|
Wastage monitoring framework |
||
| DIRECT WASTAGE |
||
|
|
||
| Factor |
Examples of contribution to wastage |
Possible indicators |
|
|
||
| Movement from health to non-health sector |
Probably small: 2 – 20 staff per year (Ghana. Mozambique, Namibia) |
% of job leavers exiting health work completely (exit interviews) |
| Emigration to health sector outside country |
10% of Mauritian nurses, 61% of Ghanaian doctors |
Certificate verification rates Routine leaving data, e.g. resignations |
| Deaths, injuries and premature removal from the workforce |
High significance of HIV/AIDS; Ghana 1.1% deaths compared with Malawi (<55%) of leavers |
Mortality rates as % of workforce leavers, or Mortality rate in workforce |
| Inappropriate Administrative systems and policies |
Affects other losses. Delays lose work input and may increase likelihood of emigration. |
Average recruitment duration Staff recruitment rate versus vacancies |
|
|
||
| INDIRECT WASTAGE |
||
|
|
||
| Wastage as unemployment |
Not well documented in Africa. Estimates of "ghost workers"? |
Unemployed health workers as % of total workforce (for each category) |
| Wastage as underemployment |
Data is not routinely collated but staff/workload indicators may help. |
Staff workload Indicators, e.g. outpatient and inpatient staff per cadre |
| Wastage as a misuse |
Significant in countries with senior medics and nurses as managers. |
% staff: technical or professional in full-time managerial/administrative function |
| Wastage as inappropriate categories |
4–6 categories to deliver package of services in Ghana. |
Workforce composition of skilled and semi-skilled staff |
| Absenteeism, low outputs |
2.3 days' sick leave per staff member versus 1.65 days off for all staff (Ghana) |
Number of days off per staff member, per annum. |
| Misdeployment and maldistribution |
Distribution differential: Doctors (Ghana): best 1:16201, worst 1:66071 |
Doctor/nurse population ratios in different parts of country. |
| Wastage from misadministration of HRH |
Difficult to assess quantitatively: e.g. 100% of new Lesotho nurses not recruited in 1998 |
Recruitment and retention rates of new graduates of health training schools. |
Dovlo Human Resources for Health 2005 3:6 doi:10.1186/1478-4491-3-6 |
||