who country assessment tool

on the uses and sources for human resources for health (HRH) data

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WHO Library Cataloguing-in-Publication Data

WHO country assessment tool on the uses and sources for human resources for health (HRH) data. 1.Health personnel. 2.Health manpower. 3.Evaluation studies. 4.Questionnaires. 5.Data collection. I.World Health Organization. ISBN 978 92 4 150428 7 (NLM Classification: W 76)

World Health Organization 2012 All rights reserved. Publications of the World Health Organization are available on the WHO web site (www.who.int) or can be purchased from WHO Press, World Health Organization, 20 Avenue Appia, 1211 Geneva 27, Switzerland (tel.: +41 22 791 3264; fax: +41 22 791 4857; e-mail: bookorders@who.int). Requests for permission to reproduce or translate WHO publications whether for sale or for noncommercial distribution should be addressed to WHO Press through the WHO web site (http://www.who.int/about/licensing/copyright_form/en/index.html). The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either expressed or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization be liable for damages arising from its use. Printed by WHO Document Production Services, Geneva, Switzerland / October 2012

who country assessment tool

on the uses and sources for human resources for health (HRH) data

Human Resources for Health Unit (HRH) Department for Health Systems Policies and Workforce (HPW) Health Systems and Services (HSS)

Country HRIS assessment tool at institutional level

Acknowledgements
This Tool was prepared by the World Health Organization (WHO) with financial support from the Norwegian Agency for Development Cooperation (Norad), the United States Agency for International Development (USAID), the United States Presidents Emergency Plan for AIDS Relief (PEPFAR) and the European Union. This tool was produced under the overall direction of Mario Dal Poz (Coordinator, Human Resources for Health Unit, Department for Health Systems Policies and Workforce, World Health Organization (WHO)). The primary author of the tool is: Angelica Sousa. We acknowledge the valuable contribution from the country human resources for health experts from around the world, the World Health Organization and colleagues from the Centers for Disease Control and Prevention (CDC), the United States Agency for International Development (USAID), USAID-funded CapacityPlus and IntraHealth, Jhpiego and others. Particular thanks to all those who contributed to the Health Information Reference Group (HIRG) meeting in Nairobi, Kenya, 56 December 2011. The following persons provided detailed comments and advice on the earlier drafts of this tool, and raised valuable issues during its preparation: Naphtali Agata, Adam Ahmat, Elisabeth David Joseph, John Dewdney, Yohana Diaz de Valle, Michael English, Paulo Ferrinho, Mario Alberto Figueroa Alvarez, Jessica Gross, Neeru Gupta, Grace Irimu Thinwa, Isaac Kimani, Rose Kiriinya, Jason Knueppel, Ramesha Krishnamurthy, Teena Kunjumen, Wuleta Lemma, Devan Manharlal, Maurice Lenga, Bagele Mbayi, Jean Moore, Jane Mudyara, Patrick Mutinda Mdindyo, Gideon Mutua, Evasen Naidoo, Edgar Necochea, Epiphane Ngumbu, Bernard Nkala, Francis Ntalazi, Jacinta Nzinga, Leonardo Pereira, Elsa Reis, Patricia Riley, Jean Robson, Xenophon Santas, Anny Sarea, Abdou Sayo Farmo, Hernan Sepulveda, Dykki Settle, Hussein Shabani Mavunde, Eiichi Shimizu, Tungamirirai Simbini, Amani Siyam, Gerhard Vermaak, Peter Waithaka, Kate Waldman, Keith Waters, Agnes Waudo and Alexandra Zuber.

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Country HRIS assessment tool at institutional level

Table of contents

Background 2 Objectives 2 Part 1: Mapping of institutions Part 2: Questionnaire Questionnaire at institutional level Section 1: Institution information Section 2: Data collection Section 3: Data reporting and use Section 4: Summary of findings 3 5 6 8 9 12 14 15 16 18

Attachment 1: Examples of institutions that produce data on human resources for health Attachment 2: Type of data on human resources for health (question 2.10) Attachment 3: Health Workforce Classification Mapping

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Country HRIS assessment tool at institutional level

Background
There is widespread recognition of the need for accurate, timely and effective human resources for health data to inform the development of policies on human resources for health in countries. However, many low and middle income countries have week information systems that can generate data that could guide the policy dialogue to scale up the health workforce. To respond to this crisis the World Health Organization has directed its efforts and achievements in leading the global research agenda to support countries to strengthen their Human Resources Information Systems (HRIS). As part of these efforts the Human Resources for Health Unit (HRH), WHO developed the Country Assessment Tool on the sources and uses of HRH data to conduct a diagnosis on the quality of data on HRH and the degree to which information is used for evidence-based decision-making. This diagnostic tool contains questions intended to gather information on the uses, type and quality of data on HRH at institutional level in countries. This step is critical to identify strengths and weaknesses of the current HRIS in countries. The resulting information can then be used to identify priorities and develop strategies to strengthen the HRIS at district, regional, or national level. The country assessment tool on the sources and uses of HRH data is an adapted version of the instrument designed by the Capacity Project, which collects information by institution, and the data mapping template at national level on human resources for health developed by the HRH, WHO. The current version of the instrument has been field tested to evaluate the uses and sources of information in Cape Verde, Guinea Bissau, Mozambique and Sao Tome and Principe and it has recently been used in Guatemala and Rwanda to understand the support required to assist countries to improve or develop their HRIS.

Objectives
The objectives of the instrument are to identify the list of institutions involved in producing data on HRH and to compile comprehensive information on the uses, type and quality of data on HRH at institutional level in countries. The tool is divided in two parts: 1. 2. Mapping of institutions Questionnaire at institutional level: 2.1 Identification 2.2 Data collection 2.3 Use of data 2.4 Summary of findings

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Country HRIS assessment tool at institutional level

Pa r t 1 M app i n g o f i n s t i t u t i o n s

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Country HRIS assessment tool at institutional level

Mapping exercise to identify the list of institutions involved in producing data on HRH
A requisite step to conduct the evaluation on the uses and sources for HRH data is to conduct a mapping of institutions to identify the institutions involved in producing data on HRH. These institutions include ministries, licensing and registration or certification bodies, private sector organizations and outside the health sector, population census bureaus and statistical offices, labour departments, and others. List in the following table the institutions identified as producers of HRH data (please refer to attachment 1 for an example of the institutions). The institutions listed in this section will be interviewed using the questionnaire in part 2. Attach additional sheets if more space is needed.
No. Name of the institution/agency

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Country HRIS assessment tool at institutional level

Pa r t 2 questionnaire

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Country HRIS assessment tool at institutional level

Questionnaire at institutional level

This questionnaire is intended to be applied in different institutions which produce data on HRH based on the mapping exercise previously conducted by the interviewer to identify the list of institutions involved in producing data on HRH.

Instructions for using the interview tool

This section will provide guidance on how to conduct the interview on the evaluation of the uses and sources for HRH data at institutional level.

1 Role of the interviewer

The interviewer is responsible for asking questions, answering the respondents queries, recording answers and editing the completed questionnaire. The interviewer must check that the respondent has understood the questions by using interviewing techniques, such as neutral probes, clarification and appropriate feedback, and determine whether the answer given is appropriate. Listening to what the respondent is communicating, both verbally and nonverbally, ensuring that the information is correct. The interviewer must set the pace of the interview and keep the respondent focused and interested. The atmosphere should be comfortable and pleasant at all times. Before going to the field, the interviewer must know the questionnaire and how it is to be administered. A thorough preparation as well as extensive practice will guarantee that this is achieved.

2 Role of respondent
The role of the respondent is to cooperate with the interviewer and follow instructions. The respondent must listen to questions attentively without interrupting, take time before answering, and try to give an accurate and complete response as much as possible. The respondent should ask for clarifications whenever a question seems unclear and ask the interviewer to repeat or rephrase it. Trying to answer an unclear question is likely to lead to an incorrect response.

3 Introduction to the interview

The interviewer must clearly communicate the objectives of the survey to the respondent. Knowing what is expected of the person will contribute to the accuracy in responses. The interviewer should establish a good rapport by introducing himself and the survey well. Make a good impression 1. 2. 3. 4. You are a professional interviewer from a legitimate and reputable organization. The questionnaire is for gathering data for important, worthwhile research. The respondents participation is vital to the success of the research. The responses given will be confidential and will only be used for research purposes. Respondents will have to sign an informed consent form, which explains about the survey and what will be expected of them.

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Country HRIS assessment tool at institutional level

The interviewer can use the following introduction or decide which one works best.
Example of introduction:

Hello my name is and I work for The reason I am contacting you is because we are conducting a survey on health workforce in your country and I would like to ask you a few questions. Let me assure you that whatever information you tell us will not be disclosed to anyone and will only be used for research purposes. Make a good interview start 1. 2. You should be pleasant and assertive, and make the respondent feel at ease. You should know the questionnaire thoroughly and be well prepared to answer any questions. You should speak slowly and clearly to set the tone for the interview. You should adapt your introduction to the respondent, as different respondents require different amounts of information. You should be motivated and interested in the interview.

3. 4.

5.

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Country HRIS assessment tool at institutional level

Section 1: Institution information

Make a separate copy of the questionnaire for each institution that is being surveyed. 1.1 Date(s) of assessment:

1.2 Institution:

1.3 Department name: 1.4 Type of institution (select only one): A Ministry of Health B Other ministries (specify): C Subregional health agency (e.g. district health office) D Health professional regulatory body E Other para-public agencies (e.g. military, police, social security) F Worker unions/associations G Nongovernmental or not-for-profit agency providing health services to the public H Private-for-profit agency providing health services to the public I Training institutions for health professionals J Research institutions K Labour organizations L Other (specify): Complete the following information for every person participating in completion of this questionnaire. Attach additional sheets if more space is needed.
Name Job title or role Telephone No. (incl. country code) Email address

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Country HRIS assessment tool at institutional level

Section 2: Data collection

Make a separate copy of Section 2 of the questionnaire for each type of data on human resources for health collected in this institution. 2.1 Indicate the type of data on human resources for health collected in this institution on a routine basis. A Student enrolment B Pre-service training in health-related fields (e.g. graduates) C In-service training of health professionals D Health professional licensing E Health professional registration F Staff in a health facility G Payroll H Retired/discharged I Performance evaluation J Leave management K Planning and budget L Other (specify): 2.2 How often is this data collected? A Daily B Weekly C Monthly D At least once a year E In the last 1 to 2 years F Within the last 3 to 5 years G Not updated within the last 5 years 2.3 On which sectors of the health workforce do you collect this data? Check all options that apply. A Public B Private-for-profit C Semi-private D Nongovernmental or not-for-profit organization E Para-public agency (e.g. military, police, social security) F Health training institution G Other (specify):

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Country HRIS assessment tool at institutional level

2.4 How are the data collected? Check all options that apply. A Paper forms B Electronic files (specify, e.g. Microsoft Excel, Word, etc.): C Mixed media (paper and electronic) (specify, e.g. Microsoft Excel, Word, etc.): D Other (specify): 2.5 How are the data compiled into a database or information system? A Paper B Electronic (e.g. spreadsheet, database, or other) C None 2.6 Once compiled, are the data of health workers mapped and disseminated using a standard classification for purpose of statistical comparability with other data sources relevant to labour market analysis? Check all options that apply. A National classification of occupation B Common definitions from the Ministry of Health C International standard classification of occupations D International classification of education E None F Other (specify): 2.7 Are the data of health workers disaggregated by occupational category? A 21 or more occupational categories B 15 to 20 occupational categories C 4 to 14 occupational categories D Fewer than 4 categories E Not disaggregated 2.8 Are the data of health workers disaggregated by the following characteristics? Check all options that apply. A Gender B Age or age group C Urban/rural D State, province or other geographical delineation E Country where health training was completed F Country of birth G Current status in the national health workforce (type of contract, temporary, probation, permanent)
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Country HRIS assessment tool at institutional level

H Public/private sector I Graduates of all health training institutions J Professionals who left the health sector (e.g. death, retirement, career change, leaving the country) K Marital status L Other (specify in question 2.9) 2.9 Provide a short description on additional data relevant to human resources for health analysis collected in this dataset:

2.10 List the type of data on human resources for health collected in this Institution (please refer to attachment 2 and check all options that apply). 2.11 Indicate which of the following population based surveys have been used to complement the data on human resources for health collected by this institution? Check all options that apply. A Population census B Labour force surveys C Health facility survey D Other (specify): E None 2.12 List of printed or electronic documents received during interview(s) (e.g.vacancy notices, sample employment contract, payroll stubs, employee continuing education brochures, graduation booklet, sample position description and others). Catalogue appropriately.

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Country HRIS assessment tool at institutional level

Section 3: Data reporting and use

3.1 Is there a plan for monitoring and evaluation of human resources for health strategic objectives? A Yes, implemented B Yes, not fully implemented C Plan is being developed D No 3.2 Do you have a standard set summary of data or set of reports that you produce regularly? A Yes B No C Unsure 3.3 Who are the principal users of the data and/or reports? Check all options that apply. A Ministry of Health B Other ministries (specify): C Other agencies (e.g. social security, parliament) D Districts health offices E Health facilities F Private sector management G Nongovernmental or not-for-profit organization H Health professional regulatory bodies I General public J Central statistical office K Health training institutions L Research institutions M Unkown N Other (specify): O None 3.4 In what format do you disseminate the data and/or reports? Check all options that apply. A Paper-based documents B Electronic-based spreadsheet C Electronic document D Online access E None
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Country HRIS assessment tool at institutional level

3.5 How often are these data and/or reports produced? A At least once a year B In the last 1 to 2 years C Within the last 3 to 5 years D Not produced within the last 5 years 3.6 How have the national data on human resources been used in the last five years? Check all options that apply. A Advocating for funds B Influencing policies C Workforce planning D Human resources management E Health professional qualification F Education and training G Other (specify): H Not used 3.7 Is the national data on human resources used to support human resources for health planning, development and management processes at all levels? Check all options that apply. A National B Subnational C International D Regional E Other (specify): F Not used 3.8 What strategies are needed to improve the use of human resources data in practical decision-making?

Other comments

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Page 14 Institution 1 (e.g. MoH) Institution 2 Institution 3 Institution 4 Institution 5

Section 4: Summary of findings

Complete the following information for every institution participating in completion of this questionnaire, indicating the acronym (e.g. Ministry of Health MoH) below the institution row as shown in the first column as an example. Attach additional sheets if more space is needed.
Institution 6

2.1

Indicate the type of data on human resources for health collected in this institution on a routine basis.

2.2

How often is this data collected?

2.3

On which sectors of the health workforce do you collect this data?

Country HRIS assessment tool at institutional level

2.4

How are the data collected?

2.5

How are the data compiled into a database or information system?

2.6

Once compiled, are the data of health workers mapped and disseminated using a standard classification for purpose of statistical comparability with other data sources relevant to labour market analysis?

2.7

Are the data of health workers disaggregated by occupational category?

2.8

Are the data of health workers disaggregated by the following characteristics?

2.11 Indicate which population based surveys have been used to complement the data on human resources for health collected by the institution.

3.1

Is there a plan for monitoring and evaluation of human resources for health strategic objectives?

3.2

Do you have a standard set summary of data or set of reports that you produce regularly?

3.3

Who are the principal users of the data and/or reports?

3.4

In what format do you disseminate the data and/or reports?

3.5

How often are these data and/or reports produced?

3.6

How have the national data on human resources been used in the last five years?

3.7

Is the national data on human resources used to support human resources for health planning, development and management processes at all levels?

Country HRIS assessment tool at institutional level

Attachment 1 Examples of institutions that could produce data on human resources for health
The table below gives some examples of institutions that may collect data on HRH as well as a brief description of what kind of data could be produced by these institutions.
Institution/agency National Institute of Statistics Ministry of Defence Ministry of Health Ministry of Finance Migration Office Ministry of Labour Ministry of Interior Medical Council Nurse Council Nurse Association School of Medicine School of Nursing School of Midwifery School of technicians on health Regional health centres Other health workers associations Labour unions Type of data on HRH Number of health workers (occupation) by public/private sector Number of military health workers (head counts) Number of health workers (head counts) Payroll information of all public functionaries Records of all categories of migrant health workers Number of health workers (head counts) Administrative records of health workers (head counts) Registry of public, private and foreign doctors Registry of public, private and foreign nurses Registry of public, private and foreign nurses Records of medical students Records of staff and students from nursing school Records of staff and students from midwifery school Records of staff and students from health technicians Records of health workers at the regional level Registry of public, private and foreign health workers Registry of public, private and foreign health workers

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Country HRIS assessment tool at institutional level

Attachment 2 Type of data on human resources for health (question 2.10)

Please check all options that apply and complete them if necessary. Please refer to the definitions from the Health Workforce Classification Mapping in attachment 3.
Health workers Health professionals Generalist medical practitioner/primary care medical doctors Specialist medical practitioner Nursing professional Midwifery professional Traditional and complementary medicine professional Paramedical practitioner or clinical officer Dentist Pharmacist Environmental and occupational health and hygiene professional Physiotherapist Dietician and nutritionist Audiologist and speech therapist Optometrist and ophthalmic optician Health professional (not elsewhere classified) please specify: Health associate professionals Medical imaging and therapeutic equipment operator Medical and pathology laboratory technician Pharmaceutical technician and assistants Medical and dental prosthetic technician Nursing associate professional/nursing assistant Obstetrics/midwifery associate professional/midwife assistant Traditional and complementary medicine associate professional/complementary medicine technician Dental assistant and therapist Medical records and health information technician Community health worker Dispensing optician Physiotherapy technician and assistants Medical assistant Environmental and occupational health inspector and associates Ambulance worker/emergency medical technician Health associate professional (not elsewhere classified) please specify: Other health associate professionals Health service manager Health care assistant/nursing aide Home-based personal care worker or other home care aide Other health service providers (not elsewhere classified) please specify: Mark

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Country HRIS assessment tool at institutional level

Attachment 2 (continuation)
Fill in all training fields which apply to you and, if necessary, complete them. (SE secondary education; PS post-secondary non-tertiary education; TE tertiary education)
Field of education Medicine Medicine Nursing Nursing and midwifery Midwifery Assistant nursing Assistant midwifery Dental studies Dentistry Pharmacy Clinical/medical services Physiotherapy Optometry Medical/health services Medical technology Ambulance service Environmental health Social work Occupational health Other fields associated with health please specify: Types of education programmes SE PS TE

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Page 18 Definition Examples of occupations classified here Medical doctor (general), medical officer (general), physician (general), general practitioner, family medical practitioner, primary health care physician, district medical doctor, resident medical officer specializing in general practice Notes

Attachment 3 Health Workforce Classification Mapping

Country HRIS assessment tool at institutional level

The classification of health workers is largely based on the International Standard Classification of Occupations (ISCO, 2008 revision), a system for classifying and aggregating occupational information obtained by means of population censuses and other statistical surveys, as well as from administrative records. The classification uses a hierarchical structure of occupational titles and codes, essentially reflecting the distinction of subgroups of the health workforce according to assumed differences in skill level and skill specialization required to fulfil the tasks and duties of jobs. The ISCO tool is intended both for statistical users and for client oriented users, and is the basis for many national occupational classifications.

This mapping gives guidelines on how health workers are to be classified into the most detailed groups, with examples of occupations included and excluded, for purposes of statistical delineation, description and analysis. It is intended to serve as a model to facilitate communication about health occupations, to enhance comparability of data on health workers within and across countries and over time, and to make it possible for data and information on health workers obtained from different sources to be produced in a form which can be useful for research as well as for decisionmaking and action-oriented activities. It is recognized that the full complexity and dynamics of national health labour markets may not be captured.

The classification of health workers maps occupation categories into five broad groupings: health professionals, health associate professionals, personal care workers in health services, health management and support personnel, and other health service providers not elsewhere classified.

Health professionals Health professionals study, advise on or provide preventive, curative, rehabilitative and promotional health services based on an extensive body of theoretical and factual knowledge in diagnosis and treatment of disease and other health problems. They may conduct research on human disorders and illnesses and ways of treating them, and supervise other workers. The knowledge and skills required are usually obtained as the result of study at a higher educational institution in a health-related field for a period of 36 years leading to the award of a first degree or higher qualification.

Occupation group

ISCO code

Generalist medical practitioners

2211

Generalist medical doctors (including family and primary care doctors) diagnose, treat and prevent illness, disease, injury, and other physical and mental impairments and maintain general health in humans through application of the principles and procedures of modern medicine. They plan, supervise and evaluate the implementation of care and treatment plans by other health care providers. They do not limit their practice to certain disease categories or methods of treatment, and may assume responsibility for the provision of continuing and comprehensive medical care to individuals, families and communities.

Occupations included in this category require completion of a university-level degree in basic medical education plus postgraduate clinical training or equivalent. Medical interns who have completed their university education in basic medical education and are undertaking postgraduate clinical training are included here. Although in some countries general practice and family medicine may be considered as medical specializations, these occupations should always be classified here.

Occupation group Specialist physician (internal medicine), surgeon, anaesthetist, cardiologist, emergency medicine specialist, ophthalmologist, gynaecologist, obstetrician, paediatrician, pathologist, preventive medicine specialist, psychiatrist, radiologist, resident medical officer in specialist training

ISCO code

Definition

Examples of occupations classified here

Notes Occupations included in this category require completion of a university-level degree in basic medical education plus postgraduate clinical training in a medical specialization (except general practice) or equivalent. Resident medical officers training as specialist practitioners (except general practice) are included here. Although in some countries stomatology may be considered as a medical specialization, stomatologists should be included under Dentists 2261. Medical research professionals who participate in biomedical research using living organisms and do not undertake clinical practice should be excluded from here (classified under Life science professionals1).

Specialist medical practitioners*

2212

Specialist medical practitioners diagnose, treat and prevent illness, disease, injury and other physical and mental impairments using specialized testing, diagnostic, medical, surgical, physical and psychiatric techniques, through application of the principles and procedures of modern medicine. They plan, supervise and evaluate the implementation of care and treatment plans by other health care providers. They specialize in certain disease categories, types of patient or methods of treatment, and may conduct medical education and research activities in their chosen areas of specialization.

Medical doctors by specialty groupings

Doctors in obstetric and gynaecological specialties and related branches focusing on the care of the reproductive system of women including before, during and after pregnancy and childbirth. Gynaecologist, obstetrician Paediatrician, neonatologist Psychiatrist, child psychiatrist, gerontopsychiatrist, neuropsychiatrist Specialist medical doctor in cardiology, dermato-venerology, forensic medicine, gastroenterology, haematology, immunology, infectious disease, internal medicine, neurology, occupational medicine, oncology, radiology, rehabilitative medicine, respiratory medicine, urology Specialist medical doctor in general surgery, accident and emergency medicine, anaesthesiology, intensive care, neurological surgery, ophthalmology, orthopaedics, otolaryngology, paediatric surgery, plastic surgery, thoracic surgery, vascular surgery

Doctors in paediatrics and related specialties focusing on the prevention, diagnosis and treatment of health problems in infants, children and adolescents.

It is of significance to countries and stakeholders to be able to distinguish the different categories of specialist medical practitioners. For purposes of international comparability, where data pertaining to specialist medical practitioners are reported and classified by medical specialty, they should be mapped to these groupings. Each specialist should only be counted once, according to the main area of practice (or, if this information is not available, the last specialty registered).

Doctors in psychiatric specialties and related branches focusing on the study and treatment of mental illness and behavioural disorders.

Doctors in the medical group of specialties and related branches (not elsewhere classified) focusing on the diagnosis, management and non-surgical treatment of health problems.

Country HRIS assessment tool at institutional level

Doctors in the surgical group of specialties and related branches (not elsewhere classified) focusing on the treatment of health problems with surgery.

Doctors in specialties not elsewhere classified includes medical doctors in specialist practice excepting obstetric, gynaecological, paediatric, psychiatric, surgical or medical specialties as classified elsewhere.

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Page 20 Definition Professional nurse, specialist nurse, nurse practitioner, clinical nurse, district nurse, operating theatre nurse, public health nurse, nurse anaesthetist, nurse educator Examples of occupations classified here Notes Professional midwife Acupuncturist, Ayurvedic practitioner, Chinese herbal medicine practitioner, homeopath, naturopath, Unani practitioner Clinical officer, primary care paramedic, advanced care paramedic, surgical technician, Feldsher Dentist, dental practitioner, dental surgeon, endodontist, oral and maxillofacial surgeon, oral pathologist, orthodontist, paedodontist, periodontist, prosthodontist, stomatologist Hospital pharmacist, industrial pharmacist, retail pharmacist, dispensing chemist Occupations included in this category normally require completion of university-level training in theoretical and practical dentistry or a related field. Although in some countries stomatology and dental, oral and maxillofacial surgery may be considered as medical specializations, occupations in these fields should always be classified here.

Occupation group

ISCO code

Nursing professionals

2221

Nursing professionals provide treatment, support and care services for people who are in need of nursing care due to the effects of ageing, injury, illness or other physical or mental impairment, or potential risks to health, according to the practice and standards of modern nursing. They assume responsibility for the planning and management of the care of patients, including the supervision of other health care workers, working autonomously or in teams with medical doctors and others in the practical application of preventive and curative measures in clinical and community settings.

This category includes occupations for which competent performance usually requires formal training at a higher educational institution in nursing. The distinction between nursing and midwifery professionals and associate professionals should be made on the basis of the nature of the work performed in relation to this definition. The qualifications held by individuals or that predominate in the country are not the main factor in making this distinction, as training arrangements for nurses and midwives vary widely between countries and have varied over time within countries. This category includes occupations for which competent performance usually requires formal training at a higher educational institution in midwifery. The distinctions between nursing and midwifery professionals and associate professionals should be made on the basis of the nature of the work performed in relation to this definition. The qualifications held by individuals or that predominate in the country are not the main factor in making this distinction, as training arrangements for nurses and midwives vary widely between countries and have varied over time within countries. This category includes occupations for which competent performance requires an extensive understanding of the benefits and applications of traditional and complementary therapies, developed as the result of extended formal study of these techniques as well as human anatomy and elements of modern medicine. Practitioners working in the singular application of approaches to herbal medicines, spiritual therapies or manual therapeutic activity are excluded from here. Occupations included in this category normally require completion of tertiary-level training in theoretical and practical medical services. Workers providing services limited to emergency treatment and ambulance practice are classified under Ambulance workers 3258.

Country HRIS assessment tool at institutional level

Midwifery professionals

2222

Midwifery professionals plan, manage, provide and evaluate midwifery care services before, during and after pregnancy and childbirth. They provide delivery care for reducing health risks to women and newborn children according to the practice and standards of modern midwifery, working autonomously or in teams with other health care providers. They may conduct research on midwifery practices and procedures, and implement midwifery education activities in clinical and community settings.

Traditional and complementary medicine professionals

2230

Traditional and complementary medicine professionals examine patients and prevent and treat illness, disease, injury and other physical, mental and psychosocial ailments by applying knowledge, skills and practices acquired through extensive study of the theories and experiences originating in specific cultures. They research, develop and implement treatment plans using applications such as acupuncture, ayurvedic, homoeopathic and herbal medicine.

Paramedical practitioners

2240

Paramedical practitioners (including clinical officers and related) provide advisory, diagnostic, curative and preventive medical services more limited in scope and complexity than those carried out by medical doctors. They work autonomously or with limited supervision of medical doctors, and perform clinical, therapeutic and surgical procedures for treating and preventing diseases, injuries, and other physical or mental impairments common to specific communities.

Dentists

2261

Dentists (including dental surgeons and related) diagnose, treat and prevent diseases, injuries and abnormalities of the teeth, mouth, jaws and associated tissues by applying the principles and procedures of modern dentistry. They use a broad range of specialized diagnostic, surgical and other techniques to promote and restore oral health.

Pharmacists

2262

Pharmacists store, preserve, compound and dispense medicinal products. They counsel on the proper use and adverse effects of drugs and medicines following prescriptions issued by medical doctors and other health professionals. They contribute to researching, testing, preparing, prescribing and monitoring medicinal therapies for optimizing human health.

Occupations included in this category normally require completion of university-level training in theoretical and practical pharmacy, pharmaceutical chemistry or a related field. Pharmacologists and related professionals who study living organisms are excluded from here (classified under Life science professionals1).

Occupation group Environmental health officer, occupational health and safety adviser, occupational hygienist, radiation protection adviser Physiotherapist, geriatric physical therapist, orthopaedic physical therapist, paediatric physical therapist

ISCO code

Definition

Examples of occupations classified here

Notes This category includes occupations for which competent performance usually requires formal training at a higher educational institution in environmental or occupational health and safety, or a related field. Professionals who assess, plan and implement programmes to monitor or control the impact of human activities on the environment are excluded from here (classified under Life science professionals1). This category includes occupations for which competent performance usually requires formal training at a higher educational institution in physiotherapy or a related field.

Environmental 2263 and occupational health and hygiene professionals

Environmental and occupational health and hygiene professionals assess, plan and implement programs to recognize, monitor and control environmental factors that can potentially affect human health, to ensure safe and healthy working conditions, and to prevent disease or injury caused by chemical, physical, radiological and biological agents or ergonomic factors.

Physiotherapists

2264

Physiotherapists assess, plan and implement rehabilitative programs that improve or restore human motor functions, maximize movement ability, relieve pain syndromes, and treat or prevent physical challenges associated with injuries, diseases and other impairments. They apply a broad range of physical therapies and techniques such as movement, ultrasound, heating, laser and other techniques. They may develop and implement programmes for screening and prevention of common physical ailments and disorders.

Dieticians and nutritionists

2265

Dieticians and nutritionists assess, plan and implement programs to enhance the impact Dietician, clinical dietician, food service of food and nutrition on human health. They may conduct research, assessments and dietician, nutritionist, public health education to improve nutritional levels among individuals and communities. nutritionist, sports nutritionist

This category includes occupations for which competent performance usually requires formal training at a higher educational institution in food and nutritional science, nutrition education, dietetics, or a related field. This category includes occupations for which competent performance usually requires formal training at a higher educational institution in audiology, speech pathology, clinical language sciences or a related field.

Audiologists and speech therapists

2266

Audiologists and speech therapists evaluate, manage and treat physical disorders Audiologist, speech therapist, speech affecting human hearing, speech communication and swallowing. They prescribe corrective pathologist, language therapist devices or rehabilitative therapies for hearing loss, speech disorders, and related sensory and neural problems. They plan hearing screening programs and provide counselling on hearing safety and communication performance.

Optometrists and ophthalmic opticians Chiropractor, osteopath, podiatrist, occupational therapist, recreational therapist, arts therapist, dance and movement therapist

2267

Optometrists and ophthalmic opticians provide diagnosis, management and treatment Optometrist, ophthalmic optician, services for disorders of the eyes and visual system. They counsel and advise on eye care and orthoptist safety, and prescribe optical aids or other therapies for visual disturbance.

This category includes occupations for which competent performance usually requires formal training at a higher educational institution in optometry, orthoptics or a related field. This category includes occupations for which competent performance usually requires formal training at a higher educational institution in a health related field. Although in some jurisdictions chiropractic and osteopathic are considered to have the attributes of medical specialties, practitioners in these disciplines should always be classified here.

Health professionals not elsewhere classified

2269

This group covers health professionals not classified elsewhere such as chiropractors, osteopaths, podiatrists, occupational therapists, recreational therapists and other professionals providing diagnostic, preventive, curative and rehabilitative health services.

Health associate professionals Health associate professionals perform technical and practical tasks to support diagnosis and treatment of illness, disease, injuries and impairments, and to support implementation of health care, treatment and referral plans usually established by medical, nursing and other health professionals. Appropriate formal qualifications are often an essential requirement for entry to these occupations; in some cases relevant work experience and prolonged on-the-job training may substitute for the formal education. Definition Examples of occupations classified here Notes This category includes occupations for which competent performance usually requires formal training in medical technology, radiology, sonography, nuclear medical technology or a related field.

Occupation group

ISCO code

Country HRIS assessment tool at institutional level

Medical imaging and therapeutic equipment technicians

3211

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Medical imaging and therapeutic equipment technicians test and operate radiographic, ultrasound and other medical imaging equipment to produce images of body structures for the diagnosis and treatment of injury, disease and other impairments. They may administer radiation treatments and monitor patients conditions under the supervision of a radiologist or other health professional.

Diagnostic medical radiographer, medical radiation therapist, magnetic resonance imaging technologist, nuclear medicine technologist, mammographer, sonographer

Occupation group Medical laboratory technician, medical laboratory assistant, blood bank technician, cytology technician, pathology technician Pharmaceutical technician, pharmaceutical assistant, dispensing technician

ISCO code

Definition

Examples of occupations classified here

Notes This category includes occupations for which competent performance usually requires formal training in biomedical science, medical technology or a related field. Technicians who conduct laboratory tests on living organisms should be classified under Life science technicians. Forensic science technicians, who perform clinical tests to aid in the investigation of crimes, should be classified under Physical and engineering science technicians1. Occupations included in this category normally require knowledge and skills in pharmaceutical services as obtained through formal training. Pharmacology technicians and related associate professionals who work with living organisms are excluded from here (classified under Life science technicians1). Occupations included in this category normally require some medical, dental and anatomical knowledge obtained through formal training. Technicians who construct and repair precision medical and surgical instruments are excluded from here (classified under Trade workers1).

Page 22 Medical appliance technician, orthotist, orthotic technician, prosthetist, prosthetic technician, denturist, dental technician Assistant nurse, enrolled nurse, practical nurse Assistant midwife, traditional midwife Acupuncture technician, Ayurvedic technician, bonesetter, herbalist, homeopathy technician, scraping and cupping therapist, village healer, witch doctor

Medical and pathology laboratory technicians

3212

Medical and pathology laboratory technicians perform clinical tests on specimens of bodily fluids and tissues in order to get information about the health of a patient or cause of death. They test and operate equipment such as spectrophotometers, calorimeters and flame photometers for analysis of biological material including blood, urine and spinal fluid.

Pharmaceutical technicians and assistants

3213

Pharmaceutical technicians and assistants perform a variety of tasks associated with dispensing medicinal products under the guidance of a pharmacist or other health professional. They inventory, prepare and store medications and other pharmaceutical compounds and supplies, and may dispense medicines and drugs to clients and instruct on their use as prescribed by health professionals.

Country HRIS assessment tool at institutional level

Medical and dental prosthetic technicians

3214

Medical and dental prosthetic technicians design, fit, service and repair medical and dental devices and appliances following prescriptions or instructions established by a health professional. They may service a wide range of support instruments to correct physical medical or dental problems such as neck braces, orthopaedic splints, artificial limbs, hearing aids, arch supports, dentures, and dental crowns and bridges.

Nursing associate professionals

3221

Nursing associate professionals provide basic nursing and personal care for people in need of such care due to effects of ageing, illness, injury, or other physical or mental impairment. They provide health advice to patients and families; monitor patients conditions; and implement care, treatment and referral plans usually established by medical, nursing and other health professionals.

This category includes occupations for which competent performance usually requires knowledge and skills obtained as the result of study in nursing; in some cases, extensive on the-job training may substitute for the formal education formal. The criteria for inclusion of individuals in this category should be made on the basis of the nature of the work performed in relation to this definition, and not the qualifications held by individuals or that predominate in the country. This category includes occupations for which competent performance requires knowledge and skills in routine and emergency midwifery care acquired through formal or informal training. The criteria for inclusion of individuals in this category should be made on the basis of the nature of the work performed in relation to this definition, and not the qualifications held by individuals or that predominate in the country. Traditional and lay midwives, who provide basic pregnancy and birthing care and advice based primarily on experience and knowledge acquired informally through the traditions and practices of the communities where they originated, are included here. Birth assistants, who provide emotional support and general care and advice to women and families during pregnancy and labour, are excluded from here (classified under Personal care workers in health services). This category includes occupations for which competent performance requires knowledge and skills acquired through relatively short periods of education and training, or informally through the traditions and practices of the communities where they originated. Faith healers, who treat human ailments through spiritual therapies, without using herbal therapies or other medicaments or physical treatments, are excluded from here (classified under Religious associate professionals). Occupations that provide therapy using traditional forms of massage and the application of pressure, such as acupressure and shiatsu therapists, are classified under Physiotherapy technicians and assistants 3255.

Midwifery associate professionals

3222

Midwifery associate professionals provide basic health care and advice before, during and after pregnancy and childbirth. They provide advice to women, families and communities on birth and emergency plans, breastfeeding, infant care, family planning and related topics; monitor health status during pregnancy and childbirth; and implement care, treatment and referral plans usually established by medical, midwifery and other health professionals.

Traditional ad compementary medicine associate professionals

3230

Traditional and complementary medicine associate professionals prevent, care for and treat physical and mental illnesses, disorders and injuries using herbal and other therapies based on theories and experiences originating in specific cultures. They administer treatments using traditional techniques and medicaments, either acting independently or according to therapeutic care plans established by a traditional medicine or other health professional.

Occupation group Dental assistant, dental hygienist, dental therapist

ISCO code

Definition

Examples of occupations classified here

Notes This category includes occupations for which competent performance usually requires formal training in dental hygiene, dental-assisting or a related field.

Dental assistants 3251 and therapists

Dental assistants and therapists provide basic dental care services for the prevention and treatment of diseases and disorders of the teeth and mouth, as per care plans and procedures established by a dentist or other oral health professional. They examine patients mouths, teeth and related structures to assess oral health status; provide advice on dental hygiene; perform basic or routine clinical dental procedures; and assisting dentists during complex dental procedures. Medical records technician, health information clerk, medical records analyst, medical records unit supervisor, clinical coder, disease registry technician Community health worker, community health aide, community health promoter, village health worker Dispensing optician, contact lens optician Physiotherapy technician, physical rehabilitation technician, acupressure therapist, electrotherapist, hydrotherapist, massage therapist, shiatsu therapist

Medical records and health information technicians

3252

Medical records and health information technicians develop, implement and assess health records processing, storage and retrieval systems in medical facilities and other health care settings to meet the legal, professional, ethical and administrative recordskeeping requirements of health services delivery.

Occupations included in this category require knowledge of medical terminology, legal aspects of health information, health data standards, and computer- or paper-based data management as obtained through formal education and/or prolonged on-the-job training. General secretarial or clerical workers are excluded from here. Occupations included in this category normally require formal or informal training and supervision recognized by the health and social services authorities. Providers of routine personal care services and traditional medicine practitioners are not included here. This category includes occupations for which competent performance usually requires formal training in opticianry. This category includes occupations for which competent performance usually requires formal training in physical rehabilitation therapy or a related field. Fitness instructors, who teach body movements used in fitness routines and recreational activities, are excluded from here (classified under Social, cultural and related associate professionals).

Community health workers

3253

Community health workers provide health education, referral and follow up, case management, and basic preventive health care and home visiting services to specific communities. They provide support and assistance to individuals and families in navigating the health and social services system.

Dispensing opticians

3254

Dispensing opticians design, fit and dispense optical lenses based on a prescription from an ophthalmologist or optometrist for the correction of reduced visual acuity. They service corrective eyeglasses, contact lenses, low-vision aids and other optical devices.

Physiotherapy technicans and assistants

3255

Physiotherapy technicians and assistants provide physical therapeutic treatments to patients in circumstances where functional movement is threatened by injury, disease or impairment. They fit patients for physical supportive devices and administer and monitor manual treatments, electrical modality treatments, ultrasound and other physical therapies. Therapies are usually provided as per rehabilitative plans established by a physiotherapist or other health professional.

Medical assistants

3256

Medical assistants perform basic clinical and administrative tasks to support patient Medical assistant, clinical assistant, care under the direct supervision of a medical practitioner or other health professional. ophthalmic assistant They perform routine tasks and procedures such as measuring patients vital signs, administering medications and injections, recording information in medical records-keeping systems, preparing and handling medical instruments and supplies, and collecting and preparing specimens of bodily fluids and tissues for laboratory testing. Health inspector, food sanitation and safety inspector, occupational health and safety inspector, sanitarian, sanitary inspector

This category includes occupations for which competent performance normally requires formal training in health services provision. Clinical care providers with advanced training and skills to provide independent medical diagnostic and treatment services should be classified under Paramedical practitioners 2240.

Country HRIS assessment tool at institutional level

Environmental 3257 and occupational health inspectors and associates

Environmental and occupational health inspectors and associates investigate the implementation of rules and regulations relating to environmental factors that can potentially affect human health, health and safety in the workplace, and safety of processes for the production of goods and services. They may implement and evaluate programmes to restore or improve safety and sanitary conditions under the supervision of a health professional.

This category includes occupations for which competent performance usually requires formal training in sanitary sciences, occupational and institutional safety and sanitation, or a related field.

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Occupation group

ISCO code

Definition

Examples of occupations classified here

Notes Occupations included in this category normally require formal training in emergency medical treatment, patient transport, ambulance principles and practice, or a related field. Ambulance drivers who do not provide health care are excluded from here (classified under Plant and machine operators1).

Page 24 Definition Health facility administrator, medical administrator, clinical director, director of nursing, hospital matron, community health care coordinator, chief public health officer Examples of occupations classified here Notes Nursing aide (home), home care aide, home birth assistant, personal care provider

Ambulance workers

3258

Ambulance workers provide emergency health care to patients who are injured, sick, Ambulance officer, ambulance infirm or otherwise physically or mentally impaired prior to and during transport to medical, paramedic, emergency medical rehabilitation and other health care facilities. They monitor changes in health status of technician, emergency paramedic patients during transport and perform procedures according to protocol or emergency medical treatment. They may patrol and provide information on first aid at large-scale public gatherings and other events where health emergencies are more likely to occur.

Health associate professionals not elsewhere classified

3259

This group covers health associate professionals not elsewhere classified including, Respiratory therapy technician, for instance, respiratory and anaesthesia technicians, HIV counsellors and others performing anaesthesia technician, HIV counsellor, technical tasks and providing support for diagnostic, preventive, curative, promotional and family planning counsellor. rehabilitative health services.

This category includes occupations for which competent performance usually requires formal training in health service provision.

Country HRIS assessment tool at institutional level

Other health associate professionals Other health associate professionals include a wide range of other types of health systems personnel, such as health service managers, health economists, health policy lawyers, biomedical engineers, medical physicists, clinical psychologists, social workers, medical secretaries, ambulance drivers, building maintenance staff, and other general management, professional, technical, administrative and support staff. Personal care workers provide direct personal care services in health care and residential settings, assist with health care procedures, and perform a variety of other tasks of a simple and routine nature for the provision of health services. These occupations typically require relatively advanced literacy and numeracy skills, a high level of manual dexterity, and good interpersonal communication skills.

Occupation group

ISCO code

Health service managers

1342

Health service managers plan, direct, coordinate and evaluate the provision of clinical and community health care services in hospitals, clinics, public health agencies and similar organizations. They provide overall direction, policy standards and operational criteria for the units they manage, including supervising and evaluating the recruitment, training and work activities of personnel. They monitor the use of health services and resources. They liaise with other health and welfare service providers, boards and funding bodies to coordinate the provision of services.

The main tasks and duties for jobs in this occupational category include guiding and directing the activities of organizations, departments and other workers, and other tasks which require complex problem solving and decision-making based on knowledge and skills normally obtained as the result of some combination of higher education, extensive work experience and prolonged on-the-job training.

Health care assistant

5321

Health care assistants provide routine personal care, support and assistance with Nursing aide (hospital or clinic), patient activities of daily living to patients and residents in a variety of health care settings such as care assistant, birth assistant (hospital hospitals, clinics and residential nursing care facilities. They assist patients with personal, or clinic), psychiatric aide physical mobility and therapeutic care needs as per established care plans and practices, and generally under the direct supervision of medical, nursing or other health professionals or associate professionals.

Occupations included in this category generally do not require extensive health care knowledge or training. Classified here are workers providing services in health care settings such as hospitals, health care facilities, rehabilitation centres, residential nursing care facilities, and other establishments with permanent medical or nursing supervision.

Home-based personal care workers

5322

Home-based personal care workers provide routine personal care, support and assistance with activities of daily living to persons who are in need of such care due to effects of ageing, illness, injury, or other physical or mental condition in private homes and other independent residential settings. They assist clients with personal, physical mobility and therapeutic care needs, usually as per care plans established by a health professional.

Occupations included in this category generally do not require extensive health care knowledge or training. Classified here are workers providing services in primary residential settings including assisted-living facilities, continuing care retirement communities, and other types of residential facilities with minimal or no on-site medical or nursing supervision. Home birth assistants, who provide emotional support and general care and advice to women and families during pregnancy and labour, but not delivery care to reduce health risks, are included here. Care workers who provide care and supervision for children in residential homes and care centres are excluded from here.

Occupation group Dental aide, first-aid attendant, hospital orderly, medical imaging assistant, pharmacy aide, phlebotomist, sterilization aide Medical student intern, hospital volunteer

ISCO code

Definition

Examples of occupations classified here

Notes

Personal care workers in health services not elsewhere classified

5329

This group covers personal care workers in health services not classified elsewhere including, for instance, dental aides, hospital orderlies, medical imaging assistants, pharmacy aides and other providers of routine health and personal care support services.

Other health service providers (not elsewhere classified)

This group covers other categories not classifiable as participating in the formal or informal health labour market but providing health services including, for instance, medical interns and trainees who are providing clinical services as part of their basic medical education.

See International Standard Classification of Occupations: ISCO-08.

Source: Adapted from International Labour Organization, International Standard Classification of Occupations: ISCO-08 (http://www.ilo.org/public/english/bureau/stat/isco/index.htm).

Country HRIS assessment tool at institutional level

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World Health Organization Department of Human Resources for Health 20 avenue Appia 1211 Geneva 27 Switzerland