Realistic manpower planning for primary health care: practical considerations.

PIP: Adequate objective data for health manpower planning are often lacking, as are commonly accepted assumptions about the quantity or mix of health professionals and distribution patterns that will assure adequate and accessible care. Several methods can be used to estimate need and demand for health manpower, including: techniques using provider/population ratios, approaches based on professionally defined criteria, methods based on current, population specific utilization rates, and economic methods. A more efficient approach would be based on task analysis of needed jobs, where the provision of health care services is focused on utilizing the most appropriate health personnel. Although no single model for planning primary health care (PHC) programs has universal application, an approach which addresses common health care delivery problems would be beneficial. Problems face health planners in much of the developing world: lack of clear national health policy; shortages and maldistribution of manpower, facilities, equipment, supplies and finances; inadequate coverage; underutilization of services; inappropriate use of health education; insufficient community participation; inappropriate training systems; and inadequate attention to environmental sanitation. A service delivery model that has been effective in developing countries is based on new manpower configurations, relying on the services of mid-level and community health workers to increase the availability of care. New methods and technology for training these personnel are being developed. In planning the strengthening of a PHC program, adequate attention must be given to: analysis and projection of health needs and demand for services; enumeration of existing health workers and task analyses; estimation of future manpower needs and expected supply; assessment and strengthening of the manpower infrastructure; and regional utilization of resources. Based on the experiences of several PHC programs using a multitiered health manpower infrastructure, several suggestions are offered to facilitate the development and enhance the effectiveness of this type of program. Broad based support and national commitment is necessary to assure the program's significant and lasting impact. A positive operating framework must be created where workers are adequately compensated and accepted in the medical and local community. Community selection of workers is advised. Special attention must be given to management capability, including supervision and support. Doctors must be involved in developing training curricula, direct training, and supervision to secure their support for the program. Training programs must be problem oriented, reflecting task analyses and competency based. A modular program can allow curricular flexibility and be modified to address country specific needs. An additional advantage of a modular program, such as MEDEX, is the creation of a training and supervision interlock between the manpower levels and the multiplier effect of 1 person training several on the next tier, maximizing service expansion.^ieng