Workload-based indicators of staffing need (WISN) for health tutors in two public health training institutions in Uganda

Abstract

Ugandan public Schools of Clinical Officers (SOCOs) face a serious problem of understaffing with qualified tutors, despite there being sufficient numbers in the country. Poor staffing of training institutions affects the quality of the graduates produced by the schools and eventually dictates poor quality provided by the health workers. This study set out to determine the workload-based staffing needs for two schools, determine the effects of understaffing and coping mechanisms adopted by the schools and the students. It was a descriptive cross-sectional study using the Workload Indicators of Staffing Need (WISN) methodology developed by the WHO, conducted in June 2006 in Mbale and Gulu SOCOs. Respondents were 150 students (75 per school), tutors and officials at the Ministries of Health and that of Education and Sports. The study identified severe tutor staffing in both schools (22 calculated against 8 present in Gulu and 24 against 12 present in Mbale). Both schools depend heavily on parttime tutors and their substitute Clinical Instructors, as well as other coping mechanisms such as out-of-hours and holiday teaching. The quality of teaching has suffered, with syllabi not completed and some key subjects not taught. The major cause of understaffing was non-appointment of tutors due to slow bureaucratic decision-making and other poor working conditions in the Education sector, compounded by poor school administration. Students cope by photocopying notes from previous students and sister schools or by privately hiring tutors in their free time. The paper recommends urgent appointment of tutors, improved funding for the schools, improved terms of service for tutors and improved school administration practices.