New York University School of Medicine, 180 Madison Avenue, 8th Floor, New York, NY, 10016, USA.
Temple University School of Medicine, 3500 N Broad St, Philadelphia, PA, 19140, USA.
Hum Resour Health. 2019 Jul 16;17(1):57. doi: 10.1186/s12960-019-0389-x.
Elevated blood pressure is the leading risk for mortality in the world. Task redistribution has been shown to be efficacious for hypertension management in low- and middle-income countries. However, the workforce requirements for such a task redistribution strategy are largely unknown. Therefore, we developed a needs-based workforce estimation model for hypertension management in western Kenya, using need and capacity as inputs.
Key informant interviews, focus group discussions, a Delphi exercise, and time-motion studies were conducted among administrative leadership, clinicians, patients, community leaders, and experts in hypertension management. These results were triangulated to generate the best estimates for the inputs into the health workforce model. The local hypertension clinical protocol was used to derive a schedule of encounters with different levels of clinician and health facility staff. A Microsoft Excel-based spreadsheet was developed to enter the inputs and generate the full-time equivalent workforce requirement estimates over 3 years.
Two different scenarios were modeled: (1) "ramp-up" (increasing growth of patients each year) and (2) "steady state" (constant rate of patient enrollment each month). The ramp-up scenario estimated cumulative enrollment of 7000 patients by year 3, and an average clinical encounter time of 8.9 min, yielding nurse full-time equivalent requirements of 4.8, 13.5, and 30.2 in years 1, 2, and 3, respectively. In contrast, the steady-state scenario assumed a constant monthly enrollment of 100 patients and yielded nurse full-time equivalent requirements of 5.8, 10.5, and 14.3 over the same time period.
A needs-based workforce estimation model yielded health worker full-time equivalent estimates required for hypertension management in western Kenya. The model is able to provide workforce projections that are useful for program planning, human resource allocation, and policy formulation. This approach can serve as a benchmark for chronic disease management programs in low-resource settings worldwide.
高血压是全球导致死亡的主要风险因素。任务重新分配已被证明对中低收入国家的高血压管理有效。然而，这种任务重新分配策略所需的劳动力数量在很大程度上是未知的。因此，我们使用需求和能力作为投入，为肯尼亚西部的高血压管理开发了一种基于需求的劳动力估计模型。
在行政领导层、临床医生、患者、社区领导和高血压管理专家中进行了关键信息人员访谈、焦点小组讨论、德尔菲法和时间运动研究。这些结果被三角剖分，以生成投入到卫生人力模型的最佳估计。当地的高血压临床方案用于得出与不同级别的临床医生和卫生机构工作人员的不同接触次数的时间表。使用 Microsoft Excel 电子表格开发了一个输入的电子表格，以生成未来 3 年内的全职等效劳动力需求估计。
两种不同的方案进行了建模：（1）“逐步增加”（每年增加患者的增长率）和（2）“稳定状态”（每月患者入组率恒定）。逐步增加方案估计第 3 年累计入组 7000 名患者，平均临床接触时间为 8.9 分钟，分别在第 1、2 和 3 年需要护士全职等效需求分别为 4.8、13.5 和 30.2。相比之下，稳定状态方案假设每月有 100 名患者恒定入组，在同一时期内需要护士全职等效需求分别为 5.8、10.5 和 14.3。
基于需求的劳动力估计模型得出了肯尼亚西部高血压管理所需的卫生工作者全职等效估计数。该模型能够提供对规划、人力资源分配和政策制定有用的劳动力预测。这种方法可以作为全球资源匮乏环境中慢性病管理计划的基准。
