The implementation of the Workforce Indicators of Staffing Needs (WISN) method to improve access to health workforce in selected South-East Asian countries

The Workload Indicators of Staffing Needs (WISN) is a tool used to estimate health workforce requirements for national or sub-national regions and health facilities. We determined the implementation of WISN for six countries in the World Health Organization South-East Asia Region (WHO-SEAR). This research ascertained whether WISN's recommendations were adopted and operationalised after the initial assessment. This will then help policymakers identify implementation barriers and enablers for the successful implementation of WISN for the improvement of access to health workforce. We used a multi-method approach comprising qualitative, in-depth, semi-structured interviews, literature reviews and document reviews. First, we conducted a desktop review to understand the context of WISN implementation in Bangladesh, Bhutan, India, Indonesia, Nepal and Sri Lanka. Second, we interviewed a key policymaker responsible for the implementation of WISN in Sri Lanka, Bangladesh, Bhutan and India. Interviews were undertaken virtually, in English using Microsoft Teams virtual software and auto transcribed and recorded using Microsoft Teams. Literature reviews were conducted using electronic databases, documents and reports were sourced from the WHO-SEAR office and/or country of interest's focal persons. Findings from the different methods were synthesized, triangulated and presented using four themes, namely, initial implementation, key findings, primary lessons and directions forward. This study found a high utility of WISN on informing policymakers of the health workforce needs or surplus once the service activity standards were determined. However, all the countries did not have pre-defined service standards and they did not always have the required service data or health information. For WISN to be of utility, countries need to first strengthen their health workforce information systems and digitize workload standards. Furthermore, the government treasury and the employing ministry must be involved at early stages of the planning process to ensure easy phasing in and adaptation of recommendations.