Publication: Scaling Up the Health Workforce in the Public Sector : The Role of Government Fiscal Policy
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Date
2010
ISSN
1029-0540 (Print)
1029-0540 (Linking)
Published
2010
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Health workers play a key role in increasing access to health care services. Global and country-level estimates show that staffing in many developing countries - particularly in Sub-Saharan Africa - is far leaner than needed to deliver essential health services to the population. One factor that can limit scaling up the health workforce in developing countries is the government's overall wage policy which sometimes creates restrictions on hiring in the health sector. But while there is considerable debate, the information base in this important area has been quite limited. This paper summarizes the process that determines the budget for health wages in the public sector, how it is linked to overall wage policies, and how this affects staffing in the health sector. The author draws mainly from a recent World Bank report.
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Publication Working in Health : Financing and Managing the Public Sector Health Workforce(World Bank, 2009)The health workforce plays a key role in increasing access to health services for the poor in developing countries. Recent evidence has demonstrated an important link between staffing levels and both service delivery and health outcomes. Various global and country-level estimates have also shown that current staffing levels in developing countries, particularly in Sub-Saharan Africa, are often well below those required to deliver essential health services. This study focuses on two main aspects of health workforce policy. First, it examines how overall government wage bill policies affect the size of the health wage bill, the hiring of health workers in the public sector, and the related policy options. This focus is important because despite the importance of fiscal constraints on the wage bill, and the persistent debate at the global level, very little documented evidence describes how health wage bill budgets in the public sector are determined, how this action is linked to overall wage bill policies, and how it affects the ability of governments to increase staffing levels in the health sector. Second, this report looks at how well health wage bill resources are used in the public sector.Publication Beyond Wage Bill Ceilings : The Impact of Government Fiscal and Human Resource Management Policies on the Health Workforce in Developing Countries, Background Country Study for Rwanda(Washington, DC, 2008-06-23)One of the main explanations put forth on why access to health workers is so low in developing countries is that there are insufficient resources within the public sector to pay the wage bill - the salary and allowance payments - of an expanded health workforce. In turn, the lack of wage bill resources for the health sector is thought to be a direct result of restrictive macroeconomic policies that limit the expansion of the overall public sector wage bill. The overarching message in this report is that, despite the relative contraction of the public sector wage bill, Rwanda has not only protected the health sector, but has succeeded through decentralization and the introduction of performance-based financing in linking salaries to performance in the health sector. The decentralization of budgets, along with the implementation of the performance-based grants scheme, has had two major effects. First, it has increased the resource envelope available for hiring health workers since there is a lot of flexibility in how the performance based grants can be used. Second, it has linked payments to health workers with performance, since the salary top amounts paid out of the grants are linked to service delivery results.Publication Political Economy of Health Workforce Policy : The Chhattisgarh Experience with a Three-year Course for Rural Health Care Practitioners(World Bank, Washington, DC, 2010-03)This case study analyzes the reasons for adoption and the implementation process of a key policy in Chhattisgarh state, India, to create a rural cadre of trained physicians in order to address the acute shortage of doctors in the state's primary health facilities. It documents the experience specific to Chhattisgarh state, but with its attention to the policy processes and implementation challenges associated, it also highlights the necessity of a political economy perspective currently missing in much of the published literature on human resources for health. A principal lesson of this case concerns why it matters how interests of various stakeholders who had interests in the three-year course are included early in the policy process, namely the anticipated opposition of the medical doctor community represented by the Indian Medical Association (IMA) and the interests of the students themselves and their desire to be given appropriate status as medical doctors. This case study addresses the legal hurdles faced and the importance of institutional support structures to maintain quality standards and provide for grievance procedures. Through this case study, it also becomes apparent why the role of institutional ownership of policy matters rather than success or failure of policy that is linked entirely to the authority of a few key appointed officials.Publication Health Workforce Policy in Turkey : Recent Reforms and Issues for the Future(World Bank, Washington, DC, 2009-07)The health status of the Turkish population has improved significantly over the past few decades, accompanying improvements in the scale and functioning of the health-care system. Impressive progress has been made in expanding financial protection to the population through expansions in the breadth and depth of health insurance coverage combined with service delivery reforms to improve equity in access to health services. This note summarizes the main developments in the area of health workforce policy and how these have affected key health workforce performance outcomes. Specifically, the main objectives are to: (i) summarize trends in key health workforce outcomes; (ii) compare health workforce outcomes in Turkey to Organization for Economic Co-operation and Development (OECD) and other countries; (iii) discuss the impact of recent reforms in the health sector on health workforce outcomes; and (iv) highlight key health workforce policy issues for the future.Publication New Insights into the Provision of Health Services in Indonesia : A Health Workforce Study(World Bank, 2010)Indonesia has made improving the access to health workers, especially in rural areas, and improving the quality of health provider's key priority areas of its next five-year development plan. Significant steps and policy changes were taken to improve the distribution of the health workforce, in particular the contracted doctors program and later the contracted midwives program, but few studies have been undertaken to measure the actual impact of these policies and programs. This book is part of the inputs prepared at the request of the government of Indonesia's national development agency, Bappenas, to inform the development of the next national development plan 2010-14. Other inputs include reports on health financing, fiscal space for health, health public expenditure review, and assessments of maternal health and pharmaceuticals. Study findings highlight the importance not only of improving the supply of health care, but also of improving quality, so as to improve health outcomes. Over the period studied, important gains in the determinants of health outcomes have occurred in Indonesia. At the same time, however, the study shows that Indonesia, despite the significant gains, continues to suffer from serious challenges in the number and distribution, and in particular the quality, of its health workers.
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