The Descriptive Analysis of the Workload at Referral Hospitals in Cambodia: the Need of Public Health Related Skills


Complementary package of activities
Public health skills
Referral hospitals
Workload indicators of staffing needs



Referral hospitals (RH) are to serve the population at province or district levels by providing Complementary Package of Activities (CPA). Besides conventional clinical services offered at the RH, other services are equally essential in supporting the operation of a hospital such as providing health education to patients and their care takers, conducting orientation and continuing education to health staff, providing technical support and supervision. This paper aimed to quantify the workload of public health related activities performed at CPA1 hospitals in Cambodia and to reflect the need of these skills in the hospital settings.


The data were based on the WHO-WISN application (Workload Indicator of Staffing Need) conducted in 12 RHs with CPA1 from 12 provinces in Cambodia in 2021.  WISN tools were used to calculate the total person-time available to perform all the task for each staff, and the service activities were used to estimate the workload for each task.


All 12 RHs with CPA1 have established services mainly into main four categories, namely out-patient, in-patient, diagnostic and treatment, and administration and management support. On average, each CPA1 hospital employed a total of 50 staff. However, no public health professionals have been employed in these RHs. The results from the workload analysis in 2021 revealed that high proportion of person-hour spent at a CPA1 hospital was on treatment and care. Public health tasks accounted for 17% of the total workload, while the tasks related to health prolonging life accounted for 68% and non-health tasks) accounted for 15%.


Workload analysis of staff working found that close to one in five of the total workload performed by RH staff required public health skills. Therefore, the RHs need health professionals who have skills in hospital management, planning, health promotion and prevention.  Further research is needed to estimate the magnitude of the need of public health skills more accurately if all activities included in the CPA guideline to be offered at the CPA1.