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Sri Lanka has a well-established primary health care system in which the public health midwives (PHMs) play a pivotal role. Sri Lanka has a total of 7087 field PHMs. Many stakeholders and public health experts believe that full-time equivalents of existing PHMs in the system are not adequate for performing all the tasks assigned to them by various programmes. Furthermore, the country is now facing several added challenges such as rapidly ageing population and increased non-communicable diseases, which also expand the PHMs role. To date, a systematic assessment of PHMs' workload-based staffing needs that consider traditional and newly emerging roles of PHMs has not been carried out. Objectives: To define the current workload of field public health midwives in Sri Lanka and estimate their workload  indicator-based staffing needs Methods: This study used a Workload Indicators of Staffing Needs (WISN) methodology to estimate the PHMs' staffing needs in Sri Lanka. The scope of work and workload components of PHMs were determined using a desk review and a consultative process. The workload and total interventions to be implemented by the PHMs were assessed using One Health Tool. Activity standards were set using a time motion study. Finally, WISN software was used to estimate the staffing requirements. Results: The analysis of time requirements of various programs related interventions indicated that the major share of PHM's time is utilized by the maternal and new-born program (45%), childcare programs (45%) and nutrition care (7%). Study showed that at least one field PHM is required per 1878 population to meet the current service demands, implying that Sri Lanka needs further 4525 field PHMs to meet the current needs. Conclusions: Currently, there is an acute shortage of field PHMs in Sri Lanka. The Ministry of Health should take steps to train more PHMs, in order to provide an optimum service.

Burden of work and workload indicator-based staffing needs of public health midwives in the primary health care system in Sri Lanka