The provision of health services requires a sufficient number of well-trained health workers, but many countries currently face severe health workforce shortages. In the face of these gaps, it is important for governments to be able to allocate the health workers that they do employ to the areas where they are needed most.
Beginning in 2008, CHAI worked with the Ministry of Health (MOH) of Zambia to develop a demand-based workload model to determine the number of health workers required to meet demands for essential health services at public sector health facilities in Zambia. This model aimed to inform government decisions about how to optimally allocate health workers throughout the country. Between 2009 and 2011, the MOH added 949 health workers and increased staffing in districts with severe staffing shortages by 25%. Severe staffing shortages were defined as those districts that had fewer than one health worker per 1,000 people.
Following this enhancement of the health workforce in areas with severe need, the MOH wanted a better understanding of the benefits that these staffing changes had produced. In 2012, CHAI supported an analysis that used government data sources, such as payroll data and service delivery data reported from facilities, to investigate associations between changes in health worker staffing and changes in service delivery. At facilities that had had low staffing levels in 2009, adding a skilled provider was associated with an additional 103 outpatient consultations per quarter, which represents a 15% increase in services. In facilities with a high volume of ante-natal care visits, adding a skilled health worker was associated with a 10% increase in facility deliveries.
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