Person:
Herbst, Christopher H.

Fields of Specialization

Human resources for health, Health labor markets

Last updated January 31, 2023

Biography

Christopher H. Herbst, PhD, is a senior health specialist in the World Bank’s Health, Nutrition and Population Global Practice. He is currently based in Saudi Arabia, where he is leading the World Bank’s engagement in the health sector, providing support in the areas of noncommunicable diseases, health financing, human resources for health, and pharmaceutical systems, among other areas. Throughout his career at the World Bank, Christopher has worked in more than 25 low-, middle-, and high-income countries in Africa, Asia, and the Middle East. His research and publications focus on health systems strengthening and health workforce issues. He obtained his bachelor's from King’s College London (KCL), his master's from the London School of Economics and Political Science (LSE), and his PhD from Lancaster University (LU).

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Now showing 1 - 10 of 21

Private Sector Pharmaceutical Supply and Distribution Channels in Africa : A Focus on Ghana, Malawi and Mali

(World Bank, Washington, DC, 2011-08) McCabe, Ariane ; Seiter, Andreas ; Diack, Aissatou ; Herbst, Christopher H. ; Dutta, Sheila ; Saleh, Karima

Sustainable access to affordable, high-quality medicines is an important component in all health care systems but remains limited in many African countries. Supply and distribution of medicines are a fundamental aspect of the success of any health system. Disruptions to this supply undermine health outcomes as supply chains have an impact on the availability, cost, and quality of medicines for patients. Common problems associated with the supply and distribution of pharmaceuticals often include poor supply chain management, stock pilfering, insufficient human resources, and limited financing resulting in chronic stock outs. In resource-poor settings where public services fail to meet demand, the private and voluntary sectors are increasingly being called on, prompting some policy makers to consider private mechanisms as alternatives to state-run drug procurement and distribution systems. This study reviews some of the ways in which some countries in Africa organize their private pharmaceutical supply and distribution channels, focusing on three diverse countries: Ghana, Malawi, and Mali. It discusses some of the strengths and challenges associated with such arrangements, as well as relevant options to improve access, availability, quality and affordability of privately supplied pharmaceuticals.
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) Lambert, John ; Leonard, Kenneth ; Mungai, Geoffrey ; Omindi-Ogaja, Elizabeth ; Gatheru, Gladys ; Mirangi, Mirangi ; Owara, Jennifer ; Herbst, Christopher H. ; Ramana, GNV ; Lemiere, Christophe

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.
Creating Incentives to Work in Ghana : Results from a Qualitative Health Worker Study

(World Bank, Washington, DC, 2011-11) Lievens, Tomas ; Serneels, Pieter ; Garabino, Sabine ; Quartey, Peter ; Appiah, Ebeneezer ; Herbst, Christopher H. ; Lemiere, Christophe ; Soucat, Agnes ; Rose, Laura ; Saleh, Karima

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.
Applying Market Mechanisms to Central Medical Stores : Experiences from Burkina Faso, Cameroon, and Senegal

(World Bank, Washington, DC, 2010-07) Govindaraj, Ramesh ; Herbst, Christopher H.

This study summarizes the findings of three assessments of Central Medical Store (CMS) reform and performance in Francophone Africa. The study aims to document and characterize the organizational reform of the CMSs and the impact of the reform on CMS management and performance in Cameroon, Burkina and Senegal. It seeks further to assess the extent to which increased autonomy brought about by such 'marketizing' reforms has had an impact on intermediate CMS results, service quality, product quality, and access to medicines. The findings indicate that organizational reform did contribute towards improving operational performance which, in turn, influenced service quality, product quality, and access to CMS-supplied medicine in these countries. However, improvements in these areas were premised not simply on increased autonomy, but on a whole variety of drivers, both internal and external to a CMS. These include a strong regulatory framework, the conventions, laws, regulations, and administrative acts that increase the flexibility of some decision making rights, whilst constraining others, with an emphasis on social obligations, accountability, and transparency, as well as external factors, such as technical assistance, government subsidies, and relevant external policies, institutions and regulations. The paper ends by proposing a framework that could be used both for the design as well as for the analysis of marketizing reforms in CMSs and other public sector commodity supply entities in developing countries. The framework is sufficiently general that, with some modifications, it could also be applied usefully to the design and analysis of such reform in other public sector institutions delivering social services.
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.
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) Lemiere, Christophe ; Torsvik, Gaute ; Maestad, Ottar ; Herbst, Christopher H. ; Leonard, Kenneth L.

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.
Information and Communication Technologies for Health Systems Strengthening: Opportunities, Criteria for Success, and Innovation for Africa and Beyond

(World Bank, Washington, DC, 2015-01) Otto, Kate ; Shekar, Meera ; Herbst, Christopher H. ; Mohammed, Rianna

Information and communication technologies (ICT) for health or eHealth solutions hold great potential for generating systemic efficiencies by strengthening five critical pillars of a health system: human resources for health, supply chain management, health care financing, governance and service delivery, and infrastructure. This report describes the changing landscape of eHealth initiatives through these five pillars, with a geographic focus on Sub-Saharan Africa. This report further details seven criteria, or prerequisites, that must be considered and addressed in order to effectively establish and scale up ICT-based solutions in the health sector. These criteria include infrastructure, data and interoperability standards, local capacity, policy and regulatory environments, an appropriate business model, alignment of partnerships and priorities, and monitoring and evaluation. In order to bring specific examples of these criteria to light, this report concludes with 12 specific case studies of potentially scalable ICT-based health care solutions currently being implemented across the globe at community, national, and regional levels. This report is intended to be used by development practitioners, including task team leaders at the World Bank, to strengthen their understanding of the use of ICT to support health systems strengthening (HSS) efforts as well as to highlight critical prerequisites needed to optimize the benefits of ICT for health.
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.
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) Lemiere, Christophe ; Herbst, Christopher H. ; Jahanshahi, Negda ; Smith, Ellen ; Soucat, Agnes

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.
The Human Resources for Health Crisis in Zambia : An Outcome of Health Worker Entry, Exit, and Performance within the National Health Labor Market

(World Bank, 2011-04-26) Herbst, Christopher H. ; Vledder, Monique ; Campbell, Karen ; Sjöblom, Mirja ; Soucat, Agnes

This report compiles recent evidence on the Zambian health labor market and provides some baseline information on human resources for health (HRH) to help the government address its HRH challenges. Rather than focusing on making policy recommendations, the report is designed to be a source book to benefit and fuel discussions related to HRH in Zambia. Most of the data presented in the report covers the period 2005-08. The report analyzes the national health labor market to better understand the available evidence related to the stock, distribution, and performance of HRH in Zambia (that is, the HRH outcomes). It aims to explain those HRH outcomes by mapping, assessing, and analyzing pre-service education and labor market dynamics, that is, the flow of health workers into, within, and out of the health labor market, as well as the core factors influencing these dynamics. Finally, this report examines the issue of access and equity of HRH. It finds that even if health workers are available, in either urban or rural areas, and performing adequately, the wealthy in Zambia have better access to services than the poor. This situation is found in most if not all other countries. The report finds that as far as access to health workers is concerned, the poor generally loose out. It also reveals that even if health workers are available, wealthier segments of the population often continue to have better access to health workers than poorer segments. Wealthier women have the highest probability of receiving any antenatal care. There is an even steeper pro-rich gradient in delivery attendance in Zambia. In contrast to antenatal care, there is little variation across socioeconomic quintiles among those seeking medical treatment for children with diarrhea or cough and fever. The poor are slightly more likely to be visited by a health worker and receive certain services during visits. The factors linked to these variations in use of services remain to be examined (they could be linked to expense, fear of receiving care from an individual belonging to a higher social stratum, or different gender, and so forth). Either way, they should be taken into consideration when planning to improve access for the poor to health care services and providers.