Health systems standard in Human resources
Health services are provided by trained and competent health workforces
who have an adequate mix of knowledge and skills to meet the health needs of the population.
Review staffing levels and capacity as a key component of the baseline health assessment.
Address imbalances in the number of staff, their mix of skills and gender and/ or ethnic ratios where possible
Support local health workers and integrate them fully into health services, taking account of their competence
Ensure adequate ancillary workers for support functions in each health facility.
Train clinical staff in the use of clinical protocols and guidelines
Provide supportive supervision to staff on a regular basis to ensure their compliance with standards and guidelines, including provision of feedback.
Standardise training programmes and prioritise them according to key health needs and competence gaps.
Ensure fair and reliable remuneration for all health workers, agreed between all agencies and in collaboration with the national health authorities.
Ensure a safe working environment, including basic hygiene and protection for all health workers.
Key indicators
There are at least 22 qualified health workers (medical doctors, nurses and midwifes)/10,000 population
-- at least one medical doctor/50,000 population
-- at least one qualified nurse/10,000 population
-- at least one midwife/10,000 population.
There is at least one Community Health Worker (CHW)/1,000 population,one supervisor/10 home visitors and one senior supervisor.
There are at least 22 qualified health workers (medical doctors, nurses and midwifes)/10,000 population:
-- at least one medical doctor/50,000 population
-- at least one qualified nurse/10,000 population
-- at least one midwife/10,000 population.
There is at least one Community Health Worker (CHW)/1,000 population,one supervisor/10 home visitors and one senior supervisor.
Clinicians are not required to consult more than 50 patients a day consistently. If this threshold is regularly exceeded, additional clinical staff are
recruited (see guidance note 1 and Appendix 3: Formulas for calculating key health indicators).
Guidance notes
1. Staffing levels: The health workforce includes a wide range of health workers
including medical doctors, nurses, midwives, clinical officers or physician
assistants, lab technicians, pharmacists, CHWs, etc., as well as management
and support staff. There is no consensus about an optimal level of health
workers for a population and this can vary from context to context. However,
there is correlation between the availability of health workers and coverage
of health interventions. For example, the presence of just one female health
worker or one representative of a marginalised ethnic group on a staff may
significantly increase the access of women or people from minority groups
to health services. Imbalance in staffing must be addressed through the
redeployment and/or recruitment of health workers to areas where there are
critical gaps in relation to health needs
2. Training and supervision of staff: Health workers should have the proper
training, skills and supervisory support for their level of responsibility.
Agencies have an obligation to train and supervise staff to ensure that their
knowledge is up-to-date. Training and supervision will be high priorities
especially where staff have not received continuing education or where new
protocols are introduced. As far as possible, training programmes should
be standardised and prioritised according to key health needs and competence
gaps identified through supervision. Records should be maintained of
who has been trained in what by whom, when and where. These should be
shared with the human resource section of the local health authorities
Health services are provided by trained and competent health workforces
who have an adequate mix of knowledge and skills to meet the health needs of the population.
Review staffing levels and capacity as a key component of the baseline health assessment.
Address imbalances in the number of staff, their mix of skills and gender and/ or ethnic ratios where possible
Support local health workers and integrate them fully into health services, taking account of their competence
Ensure adequate ancillary workers for support functions in each health facility.
Train clinical staff in the use of clinical protocols and guidelines
Provide supportive supervision to staff on a regular basis to ensure their compliance with standards and guidelines, including provision of feedback.
Standardise training programmes and prioritise them according to key health needs and competence gaps.
Ensure fair and reliable remuneration for all health workers, agreed between all agencies and in collaboration with the national health authorities.
Ensure a safe working environment, including basic hygiene and protection for all health workers.
Key indicators
There are at least 22 qualified health workers (medical doctors, nurses and midwifes)/10,000 population
-- at least one medical doctor/50,000 population
-- at least one qualified nurse/10,000 population
-- at least one midwife/10,000 population.
There is at least one Community Health Worker (CHW)/1,000 population,one supervisor/10 home visitors and one senior supervisor.
There are at least 22 qualified health workers (medical doctors, nurses and midwifes)/10,000 population:
-- at least one medical doctor/50,000 population
-- at least one qualified nurse/10,000 population
-- at least one midwife/10,000 population.
There is at least one Community Health Worker (CHW)/1,000 population,one supervisor/10 home visitors and one senior supervisor.
Clinicians are not required to consult more than 50 patients a day consistently. If this threshold is regularly exceeded, additional clinical staff are
recruited (see guidance note 1 and Appendix 3: Formulas for calculating key health indicators).
Guidance notes
1. Staffing levels: The health workforce includes a wide range of health workers
including medical doctors, nurses, midwives, clinical officers or physician
assistants, lab technicians, pharmacists, CHWs, etc., as well as management
and support staff. There is no consensus about an optimal level of health
workers for a population and this can vary from context to context. However,
there is correlation between the availability of health workers and coverage
of health interventions. For example, the presence of just one female health
worker or one representative of a marginalised ethnic group on a staff may
significantly increase the access of women or people from minority groups
to health services. Imbalance in staffing must be addressed through the
redeployment and/or recruitment of health workers to areas where there are
critical gaps in relation to health needs
2. Training and supervision of staff: Health workers should have the proper
training, skills and supervisory support for their level of responsibility.
Agencies have an obligation to train and supervise staff to ensure that their
knowledge is up-to-date. Training and supervision will be high priorities
especially where staff have not received continuing education or where new
protocols are introduced. As far as possible, training programmes should
be standardised and prioritised according to key health needs and competence
gaps identified through supervision. Records should be maintained of
who has been trained in what by whom, when and where. These should be
shared with the human resource section of the local health authorities
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