Measuring workload for tuberculosis service provision at primary care level: a methodology

In view of reaching the Millennium Development Goals' (MDG) targets for health, the demand for well trained and productive health staff in global health programmes is high [1]. The global Stop TB Strategic Plan 2006-2015, established to facilitate the achievement of TB-related MDGs, describes the need for expanded services in order to halt and reverse TB incidence [2]. The application of new technologies and improvements in service delivery according to quality standards, create additional demands on health staff. Therefore, the global strategic plan for TB stresses the importance of careful planning for human resources for health, citing the insufficient quantity and quality and the mal-distribution of staff as the main barriers limiting effective TB control [3].Given the current crisis in human resources for health in many resource-poor countries, combined with often major staff shortages in rural and remote areas, rational planning for HRH is crucial and requires better justification of staffing requests for specific interventions. The use of generic staffing norms for planning of human resources for health (HRH) in TB control is unsatisfactory. Field experience shows that there is significant variability in workload and productivity of staff within and between countries [4,5]. Major factors contributing to this are patient load, organisation of services and Human Resource Management activities, all will be different in different settings. This implies that context specific staffing norms need to be developed to maximize effectiveness of services, and thereby assuring to reach the TB program targets. Such norms can only be formulated on the basis of local evidence. In light of this, a comprehensive insight into the organization of services, the patient flow in TB control, and the workload of staff within countries or districts is required to estimate HRH requirements.In this article we describe a methodology that we developed to establish TB related work load in