MMUST's Novel Health Workforce Analytics

lack of alternative tools and models to measure and improve service delivery among the majority vulnerable and under-served populations in public primary health facilities results in a huge challenge to all  health stakeholders. To make evidence-based decisions regarding the health and well-being of the people they serve health managers partners and Government require quality measurements tools and models that are easy to understand, data driven, dynamic, and can be used to track,monitor and evaluate the entire health systems performance. Consequently us a result of this lack,  Access and availability of quality, acceptable and safe health services is a daunting task  globally . However It is worse in low-income settings, Urban slums , Hard to reach rural areas and among vulnerable undeserved populations. In these settings, many patients go home unattended for lack of the service they need, and those who are attended receive  substandard and low quality service. Currently according to the world health organization about 1/2 of the the worlds population  has limited access to care when they need it. This limitation endangers their lives and expose them to complications which are very difficult and  expensive to manage. Eventually they may die in numbers. In Kenya Public Primary Health facilities where the majority  seek care are in deplorable condition. Many of the primary  facilities are more than five kilometers away with roads in deplorable state. Further the facilities have persistent shortages of health workers and therefore low staffing levels . The existing workforce in these facilities is demoralized and not motivated because they are overworked and least appreciated. For example over the last 10 years Workers unrest in Kenya become a norm other than an exception. Another issue of concern that affect the health systems performance is Workers absence from their work station. It is  a complex issue but common in many countries in Africa and  low income settings.In  some countries absence from duty  is almost at 50 percent as reported by intra-health . In addition many of these facilities do not have adequate basic infrastructure for service delivery. Also more often the facilities have inadequate essential Medicine including emergency drugs. Kenya's  health systems is devolved and the challenge of access and availability of basic health services appear to overwhelmed County Governments mandated by the constitution to operate the facilities. We are in agreement with the  world health organization observation and statement that there is no health without health workers. Workforce shortage affect access , quality and availability of health services and therefore measuring workforce performance is a good measure of the health systems performance. However Tools and workforce measuring and planning models are either lacking or inadequate. Conventional models like the fixed ratio staffing norms and standards though useful are inadequate to address the ever changing health needs and demands. Over the last 10 years the world health organization developed and published for use the workload indicator of staffing needs model to measure and support workforce planning. The model studies report it as a good indicator of effective and efficient workforce planning as well as the health systems performance.  However despite the progress made regarding workforce planning the world has alooming shortage of 18 million workers. The shortage is worse in Africa south of the Sahara involving 36 Countries because they can not raise the minimum threshold of 23 Health workers per 10000 population required to deliver access to 80 percent of maternal child health services. In addition the workforce is unequally allocated and inequitably distributed favouring secondary and tertiary care. Although primary health is recognize as the most effective and efficient approach to deliver essential health services to most of the population at low cost it has not achieved much in low income settings. Consequently universal health coverage and sustainable development goal of health and wellbeing for all seems unachievable. According to the world health organization (2016) strong primary care requires quality, easy to understand data to monitor and evaluate the health systems performance. Equally to track progress and improved performance assessment tools and models are required. Health Workforce planning suffers the most due to lack or inadequate data driven tools models and evidence required to support human resources for health investment. It is worse for decentralized (devolved) health systems because they lack capacity and financial resources to measure and support  workforce planning that is essential for the overall performance of the health system. The consequences of this is that it exacerbates the bad situation . Makes the working environment unconducive for the existing workforce and increases turnover. Increases workload which has a direct relationship with work pressure  increases the risk to occupation injuries, infection and mental anguish among other negative impacts to the workforce. Also medical errors increase thus endangering lives of clients and patients . Improper hazardous health care Waste disposal may also affect the environment endangering both people and animals . The costs and impacts of the negative outcomes is enormous . Therefore it is imperative that Governments and states understand the complex nature of the health systems , the difficulty in obtaining and measuring performance 

Our solution the Novel Health Workforce Analytics addresses the challenge by providing

1. A non-conventional health workforce planning model that does not use the usual fixed ratio staffing norms and standards method but instead it uses a workload based method  for it's analytics.

2.The model improves on the Who's Workload indicator of staffing needs model that has been in use for the last almost two decades

3 It leverages the existing health systems currently in use for example the district health information systems DHIS2 that measures performance using routine health service data

4 Provides accountability mechanism for all stake holders since it is people centered

5 Is people centered and places the worker and the client at the center and control of the whole operation

6 The model provide an all in one mean to measures , analyse, interpret workforce requirements for optimal health systems performance. provides data driven evidence for decision making by all health stake holders. It  also models solutions for access and availability of quality acceptable and safe health service delivery especially for the vulnerable and undeserved population including primary health. In addition we provide technical support capacity building and  means to track monitor and evaluate performance of the entire health system. Our analytics model is a novel health workforce measurement approach adopted from the WHO'S Workload indicator of staffing needs.The model  links the worker and the client/patient through workload. Available working time is calculated and together with Time motion observation of the time it takes a health worker to deliver service to a client is recorded. The two are then used to compute standard workload that is used to compute the required number of workers for the actual annual facility work load. Workers absence a major contributor to non availability of workers is addressed by automation where by workers bio-metrics are used to monitor their presence through clocking in and out. Automation and use of electronic medical records provides the health worker a tool to account for the use of their time and the service they provide . Also reports are generated real time thus saving time spent on some of the support services. The model can be used to inform training  institution a bout the community needs that are not met by the current curriculum. Also the model is used to identify tasks that do not require highly technical skills that can be transferred to other cadres after short training . The model places the worker and the patient at the center of the health action thus it's a people centered approach to health care. Several system can be Linked using workload as the anchor-the district health information systems (DHIS2) the electronic medical records and the WHO's international classification of diseases (ICD 11) . Overall our solution is versatile and can be used by most health stake holders to meet their specific requirements. The model has potential for upscaling for Global use with collaboration from the solve community

Our solution targets all health stake holders . Currently our target for a pilot is public primary health facilities in kakamega country  . There are about 50 health centers with a catchment population of 30,000 each. About 105 dispensaries with a catchment population of about 10,000. 443 community units with a catchment population of about 5,000 each. The population is served by about 2590 assorted cadres of health workers, Several partners and Government institution within kakamega County. The Care is provided majorly by these Government facilities . We  Provide data driven evidence to empower health managers and Government to make the right decision regarding the health workforce that supports Access, Availability , quality and safety health services. Health workers benefit since the working environment is improved through our modelling. Medical errors reduce and patients get the promised constitutional highest attainable health standard . Our objective is to support stake holders achieve universal health coverage and attain sustainable development goal of health and well-being for all ages and foster a good working environment that is equitable safe and enjoyable to all.our solution quantifies   

1) The Health standard to measure quality

 2) Workload to measure utilization and demand for health care

 3) Available working time to measure availability of the health worker.

 This makes it a precision science that can be used to bring efficiency and effectiveness to workforce planning including tracking of wastage. More benefits can be derived from the analytics and modelling if improved through collaboration with experts in analytics and artificial intelligence

This is a Front-line health workers initiative that seeks to answer the following questions 

1. Why is it difficult to access quality acceptable safe health service public Primary Health facilities

2. What can be done to improve the situation in the public health facilities 

3. How can it be  done 

4.Who is responsible for what health action

 Our team is made up of experienced Front-line health workers, professional experts, experience health managers and experienced researchers working both at the University and the Country Governments Department of Health Services. This is a research project for our team lead supported through mentorship  by university lecturers and fellow workers. The tools and the have been tasted and validated through a pilot . The model has a big potential for growth and scale up beyond Kenya. The tools and the model is a collaborative effort from clients/patients, Health workers Health managers from the county Government and the University to build capacity for the right decision regarding the community's health. Their input  is incorporated in the final tool for use in the projects analytics.

Working in primary public health facilities in Kenya is quite challenging because of a number of inadequacies :

1. The infrastructure is either lacking or inadequate requiring improvisation
2. Extremely low levels of staffing that compromise quality endangering both the patient and the workers.
3.  Many patients go home unattended risking complications and even death 
4. lack or Inadequate essential Medicine including emergency drugs make the working environment  difficult to work in 
5. No data-driven evidence to inform decision that affects patient and workers alike

The challenge will indeed help us improve the model and scale it up to web-based model software and mobile phone applications. Also, capacity building in Big data analytics and artificial intelligence can improve our capacity to scale up the model beyond Kenya. The University is in the process of strengthening its program of health information and informatics, therefore, collaboration with MIT solve through mentorship and fellowship programs will help in building the University's capacity to deliver its mandate of providing solutions to the society problems. Since this is a Master of public health project the challenge can help the University to set up a consultancy in health information systems and informatics.networking with other solvers will help improve the model 

Our solution adopts the WHO's workload indicator of staffing needs model and quantifies the qualitative measure of standard service to standard working rate and measure availability of the worker by calculating their available working time . Then using routine data from the District health information systems DHIS2 - standard workload is calculated. The analytics then calculates the required number of workers based on the facilities annual workload. and establishes between the health standard , workload  and available working time and how they affect one another in a mathematical equation that requires delicate balance. This approach provides answers as to how workload affects the standard and how available working time affects workload and the standard. Further it explains why we must have an optimal number of workers in order to maintain highest attainable health standards for health and we'll being. The model has a multiplier effect once adopted it will reduce medical errors , improve access to care and maintain quality . Overall it will improve the working environment for the worker reduce occupation health injuries, infection and improve mental health of the workforce . we intend to integrate our model with other existing models - dhis2 and the WHOs ICD 11 , the Kenya electronic medical record (KEMR) and the Government human resource management system (GHRIS)

Our solution has an impact on the way health services are provided . It explains the relationship between work load , available working time and the health standard and how they affect access availability quality acceptability and safety in health services provisions essentially it impacts every stake holder in one way or the other. For example health workers availability has a direct impact to availability of the health service provider this also influences access quality and safety in a mathematical expression of the workforce analytics

We will measure the impact using a blend of logical and logistic framework works. The following figures and tables will provide the illustration for progress tracking Monitoring and Evaluation. The framework looks at the process output outcome and then the impact. In addition, the logical framework provides the indicator and the means of verification .

What gets measured gets done

Our quantification of the usually qualitative service standard means that the standard can only be maintained if certain conditions are met one of those conditions is available working time and the required number of workers for the standard workload

These are actuarial for health worker's efficiency and effectiveness and can be measured by our analytics solution

Measuring health workforce performance is equivalent to measuring the health systems performance- Our analytics solution provides that and more.

Microsoft excel spreadsheet and formulas

Website based technology software and mobile phone applications

Our solution uses three sources of data 

1. Routine health service data that is mandatory for the essential health package for the country this data is uploaded to the district health information systems DHIS2 monthly

2. Primary data for the project is collected by the principal investigator and team through a) participatory observation 

b) Questionnaire and key informant interview

c) Desktop review of relevant official Government documents by the Principal investigator (pI) supported by research supervisors from the University

The motivation is to successfully complete the masters programs for the Principal investigator the MPH Candidate

Our team blends diversity inclusion and equity. It considers gender age and diversity of culture as our inclusive criteria

Our solution provides consultancy service and capacity building among all stakeholders- the community,Frontline health workers,health managers policy makers, partners training, and the Government in line with the world health organization guidelines for Global monitoring and evaluation of the health workforce through the national health workforce accounts (NHWA) 

As a subsidiary of a public university, the department of public health and the health  informatics program we will rely on the government grants and through sustained donations and grants to sell our services and provide service contracts to Government partners and private entities 

our solution is at the pilot level but projected to initial and scale in one year's time