Workload Indicators of Staffing Need (WISN) User Manual, 2nd edition
Overview
The health workforce is the fulcrum on which health system performance relies. Human resources for health (HRH) is crucial to affordable, accessible and high-quality health services. The ability of a country to meet its health commitments and goals largely depends on the number, skills, competencies and availability of health workers, and on whether those workers are organized and equitably distributed to deliver integrated, people-centred health services. The health workforce is essential towards achieving universal health coverage and the Sustainable Development Goals (SDGs) (1), especially Indicator 3.c.1, which relates to ”health workforce density and distribution” and improved data on HRH (2).
Health service managers around the world face increasing HRH challenges, such as:
- inadequate resources to respond to the populations’ demand for services;
- the distribution of human resources being generally poorly balanced between urban and rural areas, and between primary, secondary and tertiary levels of care;
- inefficiencies due to uncoordinated HRH practices from various stakeholders; and
- weak HRH coordination mechanisms and weak human resources for health information systems.
The Workload Indicators of Staffing Need (WISN) method is based on a health worker’s workload, with activity (time) standards applied for each workload component. This principle has long been used in business but was not employed in the health sector until the late 1990s, when the WISN method was field tested and used in several countries.
This manual is a revision of an earlier Workload Indicators of Staffing Need (WISN) user manual, which was prepared by Peter Shipp and published by WHO in 1998 (3). The earlier manual focused on using the WISN method in a topdown manner, in which the administrative focal point was a country’s ministry of health. Through a decade of implementation and its documentation, some limitations and several ways to apply the approach in different settings became evident. By 2008, it was felt that the approach should be reviewed and updated and the second version was developed in 2010.
The second review of this manual, in 2010, had a particular focus on health service planning and management. Since that time, many changes in health services and their governance have taken place. This revised manual takes into account both the centralized and decentralized nature of health management and offers real experiences from countries that have implemented WISN. It also captures workforce planning during the coronavirus disease (COVID-19) pandemic and the strains that puts on health systems. Accordingly, this manual has been further revised in 2021 to include these scenarios. It is intended for the wide range of managers working in today’s health systems. Additionally, the manual addresses the many uses of WISN that can contribute to expanding HRH efforts within a country
