Workload Indicators of Staffing Need (WISN) Methodology for Midwives Planning and Estimation at Asrade Zewude Memorial Primary Hospital, North west Ethiopia
Authors: Asres Gizew Dessie 
Published: May 2022

Abstract
Background: Work force is a crucial component of health services and health systems necessary to achieve Primary Health Care (PHC) and Universal Health Coverage (UHC). Ethiopia faces health workforce challenges with regard to evidence based health work force planning. Even though Ethiopia is constantly reforming its health system with the primary aim of having the right number of health workers in the right place at the right time to meet the population’s health needs, the health facilities in the country are staffed using perceived needs. The Workload Indicators of Staffing Need (WISN) tool developed by the World Health Organization is not used to determine staffing requirements for facilities. Rather the traditional method of health worker to population ratio is used instead. But the traditional method of staffing health workers does not satisfy the staffing need of the health facilities as well as the health service need of the community. Therefore this study was assumed for policy recommendation on the use of Workload methods of staffing need (WISN) for regional health bureau based on WISN results of midwives needed for Asrade zewude memorial Hospital north west Ethiopia.Methods: WISN model was used to determine the gaps or excess and workload pressure in midwives at Asrade Zewude Memorial primary hospital, north west Ethiopia. Midwives were selected as priority cadre based on current staffing problems. Available working time was determine using national calendar, personnel files and HR regulatory documents. Workload components of midwives were determined by establishing expert working group comprised of midwives hospital performance monitoring and evaluation unit staff and human resources management staff. Two hours detail training was given for expert working group using WHO WISN manual. The data that has been used by expert working group were; detail midwives job descriptions obtained from human resources management, annual service statistics obtained from hospital performance monitoring and evaluation unit and midwifery service activities and support activities were listed and explained by head of hospital midwifery service unit. We also cross check workload data from July 1, 2019–June 30, 2020 G.C for midwifery department using health service activity data of district health information system (DHS2)data base.Results: The WISN analysis showed that a shortage of five midwives with WISN ratio of 0.8 and high workload pressure among 20 midwives at Asrade Zewude Memorial primary hospital north west Ethiopia.Conclusion and Recommendation: This study showed that midwives at the study area were doing their routine work under high workload pressure by covering the additional five midwives' position. With this working condition, it may be hard to achieve primary health care (PHC) and universal health coverage (UHC). Therefore regional health bureau should institutionalize WISN method for staffing need to objectively employ five additional midwifery professionals so as to achieve health development goals set by the hospital.