Modelling primary health care workforce needs towards health professions education and employment investment planning in Ghana

Abstract

The health workforce is a critical part of developing responsive health systems that address routine population health needs and responding to health emergencies. However, defective planning has resulted in underinvestment and a looming shortage of about 18 million health workers globally. The empirical literature demonstrates substantial lacunae in existing health workforce planning models. Most models focus on one side of either supply or number needed, and even where there is an attempt to integrate them, the need component is often not linked to the population’s need for health services. The need-based framework combines the population’s health status, planned or otherwise necessary services, and professional standards of service delivery to estimate the health workers needed for a given population. Despite its intuitive appeal, several methodological gaps, and lack of open-access tools, have limited its use for planning in most countries, including Ghana. To address this gap and to contribute to knowledge in the field of health professions education, a need-based model for planning health professions education and employment in Ghana’s primary healthcare context was developed and empirically applied. Leaning on the pragmatic research paradigm, this study adopted a sequential multi-method approach. In the first phase, this study conducted a systematic scoping review of empirical applications of the needbased health workforce planning approach to identify the key methodological gaps, from which six critical methodological considerations were synthesised. The second phase involved model development. Building on the synthesised evidence, a conceptual and empirical comprehensive need-based health workforce model was developed with an accompanying open-access Microsoft® Excel-based model. In the third phase, a cross-sectional survey was conducted amongst a nationally representative sample of health professionals to establish professional standards of service delivery (which is a proxy measure of productivity) that would be incorporated into the need-based analysis. In the final phase, data was triangulated from multiple sources to systematically apply the model to forecast the needs and supply of 11 health professionals in Ghana’s primary health care context. The model application showed a significant gap between the needs of the population and that of the supply of health care professionals in Ghana. The needbased shortage was 73,203 health professionals across 11 professions, which could reach 161,502 health professionals by 2035. Regarding education and employment of health professionals for primary health care in Ghana, averting an existing 33% shortage would require, among others, increasing the intake of pharmacy technicians by 7.5-fold, general practitioners by 100%, and general nurses by 55%, whilst scaling down that of midwives by 15%. At least US$480.39 million investments from both the public and private sectors would be required in health professions education while planning for US$1.762 billion per annum (up to US$2.374 billion in 2035) in terms of the wage bill to maintain jobs and employ those to be trained. Linking the population’s health needs to health professions education curricula and testing the economic feasibility of the need-based health workforce estimates are areas that may warrant further research.