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Assessment of staffing needs for physicians and nurses at Upazila health complexes in Bangladesh using WHO workload indicators of staffing need (WISN) method
  1. Taufique Joarder1,2,
  2. Samiun Nazrin Bente Kamal Tune1,
  3. Md Nuruzzaman3,
  4. Sabina Alam4,
  5. Valeria de Oliveira Cruz3,
  6. Tomas Zapata5
  1. 1 BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
  2. 2 Bangladesh Office, FHI 360, Dhaka, Bangladesh
  3. 3 World Health Organization Bangladesh Country Office, Dhaka, Bangladesh
  4. 4 Ministry of Health and Family Welfare, Government of Bangladesh, Dhaka, Bangladesh
  5. 5 WHO South-East Asia Regional Office, New Delhi, India
  1. Correspondence to Dr Taufique Joarder; taufiquejoarder{at}


Objective This study aimed to assess the current workload and staffing need of physicians and nurses for delivering optimum healthcare services at the Upazila Health Complexes (UpHCs) in Bangladesh.

Design Mixed-methods, combining qualitative (eg, document reviews, key informant interviews, in-depth interviews, observations) and quantitative methods (time-motion survey).

Setting Study was conducted in 24 health facilities of Bangladesh. However, UpHCs being the nucleus of primary healthcare in Bangladesh, this manuscript limits itself to reporting the findings from the providers at four UpHCs under this project.

Participants 18 physicians and 51 nurses, males and females.

Primary outcome measures Workload components were defined based on inputs from five experts, refined by nine service providers. Using WHO Workload Indicator of Staffing Need (WISN) software, standard workload, category allowance factor, individual allowance factor, total required number of staff, WISN difference and WISN ratio were calculated.

Results Physicians have very high (WISN ratio 0.43) and nurse high (WISN ratio 0.69) workload pressure. 50% of nurses’ time are occupied with support activities, instead of nursing care. There are different workloads among the same staff category in different health facilities. If only the vacant posts are filled, the workload is reduced. In fact, sanctioned number of physicians and nurses is more than actual need.

Conclusions It is evident that high workload pressures prevail for physicians and nurses at the UpHCs. This reveals high demand for these health workforces in the respective subdistricts. WISN method can aid the policy-makers in optimising utilisation of existing human resources. Therefore, the government should adopt flexible health workforce planning and recruitment policy to manage the patient load and disease burden. WISN should, thus, be incorporated as a planning tool for health managers. There should be a regular review of health workforce management decisions, and these should be amended based on periodic reviews.

  • health policy
  • public health
  • health services administration & management
  • human resource management

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See:

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  • Twitter @taufiquejoarder

  • Contributors TJ conceived and designed the study. TJ and SNBKT carried out the data analyses and drafted the manuscript. MN, SA and VdoC provided substantial technical inputs in the inception phase and throughout the research process. MN, SA, VdOC and TZ thoroughly reviewed the manuscript and contributed substantially with the necessary revision. TJ and SNBKT again reviewed the manuscript and prepared for the final submission. All authors approved the final manuscript.

  • Funding World Health Organization Bangladesh Country Office

  • Map disclaimer The depiction of boundaries on this map does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. This map is provided without any warranty of any kind, either express or implied.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval Ethical approval for this study was obtained from the Institutional Review Board (IRB) of BRAC James P Grant School of Public Health, BRAC University. We strictly adhered to all ethical principles.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request. All research data have been submitted to WHO Country Office for Bangladesh, as per the agreement with the research organisation, BRAC James P Grant School of Public Health, BRAC University. This manuscript only used the data pertaining to the physicians and nurses working at the two study Upazila (subdistrict) Health Complexes. Unpublished data include: consultants, general physicians and nurses at the district hospital level; physicians, and Family Welfare Visitors at Maternal and Child Welfare Center level; subassistant community medical officers at the Upazila Health Complex level; subassistant community medical officers at Union SubCenters level, subassistant community medical officers, and Family Welfare Visitors at Union Health and Family Welfare Centers level and Community Health Care Providers, and Family Welfare Assistants at the Community Clinic/ Outreach level. Data may be obtained from the World Health Organization Bangladesh Country Office on reasonable request (Focal Point: NPO-HRH-

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