One of the main causes of shortages is inadequate numbers of persons with appropriate education and training entering the health workforce labour market. Many low and middle-income countries do not have the sophisticated data collection systems needed by ministries of health and education to assess unmet needs nor the capacity to analyse and utilize this data to inform and strategically envision, determine, and plan health workforce strategies.
It is critical to monitor and track each of the components of capacity and output. By drawing on assessments of oversupply or undersupply of various cadres of the active health workforce, institutional capacity for producing new health workers can be reduced or increased, or training programmes for new cadres can be developed. This information can be used to identify the specific bottlenecks in capacity so that if rapid increases in production are required, capacity can be increased accordingly.
Monitoring the intake of students into health professional programmes and pass/failure rates on licensing and certification exams may indicate problems with entry requirements, the curricula, the teaching methods used or a number of other issues such as the lack of clinical placements, or a combination of factors. Each situation would have to be evaluated to determine where the problems lie.
An important consideration, in addition to the number of graduates who are certified to practice, is their locale of practice upon graduation. High departure rates, through exit from the health sector or through migration to other countries, is an indicator of major retention problems that require the immediate attention of policy-makers. The same applies if data show an overconcentration of new graduates in well-served areas and organizations. There are cases where graduates succeed in the institutional proficiency tests, but fail the certification exam, indicating a mismatch in the level of proficiency expected at the institutional versus the certification level.
In settings with extreme shortages or uneven distribution of highly skilled service providers, it is important to institute mechanisms to monitor the quality of the large cadres of lower skilled workers who are trained to meet the immediate needs for basic health services among unserved and underserved, mainly rural communities. Since these workers will often be the first point of contact with the formal health-care system, and therefore will represent the system at the community level, guaranteeing the quality of their training and practice through proper certification and supervision is of extreme importance.