Staffing and Workload in Primary Care Facilities of Selected Geographically Isolated and Disadvantaged Communities in the Philippines

Abstract

Background and Objective. Staffing shortages and health inequities are persistent barriers in the Philippines toward achieving universal health care. To ensure an adequate and responsive health workforce, there is a need to evaluate the Human Resources for Health (HRH) status across health facilities, particularly those in underserved communities. Hence, this study aims to determine the staffing requirements and workload pressure among primary care facilities in selected geographically isolated and disadvantaged areas (GIDAs) in the Philippines.

Methods. The study utilized the workload indicators of staffing need (WISN) methodology from the World Health Organization to determine the staffing and workload situation among three health worker cadres (physicians, nurses, and midwives) in the study sites. Particularly, six primary care facilities (four rural health units and two community hospitals) located in Surigao del Norte were involved in the study. WISN-related data (health service statistics, available working time, and health professionals’ workload components) were collected through records review, focus group discussions, and key informant interviews. The WISN software was used to analyze the staffing levels and workload pressure in the selected facilities.

Results. A total of 40 health workers, including physicians (n = 5, 13%), nurses (n = 21, 52%), and midwives (n =
14, 35%) participated in the study. The findings noted varying levels of staffing and workload pressures among
the three cadres in selected primary care facilities, which were influenced by several factors. Particularly, health
facilities with additional human resources obtained from deployment programs indicated adequate staffing
and low to normal workload pressures. However, further analysis revealed potential HRH maldistribution
and reliance on the temporary nature of the staff augmentation program in delivering primary care services, which need to be addressed to optimize health workforce planning. Service workload may also have been impacted by the temporary closure of health facilities due to disasters. Among the few cadres tha reported staffing shortage and high workload pressure, these were due to higher service demands, increased task delegation, and inadequate service coordination. Hence, context-specific challenges and situational factors in GIDAs need to be considered when determining the staffing and workload requirements.

Conclusion. There is a need to improve the capacities of health facilities and local government units (LGUs)
to engage in evidence-based HRH planning through the WISN methodology. Doing so could improve staffing and workload distribution among health care facilities in the country. Moreover, interorganizational collaboration (DOH, LGUs, and health facilities) should be strengthened to improve delineation and prevent
duplication/omission of health services, rationalize HRH distribution and augmentation, and streamline the
priority health services based on the local contextual factors.