Working in Health: Financing and Managing the Public Sector Health Workforce

by Marko Vujicic, Kelechi Ohiri, Susan Sparkes, Aly Sy, Tim Martineau

Overview

'Working in Health' addresses two key questions related to health workforce policy in developing countries: • What is the impact of government wage bill policies on the size of the health wage bill and on health workforce staffing levels in the public sector? • Do current human resources management policies and practices lead to effective use of wage bill resources in the public sector? Health workers play a key role in increasing access to health services for poor people in developing countries. Global and country level estimates show that staffing levels in many developing countries—particularly in sub-Saharan Africa—are far below what is needed to deliver essential health services to the population. One factor that potentially limits scaling up the health workforce in developing countries is the government overall wage bill policy which sometimes creates restrictions. Through a review of literature, analysis of data, and country case studies in Kenya, Zambia, Rwanda, and the Dominican Republic, this book examines the process that determines the health wage bill budget in the public sector, how this is linked to overall wage bill policies, how this affects staffing levels in the health sector, and the relevant policy options. But staff numbers are not everything and more money for the health wage bill alone will not solve the health workforce problems of developing countries. 'Working in Health' looks at how effectively governments use the available wage bill resources in the health sector and policy options. Policies and practices in recruitment, deployment, promotion, transfer, sanctioning, and remuneration for health workers are reviewed to identify their influence on budget execution rates, geographic distribution, and productivity of health workers.

Product Details

ISBN-13:	9780821378021
Publisher:	World Bank Publications
Publication date:	04/22/2009
Series:	Directions in Development - Human Development
Pages:	320
Product dimensions:	5.90(w) x 8.90(h) x 0.80(d)

Table of Contents

Foreword xv

Acknowledgments xix

Executive Summary xxi

Abbreviations xxvii

Chapter 1 Overview 1

The Wage Bill Budgeting Process in the Public Sector 7

The Effect of the Wage Bill Budgeting Process on the Health Workforce 21

Managing Health Wage Bill Resources in the Public Sector 24

Policy Options to Address Fiscal Constraints on the Health Wage Bill and to Improve Management of the Health Workforce in the Public Sector 37

Notes 55

References 55

Chapter 2 Background Country Study for Kenya 61

The Health Wage Bill in Kenya 62

Public Sector Employment of Health Workers 74

Key Messages 87

Notes 90

References 91

Chapter 3 Background Country Study for Zambia 93

The Health Wage Bill in Zambia 94

Public Sector Employment of Health Workers 108

Key Messages 121

Notes 123

References 125

Chapter 4 Background Country Study for Rwanda 127

The Health Wage Bill in Rwanda 127

Public Sector Employment of Health Workers 139

Donor Funding of Health and Education Workers' Salaries 148

Key Messages 150

Annex 152

Notes 162

References 162

Chapter 5 Background Country Study for the Dominican Republic 165

The Health Wage Bill in the Dominican Republic 166

Public Sector Employment of Health Workers 182

Key Messages 194

Notes 197

References 197

Appendix A Comparative Analysis of Health Outcomes, Service Delivery, and Health Workforce Levels in Kenya, Zambia, Rwanda, and the Dominican Republic 199

Appendix B Analysis of the Share of Government Health Expenditure Going to the Health Wage Bill: Some Stylized Facts 207

Appendix C Decentralization and Human Resources for Health 215

Appendix D Review of Alternative Compensation Methods forHealth Workers 233

Appendix E Review of GFATM Round 6 and GAVI HSS Round 1 Policies and Practices for Funding Health Workers Remuneration 253

Index 265

Boxes

Chapter 1 Overview 1

1.1 Challenges of Civil Service and Administrative Reform 39

1.2 The Kenya Emergency Hiring Program: A Promising Practice in Using Donor Assistance to Scale Up the Health Workforce 45

1.3 Summary of Policies and Practices in GFATM and GAVI HSS for Remuneration of Health Workers 46

1.4 Political Economy of Removing Health Workers from the Civil Service 53

Chapter 3 Background Country Study for Zambia 93

3.1 Confirming That an Existing Post Has Become Vacant 113

Appendix C Decentralization and Human Resources for Health 215

C.1 A Tale of Two Ugandas: Successes and Failures in Administrative Efficiency under Decentralized Human Resources Management 222

Appendix D Review of Alternative Compensation Methods for Health Workers 233

D.1 Provider Payment Mechanisms and Performance: How Fee-for-Service, Capitation, and Salaried Systems Affect Health Worker Performance 238

D.2 Case Study: Performance Contracts with Physicians in Romania 242