A longitudinal WISN analysis in Ajmer District, Rajasthan (2021-2024) examines systematic deficiencies in the human resource norms of Indian Public Health Standards (IPHS) at 24x7 primary and secondary health centres as part of a critical evaluation

<title>Abstract</title> <p>Background Indian Public Health Standards (IPHS) were introduced to improve infrastructure and staffing in public sector health facilities. However, staffing norms remain largely population-based and may not adequately capture variations in service demand, geographic accessibility, and continuous service delivery requirements in rural settings. Objective To estimate workload-based staffing requirements using the World Health Organization Workload Indicators of Staffing Need (WISN) methodology and examine longitudinal trends in staffing adequacy in public health facilities. Methods A longitudinal secondary data analysis was conducted across 108 public health facilities in Ajmer district, Rajasthan, between 2021–22 and 2023–24. Service utilisation data and workforce records were obtained from administrative health information systems. Cadre-wise staffing requirements were calculated using WISN ratios and categorised into workload pressure levels. Results Outpatient attendance increased by approximately 10% and inpatient admissions by over 50% during the study period, whereas antenatal registrations and institutional deliveries declined. Persistent vacancies were observed across cadres, particularly among nursing and paramedical staff. In 2023–24, WISN ratios indicated critical shortages among Medical Officers (0.42), Staff Nurses (0.45), Pharmacists (0.12), and Laboratory Technicians (0.31). Longitudinal analysis demonstrated progressive deterioration in staffing adequacy, with a majority of facilities experiencing high workload pressure. Conclusion Current IPHS staffing norms may underestimate workforce requirements for continuous service delivery in rural healthcare facilities. Incorporating workload-based workforce planning approaches into routine health system management could improve staffing distribution and strengthen primary healthcare performance.</p>