Person:
Lemiere, Christophe
Author Name Variants
Fields of Specialization
Human resources for health,
Health labor markets
Degrees
Externally Hosted Work
Contact Information
Last updated
January 31, 2023
Biography
Christophe Lemiere is a senior health specialist for the World Bank and has worked about 10 years in developing countries, mostly in Sub-Saharan Africa. He holds an MS in Health Economics (Paris University) and an MBA (Harvard University). After several years as a hospital manager, Christophe worked as a consultant in more than 15 countries, focusing on issues related to health services management (including hospital reforms) and human resources issues, his two specific areas of expertise.
Publication Search Results
1 - 10 of 12
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Publication
The Contribution of Traditional Herbal Medicine Practitioners to Kenyan Health Care Delivery : Results from Community Health-seeking Behavior Vignettes and a Traditional Herbal Medicine Practitioner Survey
(World Bank, Washington, DC, 2011-09)This study examines the role that Traditional Herbal Medicine Practitioners (THMPs) play in Kenya in the context of its human resources for health crisis. Two surveys were carried out to obtain evidence. The first documented the choices and perceptions of households in 36 communities on seeking medical assistance for eight common illnesses. The second survey asked 258 THMPs in five provinces to identify their knowledge sources, training, common illnesses treated, forms of payment, challenges, and concerns. Community-derived data show that households make reasonable decisions when faced with difficult circumstances: they prefer hospitals when these are affordable and seek care at clinics and health centers when hospitals are too far away. There is significant self-care and use of pharmacies, although THMPs are preferred for worms and lower respiratory problems. In general, THMPs provide an important though diminishing role in the provision of health care; they are not sought out in situations when inadequate care is dangerous, specifically infant diarrhoea and potential TB. Whilst Human Resources for Health (HRH) policies are urgently required to strengthen the conventional health workforce and increase their accessibility for the poor, policies should not ignore the findings from this study: many of the rural poor currently receive services from a traditional health workforce not linked to, or regulated by, the national government. This paper argues that formal recognition of their role by the government and by the conventional medical associations, and a targeted strategy to strengthen and build on the positive qualities evident in many traditional medicine practices may be beneficial to safeguarding the well-being of the poor. -
Publication
Creating Incentives to Work in Ghana : Results from a Qualitative Health Worker Study
(World Bank, Washington, DC, 2011-11)The Ministry of Health, Ghana, is engaged in developing new Human Resources for Health (HRH) Strategy (2001-15); one that tries to draw on some of the evidence pertaining to the dynamics of the health labor market. This study is one of several efforts by the World Bank to support the Ministry of Health in its endeavor to develop a new evidence based HRH strategy. Using qualitative research (focus group discussions), this study carries out a microeconomic labor analysis of health worker career choice and of job behavior. The study shows how common problems related to distribution or performance of HRH are driven by the behavior of health workers themselves and are determined largely by select monetary and nonmonetary compensation. Such findings generate insights that provide a starting point for further analysis and a basis for the development of effective human resources for health policies. -
Publication
Towards Interventions in Human Resources for Health in Ghana : Evidence for Health Workforce Planning and Results
(Washington, DC: World Bank, 2013-03-22)This book towards interventions in human resources for health in Ghana is a collaborative effort between the government of Ghana and the World Bank, was developed to assist the ministry of health to obtain an overview of the unique human resources for health (HRH) challenges that Ghana faces. Evidence on the stock, distribution, and performance of health workers in Ghana, as well as on some of the underlying determinants of these HRH outcomes, will help support the government resolve to develop strategies and interventions to address HRH concerns and ultimately strengthen its health system. The content of this book was developed, discussed, and validated by means of extensive consultations with the technical working group on (HRH) in Ghana. This book contents totally eight chapters: chapter one covers toward evidence-based interventions for HRH; chapter two covers the stock of health workers; chapter three covers the distribution of health workers; chapter four covers the performance of health workers; chapter five covers Ghana Agencies and their roles and responsibilities in HRH; chapter six covers interventions to increase stock and improve distribution and performance of HRH; chapter seven covers financing available for policy and interventions; and chapter eights covers the political economy of crafting policy. -
Publication
A Tale of Excessive Hospital Autonomy? An Evaluation of the Hospital Reform in Senegal
(World Bank, Washington, DC, 2012-05)This report evaluates the hospital reform that took place in Senegal in 1998. The reform was successful in granting hospitals considerable autonomy in all management areas, yet resulted in many hospitals closing to bankruptcy. After the reforms the population continued to regard hospital care as unaffordable and of inadequate quality. The very mixed results of the hospital reform are due to a lack of efficiency and built-in accountability. The report concludes that it might have been possible to avoid the current situation if in addition to empowering hospitals, an accountability mechanism had been implemented. The priorities will be to restore some government control over hospitals, restore the efficiency of hospitals, and create some progress on equity of access to hospital care. -
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Evaluating the Impact of Results-Based Financing on Health Worker Performance: Theory, Tools and Variables to Inform an Impact Evaluation
(World Bank, Washington, DC, 2013-01)In order to advance our understanding of why Results Based Financing (RBF) works or not, it is crucial that evaluations not only measure the impact of such an arrangement on final outcomes (population health), but also assess the changes in variables in the causal chain between intervention and final outcomes. Health worker performance is a key variable in this chain; it is only by changing health workers’ behaviors—their performance—that RBF can influence health outcomes. Careful assessment of impacts on health worker performance is therefore a natural and important element of any RBF impact evaluations. This paper discusses various approaches to evaluating the impact of RBF on health worker performance. The first part is a discussion of possible ways in which RBF may affect health worker behavior, based on economic theory and empirical evidence. The second part is a more practical discussion of how health worker performance and other relevant variables can be measured and how impacts can be estimated. This is followed by some practical steps that can be taken to ensure that the evaluation leads to actions that can be implemented; a brief conclusion completes the paper. -
Publication
Assessing Health Workers’ Revenues and Coping Strategies in Nigeria: A Mixed-Methods Study
(BioMed Central, 2013-10-04)The setting of realistic performance-based financing rewards necessitates not just knowledge of health workers’ salaries, but of the revenue that accrues from their additional income-generating activities. This study examined the coping mechanisms of health workers in the public health sector of Nasarawa and Ondo states in Nigeria to supplement their salaries and benefits; it also estimated the proportionate value of the revenues from those coping mechanisms in relation to the health workers’ official incomes. -
Publication
Why Do Health Labour Market Forces Matter?
(World Health Organization, 2013-11)Human resources for health have been recognized as essential to the development of responsive and effective health systems. Low- and middle-income countries seeking to achieve universal health coverage face human resource constraints – whether in the form of health worker shortages, maldistribution of workers or poor worker performance – that seriously undermine their ability to achieve well-functioning health systems. Although much has been written about the human resource crisis in the health sector, labor economic frameworks have seldom been applied to analyze the situation and little is known or understood about the operation of labor markets in low- and middle-income countries. Traditional approaches to addressing human resource constraints have focused on workforce planning: estimating health workforce requirements based on a country’s epidemiological and demographic profile and scaling up education and training capacities to narrow the gap between the “needed” number of health workers and the existing number. However, this approach neglects other important factors that influence human resource capacity, including labor market dynamics and the behavioral responses and preferences of the health workers themselves. This paper describes how labor market analysis can contribute to a better understanding of the factors behind human resource constraints in the health sector and to a more effective design of policies and interventions to address them. The premise is that a better understanding of the impact of health policies on health labor markets, and subsequently on the employment conditions of health workers, would be helpful in identifying an effective strategy towards the progressive attainment of universal health coverage. -
Publication
The Systematic Assessment of Health Worker Performance: A Framework for Analysis and its Application in Tanzania
(World Bank, Washington, DC, 2015-08)This paper introduces a simple framework for understanding the dimensions and determinants of health worker performance based on the idea that there can be three different gaps affecting performance: a knowledge gap, the knowledge-capacity gap and the capacity-performance gap. The paper argues that performance is determined by a combination of competence, capacity and effort, and that any of these elements may lead to poor performance, and applies this framework to the measurement of health worker performance in Tanzania. Whilst discussing and highlighting key findings related to the assessment of health worker performance in Tanzania, the overarching objective of the paper is to offer a systematic way to analyze health worker performance through primary data collection and analysis to benefit researchers and countries beyond Tanzania. -
Publication
Reducing Geographical Imbalances of Health Workers in Sub-Saharan Africa : A Labor Market Perspective on What Works, What Does Not, and Why
(World Bank, 2011)This report discusses and analyzes labor market dynamics and outcomes (including unemployment, worker shortages, and urban-rural imbalances of categories of health workers) from a labor economics perspective. It then uses insights from this perspective as a basis for elaborating policy options that incorporate the underlying labor market forces. The goal of the study is to address undesirable outcomes (including urban-rural HRH imbalances) more effectively. The study draws on an extensive inventory of policy options relevant to urban-rural labor force imbalance in Sub-Saharan Africa and the experiences with these imbalances to date. Given the limited documentation available on this topic through formal channels, the review relies heavily on 'gray literature' from policymakers in Sub-Saharan Africa and their development partners, especially the World Bank and the World Health Organization (WHO). The report is divided into five main sections. The first section focuses on economic policies related to Human Resources for Health (HRH) objectives. It argues that policymaking has ignored health labor market dynamics. The second section provides data showing the extent of urban-rural imbalances and describes how these imbalances affect health system outcomes. The third section uses a health labor market framework to explain these imbalances. The fourth section outlines policy options relevant to Sub-Saharan Africa for addressing market distortions and affecting labor market outcomes. It also reviews evidence on the policies, strategies, and programs designed to address geographic imbalances in Sub-Saharan Africa, highlighting what has been done, what has worked, and what has not. The last section provides a roadmap for policymakers. -
Publication
Health Labor Market Analyses in Low- and Middle-Income Countries: An Evidence-Based Approach
(Washington, DC: World Bank, 2016-10-12)This book, produced jointly by the World Bank, the University of California, Berkeley, and the WHO, aims to provide decision-makers at sub-national, national, regional and global levels with additional insights into how to address their workforce challenges rather than describe them. In order to optimize and align HRH investments and develop targeted policy responses, a thorough understanding of unique, country-specific labor market dynamics and determinants of these dynamics is critical. Policies need to take into account the fact that workers are economic actors, responsive to different levels of compensation and opportunities to generate revenue found in different sub-labor markets. Policies need to take into account the behavioral characteristics of the individuals who provide health care, but also the individuals who consume health care services and the institutions that employ health personnel. In other words, it is necessary to understand the determinants of both the supply (numbers of health workers willing to work in the health sector) and the demand for health workers (resources available to hire health workers), how these interact, and how this interaction varies in different contexts. This interaction will determine the availability of health personnel, their distribution as well as their performance levels, thus ensuring stronger health systems capable to deliver universal health coverage. The book is structured to be of use to researchers, planners, and economists who are tasked with analyzing key areas of health labor markets, including overall labor market assessments as well as and more narrow and targeted analyses of demand and supply (including production and migration), performance, and remuneration of health workers. The chapters, written by a number of internationally renowned experts on Human Resources for Health, discuss data sources and empirical tools that can be used to assess health labor markets across high-, middle- or low-income countries, but draws primarily from examples and case-studies in LMICs.