Preparing for Paediatric Service Redesign (PREPARE) in a Low-Income Country: exploring the needs and capacity of producing paediatric workforce in Bur

Background
Despite Burundi aspiring to deliver on a universal health coverage agenda, this is undermined by severe shortage and maldistribution of health workers.1 With attention to the quantity of trained health personnel, for instance, the number of medical doctors per 10 000 population did increase from 0.28 in 2010 to 1.00 in 2017 but remains low.2 Achieving neonatal, child, and adolescent health targets by 2030 especially in Burundi requires the redesign of health systems to meet the needs of all childern.3,4 One pillar of any redesign is development of a paediatric workforce that is appropriate for the context and the major health challenges experienced.3 This study aims to examine the current status and plans for development of the paediatric workforce in Burundi and how it might meet current and future population needs as part of universal health coverage. Further, it will examine the costs of producing and employing different types of paediatric health workers and explore what future professional skill-mix might both meet priority paediatric service delivery needs while promoting equity in access. The study findings will inform paediatric workforce development policy and services redesign as part of delivering on the aspirations of universal health coverage and meeting the 2030 global targets.

Research questions
RQ1. What do national strategy and policy documents indicate is planned in terms of numbers and mix of paediatric professionals and their roles and what forms of task-sharing across different professionals are either explicit or implicit in current policies?
RQ2. Do the current number, roles, distribution and mix of paediatric professionals respond to the needs as planned in national strategy and regional / global policy documents?
RQ3. What are the financial costs of producing and employing different cadres of professional health workers and what is the likely budget impact, or affordability, of expanding the workforce in line with national or global policy recommendations?
RQ4. What should be included in a priority national package of paediatric services as part of universal health coverage, what alternative models of professional skill-mix might be used to deliver such a package and what trade-offs might alternative skill-mix models have in terms of health outcomes and equity of access?

Methods
The first question will be answered by conducting a national policy document review in relation to paediatric staffing (numbers, distribution and skills), their roles and the forms of task-sharing arrangements complemented with key informants interviews.
In the second stage, a cross-sectional descriptive mapping of the number, roles and mix of paediatric professionals will be done using secondary data from the Ministry of Health and the Ministry of Labour5. Also, given the small size of Burundi's health workforce and the country as a territory, it may be possible to conduct primary data collection. Findings from the above two objectives will be used to estimate the real-time paediatric workforce gap.
Financial costs of training will be assessed using a provider perspective (government) by looking at the actual budget going into training plus direct payments from trainees. Total educational financial costs6 will be analysed for different medical cadres. We will continue with the analysis of the health labour market using the framework for analysis of the health labour market.7-10 In the second instance, the actual annual financial costs of employing different paediatric cadres will be estimated using employee-based data.
Finally, an expert / policy maker panel supplemented with selected paediatric health professionals will be convened to define / prioritise the most important paediatric services or packages and level(s) of the health system they should be provided at. Based on expert consensus and scenario trade-offs, we will develop economic scenarios / models to inform policy making.