Lemiere, Christophe

Person:
Lemiere, Christophe

Author Name Variants

Lemiere, Christophe, Lemière, Christophe

Fields of Specialization

Human resources for health, Health labor markets

Last updated:October 6, 2025

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.

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Now showing1 - 10 of 14

Combining Safe Spaces with Accompanying Measures: A Solution to Empower Adolescent Girls in Côte d’Ivoire
(Washington, DC: World Bank, 2024-12-16) Boulhane, Othmane; Boxho, Claire; Cavagnero, Eleonora; Garcia-Meza, Alejandra Mia; Guerrero Horas, Olga; Kanga, Desiré; Karamoko, Djibrilla; Kouacou, Karine; Koussoubé, Estelle; Lemiere, Christophe; Harrit, Margareta Norris; Rouanet, Léa; Traore, Adama; Van Damme, Jozefien
This cluster-randomized trial in Côte d’Ivoire examined multi-sectoral approaches to improving adolescent girls’ empowerment (AGE). Safe spaces offering life skills and sexual and reproductive health (SRH) education were assessed alone and combined with livelihood support, male engagement (husbands’ clubs), and community leader involvement. Pairing safe spaces with both husbands’ clubs and community leader engagement had the strongest impacts, improving SRH, economic participation, decision-making, and marriage and childbearing outcomes. Safe spaces alone showed limited effects beyond SRH. Findings highlight the importance of fostering community support for gender norm change and ensuring cohesive messaging and high-quality implementation. Multi-sectoral strategies outperform standalone interventions in advancing AGE across multiple domains.
Financial Protection Outcomes in Four East Asian Countries During COVID-19: Cambodia, Vietnam, Thailand and Indonesia
(Washington, DC: World Bank, 2024-11-25) Yoo, Katelyn J.; Sharma, Jayendra; Eozenou, Patrick Hoang-Vu; Lemiere, Christophe
This paper examines the impact of the COVID-19 pandemic on Universal Health Coverage (UHC) and financial protection in four East Asia and Pacific (EAP) countries, focusing on the dynamics of healthcare access and out-of-pocket (OOP) expenditures. From 2000 to 2021, while countries in East Asia have generally seen a convergence in service coverage improvement, those in the Pacific exhibited slower progress. The pandemic has significantly stalled global health service coverage and exacerbated financial vulnerabilities due to increased OOP spending, pushing more people into financial hardship. In 2021, approximately half of the global population lacked access to essential health services, with the EAP region home to a disproportionate share of individuals burdened by high OOP costs. The analysis reveals that 38 percent of the EAP population spent more than 10 percent of their budget on health expenses, and 43 percent were pushed below the poverty line by medical expenses, highlighting the region's exposure to financial hardship. Data from Indonesia, Cambodia, Vietnam, and Thailand during the COVID-19 years indicate growing disparities in healthcare access and financial protection, especially among vulnerable populations without insurance, who are often most affected by foregone care and catastrophic expenditures. Healthcare financing trends suggest that public health expenditure (PHE) needs strengthening against the backdrop of rising OOP payments, which have increased faster than public health financing and faster than final consumption expenditure between 2015 and 2020. The findings of this paper advocate for enhanced government interventions to extend health service subsidies targeted to the poorest and to expand population coverage of pre-payment schemes for health, to improve financial protection and reducing inequities in healthcare access.
Health Labor Market Analyses in Low- and Middle-Income Countries: An Evidence-Based Approach
(Washington, DC: World Bank, 2016-10-12) Scheffler, Richard M.; Herbst, Christopher H.; Lemiere, Christophe; Campbell, Jim; Scheffler, Richard M.; Herbst, Christopher H.; Lemiere, Christophe; Campbell, Jim; Araújo, Edson C.; Bruckner, Tim; Damascène Butera, Jean; Cohen, Robert; El Maghraby, Atef; Jaskiewicz, Wanda; Keuffel, Eric; Leonard, Kenneth; Lievens, Tomas; Liu, Lenny; Mæstad, Ottar; Menkulasi, Genta; Ozden, Caglar; Phillips, David; Preker, Alex S.; Scott, Anthony; Serneels, Pieter; Soucat, Agnes; Spetz, Joanne; Tulenko, Kate; Zolia, Yah M.
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.
Understanding Health Workers' Job Preferences to Improve Rural Retention in Timor-Leste: Findings from a Discrete Choice Experiment
(PLoS, 2016-11-15) Smitz, Marc-Francois; Witter, Sophie; Lemiere, Christophe; Eozenou, Patrick Hoang-Vu; Lievens, Tomas; Zaman, Rashid U.; Engelhardt, Kay; Hou, Xiaohui
Timor-Leste built its health workforce up from extremely low levels after its war of independence, with the assistance of Cuban training, but faces challenges as the first cohorts of doctors will shortly be freed from their contracts with government. Retaining doctors, nurses and midwives in remote areas requires a good understanding of health worker preferences. The article reports on a discrete choice experiment (DCE) carried out amongst 441 health workers, including 173 doctors, 150 nurses and 118 midwives. Qualitative methods were conducted during the design phase. The attributes which emerged were wages, skills upgrading/specialisation, location, working conditions, transportation and housing.
The Systematic Assessment of Health Worker Performance: A Framework for Analysis and its Application in Tanzania
(World Bank, Washington, DC, 2015-08) Leonard, Kenneth L.; Masatu, Melkiory C.; Herbst, Christopher H.; Lemiere, Christophe
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.
Why Do Health Labour Market Forces Matter?
(World Health Organization, 2013-11) McPake, Barbara; Maeda, Akiko; Correia Araújo, Edson; Lemiere, Christophe; El Maghraby, Atef; Cometto, Giorgio
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.
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) Torsvik, Gaute; Lemiere, Christophe; Maestad, Ottar; Leonard, Kenneth L.; Herbst, Christopher H.
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.
Towards Interventions in Human Resources for Health in Ghana : Evidence for Health Workforce Planning and Results
(Washington, DC: World Bank, 2013-03-22) Appiah-Denkyira, Ebenezer; Herbst, Christopher H.; Soucat, Agnes; Lemiere, Christophe; Saleh, Karima
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.
A Tale of Excessive Hospital Autonomy : An Evaluation of the Hospital Reform in Senegal
(World Bank, Washington, DC, 2012-06) Turbat, Vincent; Lemière, Christophe; Puret, Juliette
In 1998, Senegal launched an ambitious hospital reform. More than ten years later, despite a massive injection of government funds in hospitals, many of them are now close to bankruptcy. However, this reform clearly had the effect of 'bringing back patients' to hospitals. While hospitals were largely empty (as in many Sub-Saharan African countries), the number of hospital-based outpatient visits has increased by over 20 percent every year since 2000. This increased activity also suggests that hospitals have become more attractive for patients and that the quality of care may have improved. In contrast, equity of access to hospital care (especially for the poorest) has clearly deteriorated. While the proportion of poor is estimated at nearly 51 percent of the Senegalese population, this group constitutes only 3 percent of hospital patients. Last but not least, the hospital reform has resulted in a major deterioration in the technical efficiency of the hospital system. The first reason is the uncontrolled increase of the wage bill, both because of massive recruitment of unqualified staff and because of the creation of numerous and inconsistent staff bonuses. A second reason is the underfunding of several free care programs, especially of the Plan Sesame (that is, free care for the elderly). The mixed results of this hospital reform are due to several factors. The 1998 reform is a textbook case of granting very large management autonomy to hospitals without implementing any serious accountability mechanism. Hospitals have indeed acquired considerable autonomy in all management areas. It might have been possible to avoid the current situation if, in addition to empowering hospitals, some accountability mechanisms had been implemented; however, this did not happen. Among the various remedies proposed, the utmost priority is to restore some government control over hospitals. This can be done by establishing mechanisms for evaluating hospital managers and controlling ex ante their budgets, especially their decisions about recruitments and compensation. A second priority would be to restore the efficiency of hospitals, which would require (i) revision of rates for hospital user fees so that they better reflect actual costs, (ii) reduction of overstaffing with nonqualified workers, and (iii) restructuring of the hospital system in Dakar.
A Tale of Excessive Hospital Autonomy? An Evaluation of the Hospital Reform in Senegal
(World Bank, Washington, DC, 2012-05) Turbat, Vincent; Lemière, Christophe; Puret, Juliette
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.