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WHO Human Resources for Health Minimum Data Set
WHO Library Cataloguing in Publication Data
WHO human resources for health minimum data set.
1. Management information systems. 2. Nurses. 3. Midwifery.
ISBN 978 92 9061 380 0 ( NLM Classification: WY 26.5 )
© World Health Organization 2008
All rights reserved.
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Acknowledgements
This Minimum Data Set (MDS) package represents the collaborative work of the University of Technology, Sydney’s (UTS) Faculty of Nursing, Midwifery and Health, a WHO Collaborating Centre for Nursing, Midwifery and Health Development; the Western Pacific and South-East Asia WHO Regions, WHO Headquarters, partners and countries. Deep appreciation is due to Jim Buchan for his expert technical guidance, as well as to Jill White and Michele Rumsey, of the UTS, for overall project management, taskforce formation and minimum data set development.
We gratefully acknowledge the valuable contributions and work of taskforce members, participating Member States and bi-regional WHO Human Resources for Health, nursing and health information staff, throughout the development and finalization of the MDS and accompanying fact-sheets.
Executive Summary
World Health Organization Human Resources for Health Minimum Data Set Package
The countries of the Western Pacific and South-East Asia Regions face major challenges in producing and sustaining well-performing health workforces that are responsive, fair and efficient in the delivery of effective, safe, quality health interventions to those who need them.1 Well-functioning health information systems are required to ensure the production, analysis, dissemination and use of reliable and timely essential Human Resources for Health (HRH) information needed for workforce planning, management and evaluation.
The World Health Organization (WHO) Western Pacific and South-East Asia Regional project on a HRH Nursing/Midwifery Minimum Data Set (MDS) aims to support Member States and areas in designing effective and efficient HRH management information systems focused on nurses and midwives, to generate, process, report on and apply essential, core data in a timely manner. The data are for planning and management, as well as to promote coordination and collaboration between various heath professionals, ministries, educational institutions and professional associations.
The accompanying Fact-Sheets 1 – 3, represent outputs of Phase 1 of the project, undertaken in direct collaboration with the University of Technology, Sydney’s (UTS) Faculty of Nursing, Midwifery and Health, a WHO Collaborating Centre for Nursing, Midwifery and Health Development; WHO Headquarters, the Western Pacific and South-East Asia WHO Regions, partners and countries. It builds on the earlier Western Pacific Regional work carried out in collaboration with Ms Chieko Sakamoto, on the development and design of nursing/midwifery information systems and other data gathering tools, such as the WHO Western Pacific Nursing Country Databanks, as well as existing WHO modules focused on the development and application of nursing/midwifery information systems.
1 World Health Organization. Everybody’s Business: Strengthening Systems to Improve Health Outcomes (WHO’s Framework for Action). Geneva, World Health Organization, 2007.
This first phase of the project was carried out in consultation with individuals from 30 countries within the Western Pacific and South East Asia Regions. The accompanying Fact-Sheets are summarized in Box 1. and have been produced for Stage 1 of this project.
Fact-Sheets in the Minimum Data Set Package
q Fact-Sheet 1—Why Human Resources for Health is Important
Provides a background to HRH; why it is top of the agenda; describes the use of effective policies and an evidence-based approach.
q Fact-Sheet 2—Using the WHO Human Resources for Health Minimum Data Set
Used in conjunction with the other fact-sheets, it describes the main elements of the data set.
qFact-Sheet 3—WHO Human Resources for Health Minimum Data Set
Outlines the indicators and domains to enable cross- country comparisons, as well as sub-regional, regional an global trend analysis and planning, based on essential nursing and midwifery HRH indicators.
PHASE 2 OF THE PROjECT
The second project phase, begun in 2008, aims to further develop and expand the HRH minimum data set template developed in Phase 1, to cover other health professional groups. Additionally, Phase 2 will support the piloting and evaluation of a HRH template at the country level, as a framework for planning and assessing HRH organization and system contexts, linked to HRH country profiles. A primary objective is to assess the extent to which the template is relevant to and has utility in health systems of different sizes, with different approaches to HRH planning, and with different levels of HRH policy and planning capacity. This will enable the identification of current strengths and limitations in capacity, as well as gaps in information and data availability.
Project Highlights
Understanding the people who work in the health system and provide the care has been recognised as a priority by WHO World Health Assembly and the Global Nursing and Midwifery Strategic Directions.
Understanding how HRH differs from country to country in our diverse and complex regions is extremely important.
The provision of quality health care is dependant on adequate numbers of equitably distributed and supported, competent, human resources for health personnel. Workforce expenditures and structures will vary considerably with our regions.
This project aims to produce a set of indicators and domains with definitions and associated fact-sheets to establish a minimum data set to record, share, analyse and apply HRH data.
To understand HRH, we need to develop an information system. These systems, where possible, need to align with other healthcare disciplines, global workforce definitions and other databases. Using the same language, where feasible, so as not to duplicate the work and continue to create “silos”.
Given the diverse countries that the minimum data set will cover, in terms of size and configuration of health services, it will not be possible to capture all data in one template that will meet all the policy related requirements of each country.
The key word through out this project has been “minimum.” The idea was to produce indicators and domains for a minimum data set. However, individual countries and organisations can adopt the minimum data set and the fact sheets. The use of standard definitions will ensure consistency by permitting jurisdictions to develop their own, more detailed and country-specific data sets, building on the core minimum data, which will also enable regional comparison and standardization.
This Fact-Sheet is designed to be used with the WHO Human Resources for Health (HRH) Minimum Data Set (MDS) package, which consists of: Fact-Sheet 1, Fact-Sheet 2 and Fact-Sheet 3.
No Health Workers, No Care
The message in the World Health Report 2006 (WHR) is simple—without health workers, vital global health challenges cannot be met.
The report reveals that there is an estimated worldwide shortage of almost 4.3 million doctors, midwives, nurses and support workers. The shortage is most severe in the poorest countries, where health workers are most needed.
Without an adequate health workforce, the three key global health challenges outlined in the WHR will be difficult to address. These challenges are:
(1) To scale up interventions in order to attain the health- related Millennium Development Goals (MDGs);
(2) To shift successfully to community-based and patient- centred models of care for the treatment of chronic diseases;
(3) To tackle the problems posed by disasters and outbreaks; and
(4) To preserve health services in conflict and post-conflict states.
The WHR highlights propose several strategies to tackle this HRH crisis over the next ten years.
HRH is top of the agenda
The WHR recommends that, in order to achieve the goal of getting “the right workers, with the right skills, in the right place, doing the right things,” countries should develop HRH plans that are able to:
(1) Act now for workforce productivity, with a focus on better working conditions for health workers, improved safety, and better access to treatment and care;
(2) Anticipate what lies ahead, including developing a well- crafted plan to train the future health workforce;
(3) Acquire critical capacity, which requires workforce planning and the creation of leadership and management competencies, as well as focusing on standard setting, accreditation and licensing as drivers for patient safety and quality improvement.
To meet these challenges in the Western Pacific Region of WHO, the Regional Strategy on Human Resources for Health 2006-2015 outlines three main key results areas (KRAs). These are:
• KRA 1: a health workforce that is responsive to population health (demand);
• KRA 2: effective and efficient workforce development, deployment and retention (supply); and,
• KRA 3: sound stewardship, good governance and effective health workforce management (utilization).
This Regional Strategy presents a range of policy options which emphasise that country-specific strategies are essential to sustain a sufficient, balanced, competent, productive, responsive and supported health workforce..
Nursing and midwifery are the core of HRH
Nursing and midwifery staffs are vital for the delivery of safe and effective health care. In recognition of this, the WHO Western Pacific Region Strategic Action Plan for Nursing and Midwifery Development focuses on the nursing/midwifery workforce crisis. This crisis is due to workforce shortages, inequitable distribution and skill-mix imbalances.
This Action Plan sets out four strategic objectives (see Box 1) for effective HRH planning and management, which match the KRAs above. Central to these objectives is the alignment of policies on information management, human resources management, education, governance and professional regulation.
Box 1: Strategic Objectives of the WHO Western Pacific Region’s Strategic Action Plan for Nursing/ Midwifery Development
(1) Ensure that health workforce planning and development is an integral part of national policy and is responsive to population and service needs (aligned with KRA 1 above);
(2) Address workforce needs, including workplace environment, to ensure optimal employee retention and participation (aligns with KRA 2 above);
(3) Improve the quality of education to meet the skill and development needs of the staff in changing service environments; and
(4) Strengthen health workforce governance and management to ensure the delivery of cost effective, evidence-based and safe programmes and services (aligns with KRA 3 above).
FAct-Sheet 1Why Human Resources for Health are important
effective hRh policies require hRh data
As outlined in the WHO Western Pacific Region’s Action Plan for Nursing/Midwifery Development, standardized and accurate HRH data is crucial for HRH decision-making, planning and health service delivery. The collection and analysis of HRH data will help to ensure that health workforce planning and development is:
• An integral part of national policy—health workforce issues are central to health service reforms and to building effective, cost-efficient health systems (WHO, 2006);
• Responsive to population and service needs; and
• Able to assess and predict HRH shortages, oversupply and future HRH needs (WHO, 2006).
HRH data needs to reflect “uniform indicators, tools and management information systems for monitoring nursing/midwifery resource levels” in order to generate a comprehensive picture of workforce movements and to identify major gaps and weaknesses (WHO, 2007).
As well as HRH data, the other important prerequisites for developing effective HRH policies and practice are an understanding of the context in which HRH policies are to be applied and an appreciation of the strengths and weaknesses of different options for addressing HRH issues.
This means that the resourcing of skilled HR managers and planners with the capacity to develop and implement policies based on well-maintained HRH data sets is a high priority and needs equal attention (WHO, 2006).
You can find out more by reading Fact-Sheet 2, in which the major elements of the HRH minimum data set (MDS) are explained. The MDS has been developed as a starting point to enable countries to plan for current and future health workforce needs and to facilitate comparison between countries on basic nursing and midwifery HRH workforce indicators.
HRH makes a difference—the evidence base
In recent years, it has been recognised that developing sufficient capacity in trained HRH managers and planners, and establishing appropriate HRH policy should be at the core of any sustainable solution to improve health system performance. A well-motivated and appropriately skilled and deployed workforce is crucial to the success of health system delivery. Good practice in HRH can make a positive difference to the performance of the organisation.
A broad range of HRH indicators can be used to measure and assess nursing and midwifery effectiveness and performance (see Fact-Sheet 2).
Indicators can be:
• "Proxy" measures, such as staff turnover or absence (the assumption being that lower turnover, for example, will lead to improved performance);
• Measures of organisational activity or financial performance;
• Direct measures of clinical activity or workload (e.g. staff per occupied bed, or patient acuity measures);
• Measures of output (e.g. number of patients treated);
• Or (less frequently) measures of outcome (e.g. mortality rates; rate of post-surgery complications).
(see Buchan 2004 for more discussion).
There is a growing evidence-base from a range of countries that demonstrates the importance of HRH data in decision-making about nurse and midwifery staffing levels, mix, and deployment (Rafferty et al 2005). In addition, many of these studies demonstrate that planning, based on HRH data and efficient use of nursing and midwifery HRH resources, can make a positive difference to health outcomes. Adequate HRH improves the health of populations (WHO, 2006). Recent reviews of available online research include those by NHS Employers (2006) and by the Robert Wood johnson Foundation (2006).
These studies may provide ideas for ways of assessing the effectiveness of nursing and midwifery HRH resources in your own country or organisation.
Finally, there are two other important findings from the evidence base that require consideration when planning for HRH (see Buchan 2004). The first one is that there must be a "fit" between the HRH approach and the characteristics, context and priorities of the organisation in which it is being applied. The second one is that linked and coordinated HRH interventions will be much more likely to achieve sustained improvements than will single or uncoordinated interventions. The MDS provides a tool that can facilitate both of these activities.
References
Buchan j. (2004) What difference does (“good”) HRM make? (2004) Human Resources for Health 2:6 (7 june 2004)
Dal Poz, M., et al. (2006) Addressing the health workforce crisis: towards a common approach. Human Resources for Health 4:21 (3 August 2006)
NHS Employers (2006) Employing nurses - a review of recent evidence http://www.nhsemployers.org/workforce/workforce-1691.cfm
Rafferty, A.M., Maben, j., West, E., Robinson, D. (2005) What Makes a Good Employer? International Council of Nurses, Geneva http://www.icn.ch/global/Issue3employer.pdf
Robert johnson Wood Foundation. (2006) New research that illuminates policy issues: balancing nursing costs and quality of care for patients. http://www.rwjf.org/files/publications/other/CNFIsh3.pdf
WHO. (2006) The World Health Report 2006—Working Together for Health.
WHO. (2007) Health Statistics Framework and Priorities for WHO. (Draft 6)
FAct-Sheet 2Using the WHO Human Resources for Health Minimum Data Set
This Fact-Sheet is designed to be used with the World Health Organization (WHO) Human Resources for Health (HRH) Minimum Data Set (MDS) package, which consists of: Fact-Sheet 1, Fact-Sheet 2 and Fact-Sheet 3.
This Fact-Sheet is designed to inform and support you in using the WHO Western Pacific Region Nursing and Midwifery Minimum Data Set of HRH Indicators (Fact-Sheet 3). It describes the main elements of this data set.
The primary purpose of the minimum data set is to support cross-country comparisons of nursing and midwifery workforce supply and demand by measuring and predicting workforce imbalances. However, the MDS can also be adapted for use in country-level planning.
The MDS, a project between WHO and selected regions, partners and countries, has built on and extended earlier Western Pacific Region work. It was also informed by reviews of relevant tools and existing modules of nursing and midwifery information systems. The MDS reflects key priorities agreed on by the HRH Project Stakeholder Group, core partners, and the feedback from vital informants at a range of consultation meetings held throughout the WHO Western Pacific and South East Asia Regions in 2006, which involved potential users from more than 30 countries.
Many other HRH data sets are lengthy and complex. The MDS is designed as a basic tool to enable a rapid assessment of the nursing and midwifery workforce.
What is a minimum data set?
An HRH MDS consists of a core set of standard indicators which are used, generally, at a national level, for the collection and reporting on key aspects of health system delivery, including current workforce/staffing resources and future HRH needs. This can enable the comprehensive analysis of supply, requirements and adequacy in profession-based workforce planning (AHWOC 2003; CIHI 2005; WHO, 2007).
By using standard definitions and agreed upon indicators, an MDS can support comparison or benchmarking across organisations, systems or countries. An MDS represents the minimum number of data elements that stakeholders agree are required to be collected in order to meet workforce planning objectives. The intention is for existing data and information to be used wherever possible in order to minimise the data-gathering burden. This may include utilising population-based (census, surveys, registers) or health services-based (surveillance, health service records and administrative records, see WHO, 2007) data sources.
Although the development and use of an MDS is dependent upon stakeholders agreeing at a national level to a uniform core set of indicators, this does not prevent agencies and stakeholders from collecting additional data to meet a specific country’s information needs.
What does the MDS “look” like? explaining domains and indicators.
The MDS consists of:
• domains;
• associated indicators (which are the data that needs to be collected);
• definitions for each indicator to provide standardization;
• possible sources of data for each indicator (such as a population-based or health-services based data source);
• a rationale for why each indicator is important; and,
• additional supporting information for those who wish to expand or adapt the core MDS for in-country HRH planning.
A “domain” is a description of each broad area of required information. Defining each domain answers the question “what are the priority elements of information that we require to know?” The WHO Western Pacific Reagion Nursing and Midwifery MDS comprises of four domains selected on the basis of their importance for the continuous monitoring of the nursing/midwifery workforce and for keeping track of HRH retention and turnover (WHO, 2006). These four domains are listed and explained in the box below:
Domain Definition
These domains (and associated indicators) were selected to allow for assessment of HRH needs, based on what actually exists (the labour pool) and what is possible in organising and managing the workforce. (WHO, 2006)
1. Country population (Demographics)
Total size of the population, by gender and age distribution. This domain enables the measurement/calculation of imbalance, in terms of available workforce-to-population ratios. The current pool of health workers and the degree to which they are engaged in delivering health services, the settings in which they deliver care and whether full-time, part-time, unemployed or underemployed are factors which affect supply.
2. current workforce (Stock)
Total current “stock” of nurses/midwives and associated healthcare workers.This represents the current potential workforce within the country and can be used to estimate if there is a problem of shortage or oversupply (inputs, losses and utilization).
3. Workforce additions (Supply)
Sources of new supply of nurses and midwives. The availability of suitable candidates to the work pool is a factor that can affect supply and can provide an indication of how available stock may be increased.
4. Workforce losses: (those“leaving” employment in the country)
Total numbers “leaving” the stock of nurses and midwives in the country. There are different types of “leaving.” Some may only be temporary, but losses from the pool are a factor that affects supply. This domain can be used to estimate if there is a problem of shortage or oversupply.
The twelve MDS indicators provide a means of “measuring” the information required (for example country population, total current number of nurses/midwives; retirements) for each domain. Relying on a single indicator is insufficient. A range of indicators is needed to obtain a more accurate measure of workforce supply and demand and possible imbalances (WHO, 2004). The emphasis is on gathering information on basic characteristics such as age, sex and geographical distribution of nurses and midwives (rural or remote) as this type of data provides essential information for HRH planning and management (WHO, 2006).
Using the MDS
To use the MDS, you need to study the domains, indicators, and data sources listed (see Fact-Sheet 3), and decide how best to complete the data requirements for each indicator. Suggested sources of data are given, however, it may be that there are other alternative data sources within your own country that are more suitable (data from government departments, professional associations or statistical agencies, for example.)
Since the necessary data sources will likely come from a range of government departments and other organizations, it is important to ensure that all relevant government and organizational stakeholders support the development and use of the MDS. Without their agreement and support, you will be much less likely to obtain complete and fully accurate data.
To achieve stakeholder support and participation in setting up and maintaining the data set, you should consider the establishment of a national working committee or implementation taskforce, which will represent a broad range of necessary expertise and relevant stakeholders. This early “buy-in” will help to involve and commit all interested parties for the duration of the project.
Possible stakeholders may include representatives from your country or region’s ministry of health, public service commission, or ministry of finance. They may also include local NGOs, representatives of hospital and health facility management, nursing and medical associations, community health management committees, and external agencies, such as WHO or other international NGOs.
Who will “own” the data and the data set?
It is important, as part of the process of setting up and using the data set, that there is early agreement among the relevant stakeholders
about:
• Who is responsible for co-ordinating the project;
• Who is the main WHO/Project team member contact;
• Who stores, manages and controls access to the data;
• Who is responsible for updating the MDS;
• How the data will be secured; and,
• How any issues of data protection and privacy will be dealt with.
Again, these issues are best discussed and agreed upon at the beginning of the project by a national working committee or taskforce. A written protocol or manual should be drafted and ratified by the committee or taskforce, so that the necessary processes and procedures are standardised and understood by all stakeholders from the outset.
Using the IMS-HRH data set for local planning
Given the diverse countries and health systems in which the MDS will be implemented, it will not be possible to capture the required data in one standard template that meets all the policy and planning requirements of any one country. However, individual countries and organisations can adapt and build on the MDS to suit their HRH planning needs.
Please note, though, that if changes are made, the core minimum data should still be retained so that regional comparisons can be made.
Suggestions for adapting the MDS within countries are made in Fact-Sheet 3
References
Australian Institute of Health and Welfare (AIHW) (2003) Health labour force National Minimum Dataset: National Health Data Dictionary, Version 12. AIHW Cat No. HWI 56. Canberra, National Health Data Committee, AIHW.
CIHI (2005) Guidance Document for the Development of Datasets to Support Health Human Resources Management in Canada Ottawa, Canada, Canadian Institute for Health Information (www.cihi.ca ).
Diallo K, Zurn P, Gupta N, Dal Poz M (2003) Monitoring and evaluation of human resources for health: an international perspective. Human Resources for Health, 1(3).
International Council for Nurses (ICN). (2004) Nursing Matters – International Nursing Minimum Dataset (I-NMDS). Geneva: ICN. Retrieved 15 December 2006, from http://www.icn.ch/matters_ I-NMDS_print.htm.
Tomblin Murphy G, O’ Brien-Pallas L (2004) The Development of a National Dataset for Health Human Resources in Canada: Beginning the Dialogue: Working Document. Ottawa, Canada, Canadian Institute for Health Information.
WHO (2004) A Guide to Rapid Assessment of Human Resources for Health. WHO, Geneva.
WHO (2007) Health Statistics Framework and Priorities for WHO
(Draft 6)
This Fact-Sheet is designed to be used with the World Health Organization (WHO) Human Resources for Health (HRH) Minimum Data Set (MDS)
package, which consists of: Fact-Sheet 1, Fact-Sheet 2 and Fact-Sheet 3.
Domain These domains (and associated indicators) were selected to allow for assessment of HRH needs, based on what actually exists (the labour pool) and what is possible in terms of organising and managing the workforce. (WHO, 2006)
1. the population of the country (Demographics)
Total size of the population, by gender and age distribution. This enables the measurement/calculation of imbalance in terms of available workforce to population ratios. The current pool of health workers and the degree to which they are engaged in delivering health services, as well as the settings where they deliver care and whether they work full or part-time, or are unemployed or underemployed, are factors which affect supply.
2. the current workforce (Stock)
Total current “stock” of nurses/midwives and associated healthcare workers. This represents the current potential workforce within the country and can be used to estimate if there is a problem of shortage or oversupply (inputs, losses and utilization).
3. Workforce additions (Supply)
Sources of new supply of nurses and midwives. The availability of suitable candidates to the work pool is a factor that can affect supply and can provide an indication of how available stock may be increased.
4. Workforce losses: those “leaving” employment in the country
Total numbers “leaving” the stock of nurses and midwives in the country. There are different types of “leaving”—some may only be temporary, but losses from the pool is a factor that affects supply. This can be used to estimate if there is a problem of shortage or oversupply.
The MDS comprises of four domains:
Each domain is associated with one or more indicator. There are also definitions for each indicator, suggestions for possible sources of data to be used in developing the indicator, and a rationale for each indicator as well as prompts for other information.
The MDS is “minimum,” that is, it sets out the minimum data required to enable cross-country comparison on key nursing and midwifery HRH indicators.
The MDS is not intended, in its current form, to provide (or replace) a country-level workforce planning system. Suggestions for supplementary
information are also given so that the MDS can be adapted or developed, if required, to support in-country workforce planning.
The following definitions have been used to help define nurses and midwives:
The International Council of Nurses (ICN) Definition of Nursing: Nursing encompasses autonomous and collaborative care of individuals of all ages, families, groups and communities, sick or well, and in all settings. Nursing includes the promotion of health, prevention of illness, and the care of ill, disabled and dying people. Advocacy, promotion of a safe environment, research, participation in shaping health policy and in
patient and health systems management, and education are also key nursing roles.
Definition of the Midwife: (ICM/WHO/FIGO, 1999) a midwife provides “care and advice to women during pregnancy, labour and the postnatal period … [and] …she has an important task in health counselling and education, not only for the women, but also within the family and the community”. Where midwifery is strong, the health of women tends to be better and this has a positive impact on families and the well-being of children as the grow from newborns to adults.
FAct-Sheet 3WHO Human Resources for Health Minimum Data Set Page 1 of 9
Do
MA
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Defi
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be
inclu
ded
as c
ore
indi
cato
rs
Defin
ition
s of
”re
mot
e” v
ary
acco
rdin
g to
cou
ntrie
s, bu
t may
be
defi
ned
acco
rdin
g to
one
or m
ore
of th
e fo
llow
ing:
deg
ree
of re
mot
enes
s fro
m a
rura
l/urb
an a
rea;
set
tlem
ent p
atte
rns;
popu
latio
n de
nsity
; dem
ogra
phic
profi
les;
and
econ
omic
profi
les
(Irel
and
et a
l., 2
007)
.
Out
er is
land
s m
ay b
e co
nsid
ered
rem
ote.
WPR
dem
ogra
phic
data
via
http
://w
ww
.wpr
o.w
ho.in
t/inf
orm
atio
n_so
urce
s/da
taba
ses/
dem
ogra
phic_
tabl
es/
FAct
-Sh
eet
3W
HO
Hum
an R
esou
rces
for
Hea
lth
(HRH
) M
inim
um D
ata
Set
(MD
S)
Page
2 o
f 9
Do
MA
iN 2
:in
dica
tors
Defi
niti
ons
Poss
ible
dat
a so
urce
s
Why
is t
his
indi
cato
r im
port
ant?
(Rat
iona
le)
if y
ou w
ere
to u
se t
he M
DS
as p
art
of in
-cou
ntry
pl
anni
ng, w
hat
else
do
you
need
to
thin
k ab
out?
the
curr
ent
wor
kfor
ce
(S
tock
)
the
tota
l “st
ock”
of n
urse
s/m
idw
ives
and
ass
ocia
ted
wor
kers
whi
ch r
epre
sent
s th
e cu
rren
t po
tent
ial w
orkf
orce
wit
hin
the
coun
try
2.1
Curre
nt n
umbe
r of
regi
ster
ed
prof
essio
nals
(sto
ck),
whe
ther
pre
sent
ly w
orki
ng in
nur
sing/
mid
wife
ry o
r not
.
Stra
tified
by
:
• a
ge•
gen
der
Num
bers
of
all n
urse
s an
d m
idw
ives
, st
ratifi
ed b
y ag
e an
d ge
nder
as
wel
l as
by ty
pe o
f pr
ofes
sion
(if
avai
labl
e).
Prof
essio
nal
regi
ster
s
Publ
ic se
rvice
ro
ster
s/re
gist
ers
Heal
th s
ervi
ce
reco
rds
Adm
inist
rativ
e
reco
rds
Giv
es a
n in
dica
tion
of p
oten
tial t
otal
num
ber o
f reg
ister
ed
prof
essio
nals
that
are
ava
ilabl
e fo
r pra
ctice
. [N
ote:
Som
e re
gist
ers
are
“liv
e” a
nd u
pdat
ed; o
ther
s m
ay in
clude
retir
ed o
r de
ad in
divi
dual
s. O
nly
the
form
er is
rele
vant
for t
his
purp
ose]
.
Age
is im
porta
nt to
ass
ess
the
impl
icatio
ns o
f an
agin
g w
orkf
orce
that
is n
ot b
eing
repl
enish
ed.
Gen
der i
s im
porta
nt a
s th
e nu
mbe
r of w
omen
(tra
ditio
nally
th
e nu
rsin
g pr
ofes
sion
attra
cts
larg
er n
umbe
r of w
omen
th
an m
en) c
hoos
ing
a ca
reer
in n
ursin
g is
decli
ning
in s
ome
coun
tries
.
Num
bers
trai
ned
with
in th
e co
untry
/num
bers
trai
ned
in
othe
r cou
ntrie
s (if
an
estim
ate
can
be m
ade
of th
e %
of t
otal
st
ock
whi
ch w
as tr
aine
d ou
tsid
e th
e co
untry
, and
this
% is
m
onito
red
over
tim
e, th
is gi
ves
an in
dica
tion
of th
e le
vel o
f re
lianc
e on
in-m
igra
tion)
.
It is
impo
rtant
to d
iffer
entia
te b
etw
een
thos
e w
ho a
re w
orki
ng
(and
for h
ow m
uch
time)
, and
thos
e w
ho a
re e
cono
mica
lly
inac
tive
or w
orki
ng in
oth
er ty
pes
of e
mpl
oym
ent,
in o
rder
to
have
an
accu
rate
est
imat
e of
ava
ilabi
lity.
Plea
se n
ote
limita
tions
of r
egist
ry d
ata
sour
ces.
Thes
e in
clude
th
e po
ssib
ility
of n
ot b
eing
regu
larly
upd
ated
. For
exa
mpl
e,
non-
wor
king
or d
ecea
sed
prof
essio
nals
have
not
bee
n re
mov
ed.
2.2
Curre
nt n
umbe
rs o
f re
gist
ered
nur
ses/
m
idw
ives
em
ploy
ed in
ea
ch o
f the
follo
win
g ar
eas:
Publ
ic/go
vern
men
t se
ctor
Priva
te/N
GO
sec
tor
and
whe
ther
full-
time
equi
vale
nt (F
TE)
(hea
dcou
nt d
ata)
Num
bers
of
nurs
es a
nd
mid
wiv
es
by p
lace
of
empl
oym
ent a
nd
whe
ther
they
are
w
orki
ng fu
ll or
pa
rt-tim
e.
In s
ome
coun
tries
, th
ere
has
been
a
larg
e m
igra
tion
of h
ealth
wor
kers
fro
m p
ublic
to
priva
te s
ecto
r.
Min
istry
of h
ealth
Min
istry
of l
abou
r
Priva
te s
ecto
r/NG
O
stat
istics
Cens
us
Labo
ur fo
rce
su
rvey
Regi
ster
s
Publ
ic se
rvice
ro
ster
s/re
gist
ers
This
give
s an
ove
rall
estim
ate
of a
ll nu
rses
/mid
wiv
es in
em
ploy
men
t, an
d th
e di
strib
utio
n ac
ross
the
mai
n pl
ace
of
empl
oym
ent b
y fu
ll or
par
t-tim
e w
orki
ng s
tatu
s. Co
mpa
ring
the
tota
l num
ber i
n em
ploy
men
t with
the
tota
l on
the
regi
ster
(if
it is
a li
ve re
gist
er) w
ill g
ive
an e
stim
ate
of th
e pa
rticip
atio
n ra
te in
em
ploy
men
t.
Som
e co
untri
es m
ay o
nly
have
dat
a fro
m th
e pu
blic
sect
or.
Whe
re p
ossib
le, i
t is
desir
able
to re
port
num
bers
wor
king
in
both
priv
ate
and
publ
ic se
ctor
s.
For i
n-co
untry
pla
nnin
g, it
is im
porta
nt to
hav
e a
clear
un
ders
tand
ing
of th
e re
lativ
e siz
e of
the
diffe
rent
em
ploy
men
t ca
tego
ries
(pub
lic v
ersu
s pr
ivate
) and
the
size
of fl
ows
betw
een
them
.
Plea
se n
ote
that
pub
lic s
ecto
r nur
ses
and
mid
wiv
es in
mos
t co
untri
es u
sual
ly in
clude
mili
tary
em
ploy
ees.
How
ever
, m
embe
rs o
f the
mili
tary
can
also
be
a se
para
te c
ateg
ory.
It
is im
porta
nt to
be
awar
e of
the
scop
e of
em
ploy
ees
cove
red
with
in e
ach
data
-sou
rce
to p
reve
nt o
verla
p an
d do
uble
-co
untin
g.
Chec
k th
at th
e HR
H da
ta is
nat
iona
lly re
pres
enta
tive
and
cove
rs th
e pr
ivate
sec
tor.
FAct
-Sh
eet
3W
HO
Hum
an R
esou
rces
for
Hea
lth
(HRH
) M
inim
um D
ata
Set
(MD
S)
Page
3 o
f 9
FAct
-Sh
eet
3W
HO
Hum
an R
esou
rces
for
Hea
lth
(HRH
) M
inim
um D
ata
Set
(MD
S)
Do
MA
iN 2
:in
dica
tors
Defi
niti
ons
Poss
ible
dat
a so
urce
s W
hy is
thi
s in
dica
tor
impo
rtan
t?(R
atio
nale
)if
you
wer
e to
use
the
MD
S as
par
t of
in-c
ount
ry
plan
ning
, wha
t el
se d
o yo
u ne
ed t
o th
ink
abou
t?
2.3
Curre
nt n
umbe
r of
regi
ster
ed n
urse
s/m
idw
ives
em
ploy
ed:
publ
ic se
ctor
by
FTE
dist
ribut
ion
stra
tified
by
:
• a
ge
• g
ende
r
• w
orki
ng in
hos
pita
l
(acu
te) o
r
• c
omm
unity
(prim
ary)
car
e
Num
bers
of
nurs
es a
nd
mid
wiv
es
empl
oyed
in th
e pu
blic
sect
or
by a
ge, g
ende
r an
d by
whe
ther
w
orki
ng in
acu
te
or p
rimar
y ca
re
setti
ngs
Min
istry
of h
ealth
/
Heal
th s
ervi
ce
exec
utiv
e
payr
oll
Labo
ur fo
rce
surv
ey
Publ
ic se
ctor
em
ploy
men
t will
ofte
n be
the
mai
n so
urce
of
empl
oym
ent f
or n
urse
s an
d m
idw
ives
. Be
ing
publ
icly
fund
ed,
ther
e w
ill o
ften
be m
ore
polic
y in
tere
st in
this
sect
or.
Estim
atin
g fu
ll tim
e eq
uiva
lent
is c
ritica
l for
det
erm
inin
g an
ac
cura
te m
easu
re o
f ava
ilabl
e nu
rsin
g/m
idw
ifery
hou
rs.
The
age
profi
le is
impo
rtant
for e
stim
atin
g lik
ely
patte
rns
of
retir
emen
t and
mor
talit
y. G
ende
r dist
ribut
ion
is ne
cess
ary
to
asse
ss e
quity
in H
R op
portu
nitie
s an
d fo
r pla
nnin
g pu
rpos
es.
Char
acte
ristic
s of
the
nurs
ing/
mid
wife
ry w
orkf
orce
(size
, co
mpo
sitio
n by
age
and
gen
der)
are
also
vita
l in
bala
ncin
g th
e ge
ogra
phica
l dist
ribut
ion
of h
ealth
pro
fess
iona
ls an
d bu
ildin
g ad
equa
te te
ams.
It is
impo
rtant
to re
port
this
data
sep
arat
ely
for n
urse
s an
d m
idw
ives
to e
nabl
e an
alys
is in
rela
tion
to fe
rtilit
y ra
tes,
repr
oduc
tive
age
grou
p of
pop
ulat
ion
etc.
It is
nece
ssar
y to
kno
w th
e di
strib
utio
n of
ava
ilabl
e nu
rsin
g/
mid
wife
ry re
sour
ces
acro
ss th
e m
ajor
type
s of
car
e se
tting
to
asse
ss im
bala
nces
.
For a
ny d
etai
led
in-c
ount
ry p
lann
ing,
it w
ill b
e ne
cess
ary
to
have
est
imat
es o
f num
bers
of n
urse
s an
d m
idw
ives
at d
iffer
ent
grad
es a
nd le
vels
with
in th
e ca
reer
stru
ctur
e. T
his
allo
ws
asse
ssm
ent o
f suc
cess
ion-
plan
ning
requ
irem
ents
and
an
iden
tifica
tion
of re
lativ
e ar
eas
of o
ver-s
uppl
y an
d un
ders
uppl
y of
ava
ilabl
e st
ock.
For d
etai
led
in-c
ount
ry p
lann
ing,
it w
ill b
e ne
cess
ary
to h
ave
info
rmat
ion
on th
e co
sts
of e
mpl
oym
ent o
f diff
eren
t cad
res
and
cate
gorie
s of
sta
ff, s
o th
at re
lativ
e co
sts
of d
iffer
ent m
ixes
ca
n be
est
imat
ed.
In-c
ount
ry w
orkf
orce
pla
nnin
g m
ay a
lso fo
cus
on a
mor
e de
taile
d as
sess
men
t of d
iffer
ent r
oles
or c
ompe
tenc
es o
f sta
ff.
Thes
e ar
e no
t cla
ssifi
ed in
tern
atio
nally
in a
ny s
tand
ard
way
, so
are
not r
elev
ant f
or u
se fo
r an
inte
rnat
iona
l min
imum
dat
a se
t.
It w
ill b
e ne
cess
ary
to h
ave
info
rmat
ion
on g
eogr
aphi
c di
strib
utio
n of
ava
ilabl
e re
sour
ces
in o
rder
to m
atch
ava
ilabi
lity
agai
nst p
opul
atio
n di
strib
utio
n an
d as
sess
any
gap
s in
ser
vice
Oth
er in
dica
tors
that
may
be
used
to a
sses
s sh
orta
ges
will
be
vaca
ncy
rate
s an
d tim
e ta
ken
to fi
ll po
sts.
Page
4 o
f 9
FAct
-Sh
eet
3W
HO
Hum
an R
esou
rces
for
Hea
lth
(HRH
) M
inim
um D
ata
Set
(MD
S)
Do
MA
iN 2
:in
dica
tors
Defi
niti
ons
Poss
ible
dat
a so
urce
s
Why
is t
his
indi
cato
r im
port
ant?
(Rat
iona
le)
if y
ou w
ere
to u
se t
he M
DS
as p
art
of in
-cou
ntry
pl
anni
ng, w
hat
else
do
you
need
to
thin
k ab
out?
2.4
Curre
nt n
umbe
r of
unre
gist
ered
nur
sing/
m
idw
ifery
ass
istan
ts
/aux
iliar
ies
empl
oyed
in
pub
lic /
priva
te
sect
ors
by:a
ge,
gend
er, -
full-
time
or
part-
time,
and
wor
k se
tting
(acu
te o
r pr
imar
y).
Plea
se d
efine
an
d di
ffere
ntia
te
“unr
egist
ered
” as
th
is te
rm is
not
sy
nony
mou
s w
ith
assis
tant
s/au
xilia
ries.
In s
ome
coun
tries
, al
l the
cat
egor
ies,
inclu
ding
ass
istan
ts/
auxi
liarie
s, ar
e kn
own
as “
regi
ster
ed”.
Num
bers
of
unre
gist
ered
nu
rsin
g/m
idw
ifery
as
sista
nts/
auxi
liarie
s em
ploy
ed,
stra
tified
by
age
and
gend
er, F
TE
or p
art-t
ime,
an
d w
orkp
lace
se
tting
(acu
te o
r pr
imar
y).
Min
istry
of h
ealth
/
Heal
th s
ervi
ce
exec
utiv
e
Payr
oll
Labo
ur fo
rce
surv
ey
Estim
atin
g nu
mbe
rs a
nd fu
ll-tim
e eq
uiva
lent
s of
unr
egist
ered
st
aff w
orki
ng w
ith n
urse
s/m
idw
ives
allo
ws
over
all a
sses
smen
t of
ava
ilabl
e sk
ill m
ix in
the
publ
ic se
ctor
.
Whe
n re
cord
ing
this
info
rmat
ion,
ple
ase
clarif
y ca
tego
ries,
grou
ps a
nd d
efini
tions
, as
thes
e va
ry fr
om c
ount
ry to
cou
ntry
. (In
Sol
omon
Isla
nds,
for e
xam
ple,
all
cate
gorie
s of
hea
lth
wor
kers
are
regi
ster
ed, w
hile
in th
e Ph
ilipp
ines
, in
cont
rast
, nu
rses
/mid
wiv
es w
ho m
ay n
ot h
ave
pass
ed th
e bo
ards
may
w
ork
as N
A’s/
care
give
rs b
ut n
ot b
e re
gist
ered
)
The
avai
labl
e m
ix o
f sta
ff ca
n va
ry s
igni
fican
tly w
ithin
and
be
twee
n or
gani
satio
ns in
side
heal
th s
yste
ms,
and
betw
een
heal
th s
yste
ms.
Whi
lst th
ere
is no
sin
gle
“cor
rect
” m
ix, i
t is
impo
rtant
that
any
var
iatio
ns in
the
mix
are
mon
itore
d, o
n gr
ound
s of
pat
ient
saf
ety,
qual
ity o
f car
e an
d co
st.
Page
5 o
f 9
Do
MA
iN 3
:in
dica
tors
Defi
niti
ons
Poss
ible
dat
a so
urce
s
Why
is t
his
indi
cato
r im
port
ant?
(R
atio
nale
)if
you
wer
e to
use
the
MD
S as
par
t of
in-c
ount
ry
plan
ning
, wha
t el
se d
o yo
u ne
ed t
o th
ink
abou
t?
Wor
kfor
ce
Add
itio
ns(S
uppl
y)
Sour
ces
of n
ew s
uppl
y of
nur
ses
and
mid
wiv
es, w
hich
can
add
to
the
avai
labl
e st
ock.
3.1
Num
ber o
f “ne
w”
supp
ly of
nur
ses
and
mid
wiv
es th
e w
orkf
orce
stra
tified
by:
• p
re-s
ervic
e in
-
cou
ntry
gra
duat
es;
• p
re-re
gist
ratio
n
in
-cou
ntry
wor
kfor
ce e
ntra
nts
into
pra
ctice
; and
,
• a
ge a
nd g
ende
r.
Annu
al n
umbe
rs o
f nur
se/
mid
wife
ry s
tude
nts
who
co
mpl
ete
pre-
regi
stra
tion
educ
atio
n AN
D w
ho e
nter
em
ploy
men
t in
nurs
ing/
mid
wife
ry w
ithin
the
coun
try, b
y ag
e an
d ge
nder
impo
ssib
le.
Basic
nur
sing
educ
atio
n is
“a
form
ally
reco
gnize
d pr
ogra
m
of s
tudy
, of a
t lea
st 2
yea
rs
dura
tion,
whi
ch p
rovi
des
a fo
unda
tion
of n
ursin
g pr
actic
e an
d fo
r pos
t-bas
ic ed
ucat
ion.
Min
istry
of h
ealth
Min
istry
of e
duca
tion
Univ
ersit
ies/
colle
ges
Regi
stra
tion
boar
ds
Mili
tary
forc
es a
nd
train
ing
scho
ols
This
is ne
cess
ary
to e
stim
ate
the
futu
re n
ew
supp
ly of
regi
ster
ed p
rofe
ssio
nals
ente
ring
the
wor
kfor
ce s
tock
and
to m
easu
re tr
ends
acr
oss
time.
It is
also
nec
essa
ry to
be
certa
in a
bout
the
num
ber w
ho c
ompl
ete
train
ing
and
who
ac
tual
ly en
ter n
ursin
g/m
idw
ifery
em
ploy
men
t w
ithin
the
coun
try.
For i
n-co
untry
pla
nnin
g, in
form
atio
n is
also
nec
essa
ry o
n:
• an
nual
num
bers
of n
urse
/ mid
wife
ry s
tude
nts
ente
ring
pre-
regi
stra
tion
educ
atio
n (b
y ag
e an
d ge
nder
, if p
ossib
le);
• an
nual
num
bers
of n
urse
/ mid
wife
ry s
tude
nts
com
plet
ing
pre-
regi
stra
tion
educ
atio
n (b
y ag
e an
d ge
nder
, if p
ossib
le);
• th
e nu
mbe
r of e
duca
tion
“pro
vide
rs”
(uni
vers
ities
,
colle
ges,
etc.
) and
est
imat
es o
f num
bers
of a
pplic
atio
ns to
pre-
regi
stra
tion
nurs
ing/
mid
wife
ry e
duca
tion;
and
,
• w
hich
org
aniza
tion
(if a
ny) c
ontro
ls th
e nu
mbe
rs e
nter
ing
pre-
regi
stra
tion
educ
atio
n.
3.2
In-m
igra
tion
- num
ber
of in
divi
dual
nur
ses/
m
idw
ives
join
ing
wor
kfor
ce fr
om o
ther
co
untri
es.
Annu
al n
umbe
r of a
ctiv
e nu
rses
/ m
idw
ives
ent
erin
g th
e co
untry
, ex
pres
sed
as a
tota
l num
ber
(stra
tified
by
nurs
ing/
mid
wife
ry)
and
FTE
and
PT.
Avoi
d co
untin
g in
-mig
rant
s m
ore
than
onc
e—i.e
., cla
rify
if co
untin
g ne
w in
-mig
rant
w
orkf
orce
join
ers,
vers
us
coun
ting
over
and
ove
r, cu
mul
ativ
ely.
Min
istry
of h
ealth
/ He
alth
ser
vice
ex
ecut
ive
Payr
oll
Labo
ur fo
rce
surv
ey
Regi
ster
In-m
igra
tion
may
repr
esen
t a s
igni
fican
t infl
ow
of n
urse
s/ m
idw
ives
and
will
hav
e im
plica
tions
fo
r est
imat
es o
f num
bers
requ
ired.
Pat
tern
s of
m
igra
tion
may
var
y ac
ross
tim
e.
Iden
tifyin
g th
e m
ajor
“so
urce
” co
untri
es (i
f any
) will
ena
ble
an a
sses
smen
t of l
evel
of r
elia
nce
on a
ny o
ne c
ount
ry o
r sm
all g
roup
of c
ount
ries.
For l
onge
r ter
m p
lann
ing,
it w
ill b
e ne
cess
ary
to a
sses
s if
mos
t in-
mig
ratio
n is
tem
pora
ry o
r per
man
ent.
FAct
-Sh
eet
3W
HO
Hum
an R
esou
rces
for
Hea
lth
(HRH
) M
inim
um D
ata
Set
(MD
S)
Page
6 o
f 9
Do
MA
iN 3
:in
dica
tors
Defi
niti
ons
Poss
ible
dat
a
sour
ces
Why
is t
his
indi
cato
r im
port
ant?
(R
atio
nale
)if
you
wer
e to
use
the
MD
S as
par
t of
in-c
ount
ry
plan
ning
, wha
t el
se d
o yo
u ne
ed t
o th
ink
abou
t?
3.3
Wor
kfor
ce re
-ent
ry
(num
ber o
f nur
ses/
mid
wiv
es (s
epar
ate
and
toge
ther
as
per
coun
try) r
e-en
terin
g w
orkf
orce
afte
r per
iod
of a
bsen
ce. S
tratif
y by
:
• a
ge
• g
ende
r
• s
ecto
r
• F
TE o
r PT
Annu
al n
umbe
rs o
f nur
ses/
m
idw
ives
who
re-e
nter
the
wor
kfor
ce a
fter a
per
iod
of
abse
nce,
suc
h as
car
eer-b
reak
, fa
mily
resp
onsib
ilitie
s, te
mpo
rary
m
igra
tion,
etc
.
Min
istry
of h
ealth
/
Heal
th s
ervi
ce
exec
utiv
e
Payr
oll
Labo
ur fo
rce
surv
ey
Regi
ster
It is
impo
rtant
to e
stim
ate
trend
s in
the
num
ber o
f “re
turn
ers”
(nur
ses/
mid
wiv
es
who
re-e
nter
the
wor
kfor
ce a
fter p
erio
ds o
f ec
onom
ic in
activ
ity o
r wor
king
in o
ther
fiel
ds o
f em
ploy
men
t). Th
is m
ay b
e a
signi
fican
t sou
rce
of e
ntra
nts
into
the
wor
kfor
ce a
nd a
s su
ch,
requ
ires
estim
atio
n an
d m
onito
ring.
“Ret
urne
rs”
may
be
a po
tent
ial s
ourc
e of
read
y-m
ade
recr
uits
. It w
ill b
e ne
cess
ary
to a
sses
s w
hat p
olici
es m
ight
be
requ
ired
to e
ncou
rage
thei
r ret
urn.
FAct
-Sh
eet
3W
HO
Hum
an R
esou
rces
for
Hea
lth
(HRH
) M
inim
um D
ata
Set
(MD
S)
Page
7 o
f 9
FAct
-Sh
eet
3W
HO
Hum
an R
esou
rces
for
Hea
lth
(HRH
) M
inim
um D
ata
Set
(MD
S)
Do
MA
iN 4
:in
dica
tors
Defi
niti
ons
Poss
ible
dat
a so
urce
s
Why
is t
his
indi
cato
r im
port
ant?
(Rat
iona
le)
if y
ou w
ere
to u
se t
he M
DS
as p
art
of in
-cou
ntry
pl
anni
ng, w
hat
else
do
you
need
to
thin
k ab
out?
Wor
kfor
ce
Loss
es: t
hose
“l
eavi
ng”
empl
oym
ent
in
the
coun
try.
the
tota
l num
bers
“le
avin
g” t
he s
tock
of n
urse
s an
d m
idw
ives
in t
he c
ount
ry.
4.1
Retir
emen
ts (p
ublic
se
ctor
)An
nual
num
ber o
f nur
ses/
m
idw
ives
retir
ing
from
pub
lic
sect
or, e
xpre
ss a
s nu
mbe
r an
d FT
E.
Min
istry
of h
ealth
/ He
alth
ser
vice
ex
ecut
ive
Payr
oll
Labo
ur fo
rce
surv
ey
The
num
ber r
etiri
ng w
ill h
ave
impl
icatio
ns fo
r es
timat
es o
f rep
lace
men
t num
bers
requ
ired.
Tren
ds
shou
ld b
e m
onito
red.
Patte
rns
may
var
y ac
ross
tim
e an
d be
twee
n or
gani
satio
ns.
The
offic
ial r
etire
men
t age
(if a
ny) i
s re
quire
d in
ord
er to
un
derta
ke p
roje
ctio
ns o
n pa
ttern
s of
retir
emen
t.
Ther
e m
ay b
e po
ols
of re
tired
nur
ses/
mid
wiv
es w
ho c
an b
e at
tract
ed b
ack
to s
ome
form
of e
mpl
oym
ent w
here
ther
e ar
e sh
orta
ges.
Cha
ngin
g th
e re
tirem
ent a
ge m
ay a
lso b
e a
polic
y op
tion.
4.2
Deat
hs
Annu
al m
orta
lity
rate
of
nurs
es/ m
idw
ives
in p
ublic
se
ctor
em
ploy
men
t.
Min
istry
of h
ealth
/ He
alth
ser
vice
ex
ecut
ive
Payr
oll
Labo
ur fo
rce
surv
ey
Mor
talit
y ra
tes
will
hav
e im
plica
tions
for e
stim
ates
of
repl
acem
ent n
umbe
rs re
quire
d. Te
nds
shou
ld b
e m
onito
red.
Patte
rns
of m
orta
lity
may
var
y ac
ross
tim
e an
d be
twee
n or
gani
satio
ns.
Mor
talit
y ra
tes
can
vary
mar
kedl
y ac
ross
tim
e, b
y ag
e co
hort
and
by g
ende
r. Fo
r exa
mpl
e, is
you
r cou
ntry
exp
erie
ncin
g gr
owin
g m
orta
lity
as a
resu
lt of
HIV
Aid
s or
sim
ilar
illne
sses
? If
so, t
his
shou
ld b
e fa
ctor
ed in
to w
orkf
orce
pl
anni
ng a
nd p
roje
ctio
ns.
Page
8 o
f 9
Do
MA
iN 4
:in
dica
tors
Defi
niti
ons
Poss
ible
dat
a so
urce
s
Why
is t
his
indi
cato
r im
port
ant?
(Rat
iona
le)
if y
ou w
ere
to u
se t
he M
DS
as p
art
of in
-cou
ntry
pl
anni
ng, w
hat
else
do
you
need
to
thin
k ab
out?
4.3
Out
-mig
ratio
n An
nual
num
ber o
f act
ive
nurs
es/ m
idw
ives
leav
ing
the
coun
try e
xpre
ssed
as
a nu
mbe
r and
FTE
.
Min
istry
of h
ealth
/
Heal
th s
ervi
ce
exec
utiv
e
Payr
oll
Labo
ur fo
rce
surv
ey
Regi
ster
Out
-mig
ratio
n m
ay re
pres
ent a
sig
nific
ant o
utflo
w
of n
urse
s/ m
idw
ives
. Thi
s w
ill h
ave
impl
icatio
ns fo
r es
timat
es o
f rep
lace
men
t num
bers
requ
ired.
Patte
rns
of m
igra
tion
may
var
y ac
ross
tim
e.
Turn
over
is a
ffect
ed n
ot o
nly
by m
ovem
ent
betw
een
publ
ic/pr
ivate
and
rura
l/urb
an s
ecto
rs, b
ut
also
by
mig
ratio
n.
Wha
t are
the
mai
n “d
estin
atio
n” c
ount
ries
(if a
ny)?
This
info
rmat
ion
will
hel
p yo
u id
entif
y if
outfl
ow is
mai
nly
to o
ne
coun
try o
r a s
mal
l gro
up o
f cou
ntrie
s.
Do y
ou k
now
if m
ost o
ut-m
igra
tion
is te
mpo
rary
or
perm
anen
t? C
an s
ome
mig
rant
s be
enc
oura
ged
to re
turn
?
4.4
Oth
er re
signa
tions
/ ou
tflow
(“w
asta
ge”)
Annu
al n
umbe
r of a
ctiv
e nu
rses
/ mid
wiv
es “
leav
ing”
, bu
t sta
ying
with
in th
e co
untry
, ex
pres
sed
as a
num
ber a
nd
FTE.
Min
istry
of h
ealth
/
Heal
th s
ervi
ce
exec
utiv
e
Payr
oll
Labo
ur fo
rce
surv
ey
This
final
cat
egor
y of
“ou
tflow
” is
requ
ired
to p
rovi
de a
n es
timat
e of
oth
er m
oves
out
of
empl
oym
ent,
for e
xam
ple
to c
aree
r bre
aks,
or to
ot
her,
non-
nurs
ing/
mid
wife
ry w
ork.
Are
ther
e sig
nific
ant fl
ows
betw
een
publ
ic an
d pr
ivate
se
ctor
em
ploy
men
t in
nurs
ing/
mid
wife
ry?
Can
appr
oach
es b
e im
plem
ente
d th
at im
prov
e w
orkf
orce
re
crui
tmen
t and
rete
ntio
n?
FAct
-Sh
eet
3W
HO
Hum
an R
esou
rces
for
Hea
lth
(HRH
) M
inim
um D
ata
Set
(MD
S)
Page
9 o
f 9
