Human resource assessment for scaling up VL active case detection in Bangladesh, India and Nepal E. Naznin 1 , A. Kroeger 1,2 , N. A. Siddiqui 3 , S. Sundar 4 , P. Malaviya 4 , D. Mondal 5 , M. M. Huda 5 , P. Das 3 , P. Karki 6 , M. R. Banjara 7 , N. Dreesch 8 and G. Gedik 8 1 Special Programme for Research and Training in Tropical Diseases, World Health Organization, Geneva, Switzerland 2 Liverpool School of Tropical Medicine, Liverpool, UK 3 Rajendra Memorial Research Institute of Medical Sciences, Patna, India 4 Banaras Hindu University, Varanasi, India 5 International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B), Dhaka, Bangladesh 6 University of Heidelberg, Heidelberg, Germany 7 Institute of Medicine, Tribhuvan University, Kathmandu, Nepal 8 Department of Human Resources for Health, World Health Organization, Geneva, Switzerland Abstract objectives To determine whether medical staff at PHC level would have the time to take up additional activities such as 1-day fever camps for active VL case detection. methods This article assessed the workload of health staff of different professional categories working at health facilities in Bangladesh, India and Nepal. Data were collected from different sites in high endemic VL areas. The study population was the health staff of government health facilities at all levels. Workload indicators of staffing need (WISN) software were adopted to carry out the analysis of staff workload and their availability in the selected health facility. The WISN difference and WISN ratio for a particular health facility were calculated from actual staffing available and calculated staffing requirement. results The results showed a mixed picture of the availability of health workers. In most settings of Bangladesh and India, physicians with or without laboratory technicians would have time for active case detection. In Nepal, this would be performed by trained nurses and paramedical personnel. conclusion If all vacant posts were filled, active case detection could be performed more easily. The elimination programme can be scaled up with the current staffing levels in the endemic areas with some short training if and when necessary. keywords visceral leishmaniasis (kala-azar), active case detection, workload indicators of staffing need, Bangladesh, Nepal, India Introduction The objective of any health policy is to maximise the benefits gained from the use of societal resources devoted to health development. Scarcity of staff is one of the major barriers to delivering adequate healthcare services in many poor countries, and staff shortages are a growing concern particularly in rural areas and especially when locally developed health programmes have to be ‘scaled up’ to national level. ‘Scaling up’ refers to extending health intervention coverage for the benefit of larger pop- ulations and support policy and programme development at a large or national scale (Simmons et al. 2007). A scal- ing up programme requires human resources for health service delivery, and their unavailability poses a foremost constraint (Kurowski et al. 2003). Unfortunately, most of the international health-related development goals are set in the form of health outcome, but barely discuss health workers required to achieve pre-set goals (Kurowski et al. 2003). Unavailability of health staff could be the result of geographical imbalance in the distribution despite of adequate numbers at national level (Hongoro & McPake 2004). Another issue is optimum use of staff productivity to bridge the staffing gap (Kurowski et al. 2003), as research in Tanzania and Chad has shown: health staff provided a work volume of only 50–60% of what they were hired for. Other studies showed that the present workforce would be sufficient to scale up activities in AIDS control (Simba et al. 2004). In another context, additional nurses were needed for quality perinatal care because the existing workforce was already working under huge workload pressure (Nyamtema et al. 2008). 734 © 2013 John Wiley & Sons Ltd Tropical Medicine and International Health doi:10.1111/tmi.12124 volume 18 no 6 pp 734–742 june 2013