SoWMy country briefs:
Methodology
• This presentation describes the key
methodology and data sources used in the
SoWMy 2014 report and the country briefs.
• It is aimed at teams preparing country
launches or advocacy efforts using the SoWMy
report.
SoWMy briefs: overview
Future
need
Current
need
Future
availability
Availability
Effective
coverage
today
Accessibility
Quality
Sources of data
Data from
secondary sources
(UN Pop)
pregnancies
Data from pregnancy
modelling
(ICS Integrare, U. of
Southampton)
births
Data from effective
coverage modelling
(ICS Integrare)
Data from
SoWMy
survey
Data from
SoWMy
survey
Data from
SoWMy
survey
Data from
secondary
sources
(DHS)
Data from
secondary
sources (WHO)
Exploring availability
na = there is no cadre in
this category providing
MNH services in the
country
In this section of the brief, health workers are grouped into
general categories based on countries’ own category choice in
the SOWMY survey.
- = no information available
Workforce numbers are
based on the responses
to the SoWMy 2014
survey. Where the
country could not
provide any data,
figures from the WHO
Global Health
Observatory, or from
national policy
documents were used.
See Footnote 1 for details
on which country cadres
are included in each
category of MNH
workers!
It’s very important to know not just how
many health workers there are, but also
how much of their time they spend on
providing MNH services.
The SoWMy survey asked countries to
report on the % time spent on MNH by
each cadre .
Multiplying this % by the total number of
workers is used to obtain the “full time
equivalent” workers in MNH – or FTE.
Example footnote page 67:
These health worker categories include the following country titles - Midwives: includes obstetricians, obstetric nurses;
Nurses: includes generalist nurses, family health nurses, specialized nurses, nurse technicians; Auxiliary nurse-midwives:
includes nursing assistants; Generalist physicians: includes general practitioners, general surgeons, family health doctors;
Obstetricians & gynecologists: includes obstetric doctors and gynecologists.
Calculating met need in the present
The model which calculates met need works in three steps:
1.Estimating the workforce requirements that are needed. How many health
workers are needed to provide the package of MNH services that women and
newborns need? This package is set as 46 essential interventions recommended
by PMNCH. The model estimates how to provide these interventions to the
population at the level of universal coverage (meeting 100% of need). The
calculation works in 2 steps:
•
How much time is needed to deliver an intervention to a single woman or
newborn?
•
How many women or newborns need this intervention? This depends on:
1.
2.
Demographic characteristics: the number of women of reproductive age,
pregnancies and births in the population; and
Epidemiological characteristics: the particular epidemiological profile of a country
(e.g. prevalence of malaria, HIV/AIDS, etc).
2. Estimating the workforce availability that the country actually has to provide these
MNH services. This is based on the data that the countries reported on FTE health workers in
More details on the
modelling methodology
are available in Annex 3
on pg. 209 of the report!
the country (the number of health workers multiplied by the % time they spend on MNH).
These are then converted into total hours of available working time (assuming that each
worker works 40 hours a week, gets 4 weeks holiday, and spends 70% of working time on
clinical tasks). AWT is then assigned to providing the set of essential interventions. The AWT is
only counted towards meeting workforce time needed for an intervention if the cadre is in
theory sufficiently skilled to deliver that intervention, based on the roles and competencies of
each cadre of health worker according to official WHO guidelines.
3. Finally, to estimate the ”met need” is a simple calculation of the difference
between the workforce required and the workforce that is available.
PMNCH Essential Interventions
The 46 essential
interventions
recommended by the
Partnership for Maternal,
Newborn and Child Health
cover the whole continuum
of MNH care – from prepregnancy, to antenatal, to
childbirth, to postnatal care.
More details on how the need for each
intervention was estimated shown in
Annex 4 on page 212 of the report!
Available at:
http://www.who.int/pmnch/knowledge/public
ations/201112_essential_interventions/en/
PMNCH Essential Interventions
Estimates and projections to 2030
To calculate future met need, the model looks at how the current stock of the workforce
will evolve between 2012 and 2030. The model takes into account:
•
•
the outflows from the workforce (due to death, voluntary attrition, and retirement).
the inflows into the workforce (from new graduates who enter each year)
The resulting projected workforce is the difference between the inflows and outflows.
Health workers
classified according
to country titles
•
•
•
ISCO Classification
Health workers reclassified according
to ISCO
For all calculations of met need, health worker cadres given by the countries were
reclassified into categories according to the international standard of classifications
(ISCO-08). This reclassification is based on the roles and responsibilities that the
countries reported in the SOWMY questionnaire for each cadre.
This results in some cases in workers “changing category” – for example, a cadre that
is titled in the country as a “midwife” may be reclassified as a Midwifery associate
professional , or auxiliary, according to ISCO code, if they do not perform all the
essential roles and responsibilities of midwives.
The reclassification allowed us to create a model that would work across different
countries, which have very different ways of naming health workers, and to provide
an accurate estimate of met need based on the actual roles and responsibilities of
each cadre.
Projections of met need to 2030: Current trajectory
The brief shows the projections of met need to
2030 if the current trajectory is maintained.
Need: total FTE MNH workers
needed to provide the 46
essential interventions to the
population at the level of
universal coverage
Available workforce: total FTE
MNH workers with the skills
available to provide the needed
set of essential interventions
What if… trajectory
The final section of the brief shows
the gains in met need by 2030 if 4
potential policy scenarios are
implemented. What if…
Projections of met need: issues for policy discussion
The met need estimates are national aggregate measures
of workforce availability, based on the best available
evidence provided by the countries in the SOWMY
survey.
Some indicative policy questions for discussion with
national stakeholders:
• Are the projections of inflows into the workforce likely
to be realized as planned?
• Can new evidence/data be obtained to improve the
accuracy of the met need estimates?
• What evidence is available on the other dimensions of
effective coverage: accessibility, acceptability, quality?
Data requirements for met need modelling
10 minimum pieces of data are needed to provide accurate estimates of met need:
1.
2.
3.
4.
5.
6.
Headcount
% time spent on MNH
Roles and responsibilities
Age distribution
Retirement age
Length of education
Default assumptions:
• Annex 5 contains default assumptions for
all 10 required pieces of data
• For example: the default assumption for
attrition (if data is missing or inconsistent)
is 4%
• More than 50% of cadres did not
have/provide attrition information,
meaning this default assumption (4%) was
used in its place.
7.
8.
9.
10.
Enrollments into education
Attrition from education
Graduates from education
Voluntary attrition from the
workforce
Source: SoWMy 2014, pg. 14
Effective coverage
CRUDE COVERAGE
•
•
EFFECTIVE COVERAGE
AVAILABILITY
ACCESSIBILITY
ACCEPTABILITY
QUALITY
Midwifery workforce is
AVAILABLE?
Midwifery workforce is
ACCESSIBLE?
Midwifery workforce is
ACCEPTABLE?
Midwifery workforce
provides QUALITY CARE?
A midwife is available in or
close to the community
As part of an integrated team of
professionals, lay workers and
community health services
•
•
•
•
Woman attends
A midwife is available
As needed
Financial protection ensures no
barriers to access
•
•
•
•
Woman attends
A midwife is available
As needed
Providing respectful care
•
•
•
•
•
Source: Campbell J. SoWMy 2014
Met need estimates are based on the
dimension of availability
Woman attends
A midwife is available
As needed
Providing respectful care
Competent and enabled to provide
quality care.
Accessibility: example issues for policy discussion
Financial accessibility:
1. Can the population afford to access the services
of MNH workers?
2. In theory, minimum health benefits packages are
available free of charge at the point of service. To
what extent is this the case in your country?
Source: SoWMy 2014 survey
Source: DHS
Geographical access: is the available
MNH workforce equitably distributed
within the country in relation to need?
Quality: example issues for policy discussion
What is the actual quality of the care
being provided by MNH workers?
The country briefs
include information on
education, regulation,
association (ERA) –
these are the enabling
environment for the
midwifery workforce to
provide quality care
Source: SoWMy 2014, pg. 32
Note this figure uses a proxy for
quality of care: >25 supervised
births in curriculum
Source: SoWMy 2014 survey
Further information
The SOWMY helpdesk is here to help!
For any queries, send us an email at:
[email protected]
Thank you!