical experts Name Level of Support Dr. Adam Ahmat WHO AFRO Regional Technical Support Team Dr. Awases Magdalene WHO AFRO Regional Technical Support Team Mrs. Jennifer Nyoni WHO AFRO Regional Technical Support Team Dr. Stanley M. Midzi WHO Zimbabwe Country Office Dr. W. Okello WHO Zimbabwe Country Representative ii WISN Main Study Report 2017 WISN Expert Working Group appointed by Health Service Board Name Category Ebi Bukutu Nursing J. Banwa Radiography Bothwel Chafanza Nursing Chidziva Erica Clinical Scientist Chivese Panganayi Pharmacy Dr. Lilian Dodzo Midwife Dr. Mudavanhu Justice Doctors Gomo Vivian Clinical Scientist Kanyemba N. Regina Principal Nursing Tutor Kondowe Elen Nursing Kufakunesu Lilian Midwife Machingauta Bonfase Pharmacist Machokoto Unice PCN Madzikwa Newman Pharmacist Maguranyanga Elen Radiography Mashanda Curthbert Laboratory Scientist Matiyenga Diamond DNO Mudenge Boniface Laboratory Muyedziwa U. Radiography Professor Charles Maposa Pharmacy Samungure Stewart Nurse Tutor Siyame Ernet Nursing - Mental Health Zanga Admire Ultra Sonographer Zvavamwe Pegy Pharmacy Dr Makoni Doctor Kambarami Doctor iii The WISN Steering Committee Name Designation Station Ms. R. R. Kaseke Executive Director ( Core Chair) HSB Major General Dr. G. Gwinji (Rtd) Secretary for Health and Child Care ( Core Chair) MoHCC Mudyradima Robert Principal Director MoHCC Mothobi Muriel Registrar Nurses Council of Zimbabwe Mr. Mafa Simangaliso President Nurses Association Dr. Edwin Sibanda Assistant Director Bulawayo City Health Mr. Musungwini Enock Deputy Secretary General HPA Dr. Chasokela Cynthia Director Nursing Services MoHCC Dr. Mahomva Egnes President ZIMA Dr. Stanley Midzi WHO Focal Person WHO Dr. Gibson Mhlanga Principal Director MoHCC MR. Stanley Makarau Principal Director MoHCC The WISN Technical Taskforce Team Name Designation Station Zhou Nonah Nesu General Manager ( Core Chair) HSB Jane Mudyara Director Human Resources ( Core Chair) MoHCC Dr. Kuretu Admire Provincial maternal & Child Health officer Mashonaland East Mangeya Mirriam PNO Chitungwiza Central Hospital Shonge Jane Work Study Officer Harare City Health Nkala Bernard Deputy General Manager HSB Ivans Chingamuka IT Manager Parirenyatwa Hospital Bernard Gotora Human Resources Officer HSB Dr. Puggie Chimberengwa Medical Superintendent Gwanda Provincial Hospital Dr. Celestino Dhege Medical Superintendant Marondera Provincial Hospital Michael Matiyashe ICT Officer HITRAC Muposha Edward Human Resources Officer HSB Manwere Peggy Human Resources officer MoHCC Kudakwashe Sylivia Human resources Officer MoHCC iv WISN Main Study Report 2017 Abstract Human Resources for Health (HRH) are essential in improving access to quality Health Care hence countries need to continue prioritizing and scaled up such. There are many HRH planning tools that can be utilised by organizations and Workload Indicators of Staffing Need (WISN) is one of the tools that help to calculate staff requirements based on workload on cadres at facility level. In Zimbabwe, the Board and Ministry adopted WISN for the Health Sector in 2012 and received technical support from WHO to conduct main study focusing on the five staff categories namely; Doctors, Pharmacy, Nurses, Laboratory and Radiography. The main WISN study was conducted in 2016 – 2017 subsequent receiving funding from Health Development Fund and Treasury. The main objective of implementing WISN in the Ministry of Health and Child Care was to identify health facilities with staff shortages in relation to workload, determine how best to improve current staffing and to proffer recommendations in addressing HRH planning challenges for the public health sector. A total of 12 facilities were randomly selected amongst country’s 10 Districts and 9 provinces as a representative sample for all levels of care starting from Rural Health facility, District, Province and Central level facilities. The main study was directed by the Steering Committee co-chaired by the Board and the Ministry, the Technical Working Group that implemented the study and Expert Working Group that developed the data collection tools including setting activity standards for respective cadres that were studied. The WISN study results were validated by WHO AFRO Technical Experts taking cognisance of the local circumstances at which the health services were being delivered. The following are the study findings reflecting staff calculations based on WISN software. v Annexure 1: WISN result for Harare Central Hospital, Zimbabwe 2017 Cadre Authorized Staff WISN Required WISN Additional Establishment in post Calculated staff additional Ratio posts Requirement Staff Doctors Anaesthetist 4 5 25 20 0.20 21 Cardiothoracic Surgeon 3 0 1 1 0.00 ENT Surgeon 3 1 3 2 0.32 General Surgeon 4 5 11 6 0.45 7 Neuro Surgeon 1 0 1 1 0.00 Obstetrician and Gynaecologist 3 3 19 16 0.16 16 Ophthalmologist 3 1 6 5 0.17 3 Orthopaedic Surgeon 5 1 7 6 0.14 2 Paediatric Surgeon 0 1 6 5 0.17 6 Paediatrician 3 2 34 32 0.06 31 Physician 3 4 22 18 0.18 19 Pathologist 2 1 3 2 0.33 1 Psychiatrist 3 1 20 19 0.05 17 Urologist 3 0 10 10 0.00 7 Nursing Intensive Care Nurse 0 64 123 59 0.52 123 Mental Health Nurse 0 29 36 7 0.81 36 Midwife 0 234 294 60 0.80 294 Nurse Anaesthetist 0 8 17 9 0.47 17 Oncology Nurse 0 0 8 8 0.00 8 Operating Theater Nurse 0 95 88 -7 1.08 88 Ophthalmic Nurse 0 1 8 7 0.13 8 Paediatric Nurse 0 153 146 -7 1.05 146 Registered General Nurse 992 338 316 -22 1.07 Renal Nurse 0 11 4 -7 2.75 4 Laboratory 0 Medical Laboratory Scientist 46 22 50 28 0.44 4 SCMLT 11 11 38 27 0.29 27 Pharmarcy 0 Dispensary Assistant 6 6 11 5 0.55 5 Pharmacist 8 8 15 7 0.53 7 Pharmacy Technician 7 7 14 7 0.50 7 Radiography Diagnostic Radiographer 19 16 15 -1 1.07 Total 1129 1028 1351 323 0.76 222 vi WISN Main Study Report 2017 Annexure 2: WISN Results for United Bulawayo Hospital, Zimbabwe 2017 Cadre Authorized Staff WISN Required WISN Additional Establishment in post Calculated staff additional Ratio posts Requirement Staff Anaesthetist 3 1 8 7 0.13 5 Cardio-Thoracic Surgeon 1 0 1 1 0.00 ENT Surgeon 2 0 1 1 0.00 Hospital Medical Officer 40 68 30 38 2.27 General Surgeon 3 3 6 3 0.50 3 Neuro-Surgeon 1 0 1 1 0.00 Obstetricians and Gynaecologist 3 1 16 15 0.06 13 Ophthalmologist 1 2 9 7 0.22 8 Orthopaedic Surgeon 2 1 4 3 0.25 2 Paediatricians 3 0 5 5 0.00 2 Pathologist 3 3 3 0 1.00 Physician 3 2 8 6 0.25 5 Psychiatrist 0 0 3 3 0.00 3 Radiologist 3 0 1 1 0.00 Urologist 1 1 1 0 1.00 Nursing Intensive Care Nurse 29 40 11 0.73 40 Midwife 101 104 3 0.97 104 Nurse Anaesthetist 5 4 -1 1.25 4 Oncology Nurse 3 3 0 1.00 3 Operating Theater Nurse 37 25 -12 1.48 25 Ophthalmic Nurse 15 36 21 0.42 36 Psychiatric Nurse 0 4 4 0.00 4 Registered General Nurse 601 320 219 -101 1.46 Renal Nurse 0 1 1 0.00 1 Laboratory Medical Laboratory Scientist 23 6 7 1 0.86 SCMLT 10 4 5 1 0.80 Pharmarcy 0 Dispensary Assistant 6 5 5 0 1.00 Pharmacist 10 3 5 2 0.60 Pharmacy technician 10 8 13 5 0.62 3 Radiography Radiographer 9 9 9 0 1.00 Ultra-Sonographer 2 0 4 4 0.00 2 X-Ray Operator 4 3 1 -2 3.00 Total 744 630 582 -48 1.08 263 vii Annexure 3: WISN results for Masvingo Provincial Hospital, Zimbabwe 2017 Cadre Authorized Staff WISN Required WISN Additional Establishment in post Calculated staff additional Ratio posts Requirement Staff Doctors General Surgeon 1 1 2 1 0.50 1 Government Medical Officer 12 11 25 14 0.44 13 Obstetrician and Gynaecologist 1 0 3 3 0.00 2 Ophthalmologist 1 1 1 0 1.00 Anaesthetist 1 0 2 2 0.00 1 Nursing Intensive Care Nurse 9 13 4 0.69 13 Mental Health Nurse 3 5 2 0.60
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