Table 2.
Wastage monitoring framework
| DIRECT WASTAGE | ||
| Factor | Examples of contribution to wastage | Possible indicators |
| Movement from health to non-health sector | Probably small: 2 – 20 staff per year (Ghana. Mozambique, Namibia) | % of job leavers exiting health work completely (exit interviews) |
| Emigration to health sector outside country | 10% of Mauritian nurses, 61% of Ghanaian doctors | Certificate verification rates Routine leaving data, e.g. resignations |
| Deaths, injuries and premature removal from the workforce | High significance of HIV/AIDS; Ghana 1.1% deaths compared with Malawi (<55%) of leavers | Mortality rates as % of workforce leavers, or Mortality rate in workforce |
| Inappropriate Administrative systems and policies | Affects other losses. Delays lose work input and may increase likelihood of emigration. | Average recruitment duration Staff recruitment rate versus vacancies |
| INDIRECT WASTAGE | ||
| Wastage as unemployment | Not well documented in Africa. Estimates of "ghost workers"? | Unemployed health workers as % of total workforce (for each category) |
| Wastage as underemployment | Data is not routinely collated but staff/workload indicators may help. | Staff workload Indicators, e.g. outpatient and inpatient staff per cadre |
| Wastage as a misuse | Significant in countries with senior medics and nurses as managers. | % staff: technical or professional in full-time managerial/administrative function |
| Wastage as inappropriate categories | 4–6 categories to deliver package of services in Ghana. | Workforce composition of skilled and semi-skilled staff |
| Absenteeism, low outputs | 2.3 days' sick leave per staff member versus 1.65 days off for all staff (Ghana) | Number of days off per staff member, per annum. |
| Misdeployment and maldistribution | Distribution differential: Doctors (Ghana): best 1:16201, worst 1:66071 | Doctor/nurse population ratios in different parts of country. |
| Wastage from misadministration of HRH | Difficult to assess quantitatively: e.g. 100% of new Lesotho nurses not recruited in 1998 | Recruitment and retention rates of new graduates of health training schools. |