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Table 2 Wastage monitoring framework

From: Wastage in the health workforce: some perspectives from African countries

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.