Page 25 - MOH Supply and Needs-Based Requirement Hyperlink 02032021

17 EXTENDED EXECUTIVE SUMMARY

The HRH requirements model, on the other side, was constructed based on the Need-based
approach which, as described by WHO (2010), is one of the most widely used requirements
projection models. This approach explores likely changes in not only population demography
but also population needs for health services, based on changes in patterns of disease,
disabilities and injuries and the numbers and kinds of services required to respond to these
outcomes. It estimates HRH requirements based on the population growth, health status, level
of services, and productivity of health personnel (Birch et al., 2009; Murphy et al., 2001). It has
also been applied in Canada ((Birch et al, 2007; Tomblin-Murphy et al, 2008; Birch et al, 2009),
United Kingdom (CfWI, 2012, 2013a, 2013b, 2014b, 2014c), and Europe (Ono et al., 2013).

It is noted that there are many other common approaches used for requirements projections, as
reviewed among others by Dreesch et al. (2005) and Birch et al. (2007), which include namely:

(i) The workforce-to-population ratio-based approach: This is a simple projection of
future numbers of required health workers based on proposed thresholds for workforce
density (e.g. 25 doctors per 10,000 population or 1:400 ratio). This approach is least
demanding in terms of data but does little to explicitly address other key variables, aside
from population growth, that can be expected to affect the type and scale of future
health services provision and the associated workforce. This approach is based on
the assumption that there is homogeneity at the levels of the numerator (all doctors
are equally productive and will remain so) and of the denominator (all populations
have similar needs, which will remain constant). Such assumptions are certainly risky.

(ii) The service demands (utilization) based approach: This approach draws on
observed health services utilization rates for different population groups, applies these
rates to the future population profile to determine the scope and nature of expected
demands for services, and converts these into required health personnel by applying
established productivity standards or norms. With the demand-based approach, the future
requirements are estimated based on the current utilization level of provided services and
future demographic projection. The advantage of this approach is it allows the projection of
requirements to implement based on little to no changes in the utilization rate and population
growth. However, the approach fails to recognise that more patients do not know that
they need the health care service or did not seek health care service when they need it in
reality. This approach includes only those patients who present themselves in the hospital.

(iii) The service targets (facility) based approach: This is an alternative approach
that specifies targets for the production (and presumed utilization) of various types
of health services and the institutions providing them based on a set of assumptions,
and determines how they must evolve in number, size and staffing per productivity
norms. This approach converts these targets into human resources required by the
mean of staffing, facilities and the productivity standard. This approach assumes that
the standard of each service is achievable and practicable through the projection time
scale. The limitation, however, is that the resources produce minimal results in the
population needs and potentially causes the unrealistic assumptions for the needs.

SUPPLY AND NEEDS-BASED REQUIREMENT PROJECTIONS OF MALAYSIAN HUMAN
RESOURCES FOR HEALTH USING SYSTEM DYNAMICS APPROACH 2016 - 2030