Workload indicators of staffing need (WISN): selected country implementation experiences

Overview

The Workload Indicators of Staffing Need (WISN) tool has been around since the 1990s and has been implemented in many countries since. The original Excel-based version was revised and computerized in 2010, making it more user friendly. Since the release of the computerized version, several countries have conducted WISN studies in varying scopes.

To date, however, there has been no consolidated effort to document the various processes undertaken, challenges faced and lessons learned. This publication attempts to document the experience of the World Health Organization (WHO) in building capacity and offering technical guidance to Member States. Though this document focuses mainly on four countries in the WHO African Region, there are many other countries not alluded to herein where WISN studies have been conducted.

The WISN tool has a methodology that can, if followed accurately, produce results that are evidence based and understood by all relevant stakeholders and partners in the country, with the ministry of health as the preferred lead institution. Implementation of the WISN tool is more likely to succeed when institutional leaders are involved in the steering process from the start. Thus, the briefing session that is conducted to enable policy-makers to make a final decision whether to proceed with WISN or not is important, as experience has shown that when this step is not properly carried out, the technical process that follows does not yield much fruit.

Capacity-building is an integral and crucial part of the WISN implementation strategy. An inclusive approach gives room to partners and other relevant stakeholders who have direct interest and involvement in the health workforce agenda, including trade unions, funding agencies and partners. Capacity-building should adopt a bottom-up, partnership-based approach. In most if not all cases, national capacitybuilding demands external support in the form of both financial and human resources. It is advisable that a country conducts a broad scoping exercise to develop a roadmap or operational plan indicating the main milestones of WISN, including allocation of responsibilities and a timeline for action. This roadmap is normally a shared responsibility between the ministry of health, WHO and funders.