Table 1 Practicability of implementing each WISN technical step
No | Technical step | Practicability consensus | Key difficulties encountered |
|---|---|---|---|
1 | Determining priority cadres and health facility types | Very easy | Negotiating a feasible study scope |
2 | Estimating available working time (AWT) | Easy | Inadequate data on staff absences Actual AWT lower than that from WISN due to late coming and unofficial absenteeism |
3 | Defining workload components | Easy | Task-shifting and task sharing complicate the process Difficulty gaining consensus on which main workload components to include in the study |
4 | Setting activity standards | Easy | The process needs a lot of time Relying only on expert group discussions to set activity standards is subjective Due to task-shifting experts tend to set activity standards for what the staff are currently doing and not what they should be doing |
5 | Establishing standard workloads | Easy | None |
6 | Calculating allowance factors (CAF) | Easy with mid-point | Explaining the CAF concept is difficult and CAF formula is intimidating |
7 | Determining staff requirements | Easy | Poor data quality—missing, incomplete, or data not easily accessible Different data systems and reporting formats in every system Data collection process is time consuming Data entry into the software is labor intensive, since data are entered one facility at a time |
8 | Analyzing and interpreting WISN results | Easy | Ensuring results are accepted and implemented is difficult Lack of policy supporting use of WISN is a key barrier |