Midwifery Manpower in Primary Healthcare Centres of Tehran, Iran: A Cross-sectional Survey

Mahsa Khoshnam; Elham Ehsani -Chime; Shahla Khosravi; Ali Mosadeghrad; Seyed Tahereh Mirmolaei

doi:10.25159/2520-5293/11574

Authors

Mahsa Khoshnam Tehran University of Medical Sciences
Elham Ehsani -Chime Tehran University of Medical Sciences
Shahla Khosravi Tehran University of Medical Sciences
Ali Mosadeghrad Tehran University of Medical Sciences
Seyed Tahereh Mirmolaei Tehran University of Medical Sciences

DOI:

https://doi.org/10.25159/2520-5293/11574

Keywords:

Midwifery, manpower, primary health services, workload, WISN, Iran

Abstract

Background: It is necessary to use accurate methods of calculating manpower to avoid wasting resources. Given that reproductive health services are an important part of primary health services, it would be useful to apply manpower calculation methods to service providers in related occupational groups. This study calculated the required midwifery manpower in health care centers using the Workload Indicator of Staffing Need method.

Methods: A cross-sectional study was conducted in 1400 in 276 health centers in Tehran according to the WISN model, in which the list of activities related to reproductive health in the centers under the auspices of the University of Tehran was determined. The available working time, main workload components, and the activity standards (service standards and allowance standards) were determined through a mixed method (direct observation, comments of service providers, and meetings with experts). The volume of services provided over the period of one year prior to the onset of the COVID-19 pandemic was estimated using national statistics. Finally, the required manpower was calculated and compared with the actual workforce.

Results: The results showed that currently Tehran health centers need 34 more staff to provide reproductive health services. The working pressure was calculated 0.9, and the current allowance factor is 1.31. Based on observations, midwifery capacity is currently not fully and exclusively used.

Conclusion: To improve the quality of reproductive health services, it is recommended to eliminate the current shortage of midwives, focus more on special midwifery tasks, and reduce the amount of indirect activities of midwives.

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References

Adebajo, Sylvia, Ekechi Okereke, and Friday Joseph. 2017. “Enhancing Frontline Health Workers’ Abilities to Improve MNCH Services in Cross River State through Task Shifting/Sharing.” https://doi.org/10.31899/rh7.1016.

Agarwal, Smisha, Pooja Sripad, Caroline Johnson, Karen Kirk, Ben Bellows, Joseph Ana, Vince Blaser, Meghan Bruce Kumar, Kathleen Buchholz, and Alain Casseus. 2019. “A Conceptual Framework for Measuring Community Health Workforce Performance within Primary Healthcare Systems.” Human Resources for Health 17 (1): 1–20. https://doi.org/10.1186/s12960-019-0422-0.

Alipour, Hamidreza, Mina Jafari, and Sajjad Salehi Kordabadi. 2015. “Assessing the Effect of Emotional Intelligence on Human Resource Productivity Case Study: Social Security Organisation of Ardabil Province.” International Journal of Computer Science 1 (2).

Annadoroh, Hani, and Dumilah Ayuningtyas. 2018. Calculated Number of Midwives Required in Indonesian Public Health Centers Based on the Minimum Standard Workforce, 347–354. KnE Life Sciences/The 2nd International Meeting of Public Health 2016 (IMOPH): Part I. https://doi.org/10.18502/kls.v4i4.2294.

Asamani, James Avoka, Christmal Dela Christmals, and Gerda Marie Reitsma. 2021. “Health Service Activity Standards and Standard Workloads for Primary Healthcare in Ghana: A Cross-sectional Survey of Health Professionals.” Healthcare 9 (3): 332. https://doi.org/10.3390/healthcare9030332.

Czarkowska-Pączek, Bożena, Małgorzata Dawidowska, and Lena Serafin. 2021. “The Number of Nurses and Midwives per 1000 Inhabitants Influences Life Expectancy: A Retrospective Analysis Based on Data from 46 Countries.” International Journal of Occupational Medicine and Environmental Health 34 (4): 505–512. https://doi.org/10.13075/ijomeh.1896.01699.

Das Saikat, Manna Nirmalya, Datta Mousumi, Sengupta Debjani, Samsuzzaman MD, Baur Baijayanti, Mundle Malay. 2013. “A Study to Calculate the Nursing Staff Requirement for the Maternity Ward of Medical College Hospital, Kolkata Applying WISN Method Planning.” Journal of Dental and Medical Sciences 8 (3): 1–7. https://doi.org/10.9790/0853-08301075.

Dawson, A. J., A. M. Nkowane, and A. Whelan. 2015. “Approaches to Improving the Contribution of the Nursing and Midwifery Workforce to Increasing Universal Access to Primary Healthcare for Vulnerable Populations: A Systematic Review.” Human Resources for Health 13: 97. https://doi.org/10.1186/s12960-015-0096-1.

Dimiri, Dixon, Nelson Mek, Mary Therese Apini, Thelma Ali, Grace Turi Pumuye, Varage John Laka, Rosemary Jogo, Pamela Kari, Okech Mollent, and Dapeng Luo. 2022. “Estimating Staffing Requirements Using Workload Indicators of Staffing Need at Braun District Hospital in Morobe Province, Papua New Guinea.” Human Resources for Health 19 (1): 1–12. https://doi.org/10.1186/s12960-021-00677-x.

Gile, Philipos Petros, Martina Buljac-Samardzic, and Joris Van De Klundert. 2018. “The Effect of Human Resource Management on Performance in Hospitals in Sub-Saharan Africa: A Systematic Literature Review.” Human Resources for Health 16 (1): 1–21. https://doi.org/10.1186/s12960-018-0298-4.

Javanparast, Sara, Fran Baum, Ronald Labonte, and David Sanders. 2011. “Community Health Workers’ Perspectives on their Contribution to Rural Health and Well-being in Iran.” American Journal of Public Health 101 (12): 2287–2292. https://doi.org/10.2105/AJPH.2011.300355.

Jeniawaty, Sherly, and Queen Khoirun Nisa Mairo. 2018. “The Analysis of Midwife Workload as an Effort to Improve Performance and Service Quality.” Aloha International Journal of Health Advancement (AIJHA) 1 (5): 105–112.

Kuehne, Flora, Laura Kalkman, Shiv Joshi, Wunna Tun, Nishwa Azeem, Dabota Yvonne Buowari, Chioma Amugo, Per Kallestrup, and Christian Kraef. 2022. “Healthcare Provider Advocacy for Primary Healthcare Strengthening: A Call for Action.” Journal of Primary Care and Community Health 13. https://doi.org/10.1177/21501319221078379.

Kunjumen, Teena, Mollent Okech, Khassoum Diallo, Pamela Mcquide, Tomas Zapata, and James Campbell. 2022. Global Experiences in Health Workforce Policy, Planning and Management Using the Workload Indicators of Staffing Need (WISN) Method, and Way forward. BioMed Central. https://doi.org/10.1186/s12960-021-00695-9.

Navidian, Ali, Maryam Navaee, and Hadis Kaykha. 2019. “Effectiveness of Stress Inoculation Training on Occupational Stress of Midwives in Healthcare Centres of Zahedan in Health Transformation Plan in 2017.” Journal of Education and Health Promotion 8.

Noura, Mohaddesseh, and Mehdi Zanganeh Baygi. 2020. “Health Transformation Plan in Iran: A New Return to the Declaration of Alma-Ata.” Health Scope 9 (2). https://doi.org/10.5812/jhealthscope.67268.

Nove, Andrea, Maria Guerra-Arias, Francisco Pozo-Martin, Caroline Homer, and Zoe Matthews. 2015. “State of the World’s Midwifery: Analysis of the Midwifery Workforce in selected Arab Countries.”

Nove, Andrea, Ingrid K. Friberg, Luc de Bernis, Fran McConville, Allisyn C. Moran, Maria Najjemba, Petra Ten Hoope-Bender, Sally Tracy, and Caroline S. E. Homer. 2021. “Potential Impact of Midwives in Preventing and Reducing Maternal and Neonatal Mortality and Stillbirths: A Lives Saved Tool Modelling Study.” The Lancet. Global Health 9 (1): e24–e32. https://doi.org/10.1016/S2214-109X(20)30397-1.

Okoroafor, Sunny, Samuel Ngobua, Maritza Titus, and Idonniboyeobu Opubo. 2019. “Applying the Workload Indicators of Staffing Needs Method in Determining Frontline Health Workforce Staffing for Primary Level Facilities in Rivers State Nigeria.” Global Health Research and Policy 4 (1): 1–8. https://doi.org/10.1186/s41256-019-0125-z.

Sajadi, H. S., and R. Majdzadeh. 2019. “From Primary Healthcare to Universal Health Coverage in the Islamic Republic of Iran: A Journey of Four Decades.” Arch Iran Med 22 (5): 262–268.

Shipp, Peter J., and World Health Organisation (WHO). 1998. Workload Indicators of Staffing Need (WISN): A Manual for Implementation. World Health Organisation.

Tabatabaee, Seyed Saeed, and Elahe Daghighbin. 2020. “Estimating of the Required Midwife in Maternity Ward in Hospital Using Workload Indicator of Staffing Need Method.” https://doi.org/10.21203/rs.3.rs-17278/v1.

Tabrizi, Jafar Sadegh, Alireza Raeisi, and Saeed Namaki. 2022. “Primary Healthcare and Covid-19 Pandemic in the Islamic Republic of Iran.” Health 12 (1): 1–10. https://doi.org/10.34172/doh.2022.11.

Wiegers, Therese A. 2007. “Workload of Primary-care Midwives.” Midwifery 23 (4): 425–432. https://doi.org/10.1016/j.midw.2006.06.007.

World Health Organisation (WHO). 2018. Building the Primary Healthcare Workforce of the 21st Century. World Health Organisation.

Xu, Kang, Kaijin Zhang, Dan Wang, and Ling Zhou. 2014. “Trend in Distribution of Primary Healthcare Professionals in Jiangsu Province of Eastern China.” International Journal for Equity in Health 13 (1): 1–8. https://doi.org/10.1186/s12939-014-0117-z.

Zulu, Brenda. 2019. “Work Load Indicators of Staffing Needs for Midwives and Nurses Offering Maternal Neonatal and Child Health Services in Chongwe District Lusaka Zambia.” The University of Zambia.