Workload Indicators of Staffing Need: A key tool for health workforce planning and management

On an early morning at Rwamagana Hospital in Rwanda’s Eastern Province, patients began to fill the busy outpatient department. As health workers started receiving patients, Beatrice Uzamukunda rushed in with her daughter, Esther. “My baby was very ill with a very high temperature. I was so worried that I had almost lost hope as we approached the facility,” says Beatrice.

The situation required urgent attention, and the staff immediately hospitalized and began attending to the toddler. “We were well received at the emergency department when we arrived. Esther is already showing signs of improvement, and I am grateful for the quick attention by the team of health care providers,” she says.

For Beatrice and many others who seek health services at Rwamagana Hospital, access to timely health care is essential—and sometimes, a matter of life or death.

As Rwanda continues to increase access to health care, the availability of human resources for health in the right quantity, quality, and location to respond to the population’s health needs and demands is among the Government’s key priorities.

Rwamagana Hospital is one of several facilities in Rwanda that has adopted the Workload Indicators of Staffing Need (WISN) application, a tool developed by the World Health Organization (WHO) to help health managers more accurately allocate staff according to service or departmental staffing needs, resulting in reduced patient waiting time and increased customer satisfaction.

“Before the introduction of WISN, we frequently sent enormous staffing requests to the Ministry of Health [MoH]. But often, recruitment would not be authorized because of the lack of clear evidence that additional staff were actually needed,” explains Justin Nkurunziza, human resources specialist at Rwamagana Hospital. In 2014, with the support of WHO and MSH through the USAID-funded Integrated Health Systems Strengthening Project (IHSSP), the MoH introduced WISN in Kibungo and Rwamagana hospitals in the Eastern Province.

Using WISN, managers systematically define each cadre’s service and support activities and the amount of time needed to perform each. Based on this information and on the average number of clients who visit the hospital daily, they then calculate the required number of staff per cadre to adequately deliver quality health services in each department.

Fidel Amedee Ndibaza, a data manager at Rwamagana Hospital, says that the WISN software not only provides an evidence-based approach to staff recruitment but also motivates staff to document their work. “Service delivery can only be improved if staff accurately record their workload, and managers take decisions based on that information. Department teams have now learned that without accurate recorded data of their work, it is impossible to determine rigorously whether the staffing levels meet the actual workload,” he says.

WISN is also well utilized in Kibungo Referral Hospital in Ngoma district, which serves a population of more than 370,000 and is among the top-performing hospitals in the country. “With WISN, we have been able to know what the gaps are and fill them. In some departments we still need staff, but we will solve the issues,” says Dr. William Namanya, Director General of Kibungo Hospital.

Based on the clear benefits demonstrated, the MoH has introduced the tool to other hospitals throughout the country. The successful application of WISN requires skilled personnel and consistent technical support and training to ensure sustainability, and the USAID-funded Rwanda Health Systems Strengthening (RHSS) Project worked with the MoH to implement the tool in each of Rwanda’s public district hospitals. A more accurate understanding of staffing needs will ensure that when clients such as Uzamukunda and her daughter arrive at the health facility, health workers are there to meet them with timely, high-quality, and lifesaving care.