Publication: Incentives and Dynamics in the
Ethiopian Health Worker Labor Market
Loading...
Date
2010-06-01
ISSN
Published
2010-06-01
Author(s)
Editor(s)
Abstract
The supply and geographic distribution of health workers are major constraints to improving health in low-income countries. A number of recent studies have highlighted the shortage of skilled health workers in many settings (World Health Organization [WHO], 2006), the impact this has on health outcomes (Anand and Barnighausen, 2004), and the risk this poses for the achievement of the Millenium Development Goals (WHO, 2006; joint learning initiative, 2004). However, there remains limited evidence about what sorts of policies will attract nurses and doctors into medical training, improve the retention of trained health workers, and encourage them to work in rural areas where problems of inaccessibility of services are most acute. Finally, our predictive results are based on a discrete choice experiment that was part of the questionnaire. This component of the study enables us to estimate the value that doctors and nurses place on different job attributes, and how they vary across individuals. Providing high quality housing would increase physician labor supply to about 27 percent, which is equivalent to paying a wage bonus of about 46 percent. Doubling wages paid to nurses for work in rural areas outside cities increases their labor supply from 4 percent to 27 percent, while the non-wage attribute that is most effective in inducing them to relocate to rural areas is the quality of equipment and drugs. The same impact could be achieved by increasing rural nursing wages by about 57 percent for men and 69 percent for women.
Link to Data Set
Citation
“Jack, William; De Laat, Joose; Hanson, Kara; Soucat, Agnes. 2010. Incentives and Dynamics in the
Ethiopian Health Worker Labor Market. World Bank Working Paper ; No. 192. Africa
Human Development Series. © World Bank. http://hdl.handle.net/10986/5951 License: CC BY 3.0 IGO.”
Associated URLs
Associated content
Other publications in this report series
Publication A Novel Tobacco Market Diversification(World Bank, Washington, DC, 2022-04-27)In this working paper, an exploration of available data and information is conducted and findings presented, to support the view that the dichotomous business model and related harm reduction narrative promoted nowadays by the tobacco industry, merits scrutiny by the international community. The promotion of e-cigarettes as welfare enhancing in rich countries, particularly because they are posited to help adult smokers quit, tends to obfuscate a dire reality. The same tobacco industry that promotes (e-cigarettes as harm reduction in rich countries, derives the bulk of its profits by selling cigarettes in lower income countries.Publication Environmental Implications of a Central Bank Digital Currency (CBDC)(Washington, DC : World Bank, 2022-07)Two-thirds of central banks in the East Asia and Pacific (EAP) region have started researching or testing the implementation of a Central Bank Digital Currency (CBDC). At the same time, the region accounts for one-third of world CO2 emissions and is vulnerable to climate risks. As the Group of 7 (G7), European Central Bank (ECB), and Bank of England (BoE) have stated in their public statements, it is increasingly important to consider environmental impact when designing CBDC. However, only a few brief studies have been done on this subject, which will be crucial for the region. This Note explores the environmental implications of CBDC by comparing technical mechanisms and energy consumption within its distributed structure. It also illustrates differences in ecological footprint between CBDC and other payment methods (cryptocurrency, cash, and card networks). As the legitimacy of CBDC is backed by the trust of central banks, CBDC does not need to prove its legitimacy through its technological structure. Therefore, CBDC does not require the energy-intensive consensus or mining mechanisms used by a cryptocurrency, so its energy consumption is lower (comparable to that of a credit card system). CBDC can be designed to use various systems, such as Real Time Gross Settlement (RTGS), Distributed Ledger Technology (DLT), or a mixture of both. Careful deliberation to meet the objectives and implications will be important as CBDC can be a catalyst for financial innovation.Publication WBG COVID-19 Crisis Response Operational Update(Washington, DC, 2022-03-31)This note provides an update on the WBG’s COVID-19 Crisis Response, outlined in June 2020 to help developing countries address the impacts of the pandemic while maintaining a line of sight to long-term development goals. It comprises five short sections: (I) the impacts of COVID-19 and compounding crises on developing countries, (II) an update on the WBG’s operational crisis response and priorities moving forward, (III) the critical role of international coordination, (IV) WBG financing framework for GRID, and (V) concluding remarks.Publication Greening Digital in Korea(Washington, DC, 2022-02)Digital technologies are making a significant impact on societies, economies, and the physical world, presenting both opportunities and challenges for the green agenda. Applications of these technologies in sectors such as energy, urban, transport, and agriculture are creating new possibilities for climate change mitigation strategies. However, the rapid expansion of digital technologies increases energy usage too, and is therefore also increasing greenhouse gas (GHG) emissions. In seeking to address these challenges, the World Bank’s Digital Development Global Practice (DD) will publish a flagship report on Digital Development Opportunities for Climate Change, which will assess opportunities for greening with information communication technology (ICT), as well as opportunities for greening the ICT sector itself. To inspire and inform this flagship report, DD studied Korea’s experience in greening its ICT sector, with support from the Korean Green Growth Trust Fund. The Republic of Korea was selected for the case study due to its experience in both the digital and green sectors, and its status as a globally recognized ICT powerhouse. The country was also an early adopter of a green policy agenda, and is integrating DNA (data, network, and AI) into these policies. The government announced a national policy vision of “Low Carbon, Green Growth” in 2008 and has taken concrete steps to build a solid foundation for the green transition, through legislation, standardization, information-based instruments, economic instruments, research and development (R&D), and green procurement. More recently, the country has been aligning its green ICT strategy with the broader national GHG reduction target. Korea's experience can offer meaningful lessons to other countries looking to reduce the ICT sector’s climate impact. It shows that public policies have an important impact on the ICT market. The policy tools that can spur decarbonization of the ICT sector include green government procurement, information-based instruments, economic instruments, and provision of guidelines on green business practices. Keys to success in applying such tools include strong and early political commitment; long-term planning and comprehensive policies; prioritization; research and development (R&D) and investment; and a governance structure that allows a whole-of-government approach. Additionally, Korea’s experience shows that renewable energy will play an increasingly important role in reducing GHG emissions from the energy-intensive ICT industry. Korea’s experience also underscores the fact that more evidence and analysis are needed to measure and determine the effectiveness of policy and regulatory pathways for greening the ICT sector.Publication Sustainable Cities Towards A Green, Resilient and Inclusive Recovery(Washington, DC, 2022-03)Cities are key to unlocking a climate-smart future for all, as they account for more than 50 percent of the global population, about 70 percent of global energy-related CO2 emissions and 80 percent of global GDP. Urban centers’ share of emissions is expected to grow as the urban population is projected to increase by 2.3 billion people by 20502. As the world recovers from the COVID-19 crisis, cities will present a huge opportunity to rebuild in a way that is climate friendly and meets some of the world’s ambitious climate targets. Cities are viewed as the source of and the solution to many of today's economic, social, and environmental challenges. This is not only because of the concentration of population and economic assets in urban areas, but also because local authorities perform key functions that impact the quality of life of their residents. From an urban management perspective, the leading resource and knowledge sharing platform is the GEF funded Global Platform for Sustainable Cities (GPSC), hosted by the World Bank. The GPSC states that achieving sustainability requires the balanced accomplishment of outcomes against four pillars, namely (1) robust economic growth, prosperity, and competitiveness across all parts of the city; (2) protection and conservation of ecosystems and natural resources into perpetuity; (3) mitigation of greenhouse gas (GHG) emissions while fostering overall city resilience; and (4) inclusiveness and livability, mainly through the reduction of city poverty levels and inequality. The Urban Sustainability Framework (USF), developed to outline the areas of work and support by the GPSC, offers a very useful representation of both outcomes as well as enabling actions and requirements (such as spatial data and good governance) cities could focus on.
Journal
Journal Volume
Journal Issue
Collections
Related items
Showing items related by metadata.
Publication The Health Workforce in Ethiopia : Addressing the Remaining Challenges(World Bank, 2012-01-12)Health indicators in Ethiopia, particularly on child health and malaria, have improved significantly in recent years, with the next challenge now focused on improving maternal health indicators. Improvements in child health and malaria in particular can be attributed to strong government commitment towards health results, reflected in a number of notable policies and programs related to Human Resources for Health (HRH), in particular the health extension worker program. However, indicators related to maternal health remain problematic. Ethiopia has one of the lowest levels of assisted deliveries in the region. Although increases in the number of health workers particularly in rural areas may have contributed to improving access to some health services, it is in the government's interest to further improve the stock, distribution, and performance of relevant health workers in Ethiopia, particularly to bring about improvement in access to maternal health services for the poor. This document reviews the current HRH situation in Ethiopia, summarizes the evidence on population use of select health services, and offers relevant policy options to assist the government finalize its new human resources strategy and address remaining health challenges.Publication The Labor Market for Health Workers in Africa : New Look at the Crisis(Washington, DC: World Bank, 2013-04-17)Health systems in Sub-Saharan Africa have changed profoundly over the last 20 years. The economic crisis of the 1980s and 1990s rattled public health care systems, which were largely holdovers from the colonial and postcolonial eras. The later wave of structural adjustments and public sector reforms wrought further change. As African economies opened to market based approaches, the private sector became a sizable source of health care service. Today about half the health expenditures in Africa are private, and private providers play a major role in the delivery of outpatient services. This is draws on the lessons, knowledge, and data gathered by the World Bank's Africa Region Human Resources for Health Program. For the first time, the various complexities of Human Resources for Health (HRH) labor markets are addressed comprehensively in one volume. Given the increasing demand in countries for strong health workforces that can help achieve universal health coverage; we hope this book will be beneficial to researchers, policy makers, and practitioners who are trying to develop evidence-based HRH interventions to achieve this end.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 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)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.Publication A Study on the Implementation of Jampersal Policy in Indonesia(World Bank Group, Washington, DC, 2014-09)Indonesia launched Jampersal in 2011, a nationwide program to accelerate the reduction of maternal and newborn deaths. The program was financed by central government revenues and provided free and comprehensive maternal and neonatal care with an emphasis on promoting institutional deliveries. Jampersal providers were public and enlisted private facilities at the primary and secondary levels. In 2013, the World Bank and the Center for Family Welfare, University of Indonesia conducted a qualitative and quantitative study to assess the implementation and impact of the program in Garut District and Depok Municipality in West Java Province. The study found that Jampersal utilization was highest among women who were least educated, poor, and resided in rural areas. Utilization was also high among women with delivery complications. The study showed Jampersal only had an impact where institutional delivery coverage was still low such as in Garut District. In this district, women were 2.4 times more likely to have institutional deliveries after Jampersal. The finding suggests implementation of Jampersal policy may have to be adjusted according to the utilization pattern for efficiency and effectiveness. The government discontinued Jampersal with the launching of the National Health Insurance Program (JKN) on January 1, 2014. The study s findings indicate the merit in reevaluating the policy to terminate the program, given that Jampersal helped increase institutional deliveries while voluntary participation in JKN remains low.
Users also downloaded
Showing related downloaded files
Publication Guide to the Debt Management Performance Assessment Tool(Washington, DC, 2008-02-05)The purpose of this document is to provide guidance and supplemental information to assist with country assessments of debt management performance, using the Debt Management Performance Assessment (DeMPA) tool. The DeMPA is a methodology used for assessing public debt management performance through a comprehensive set of 15 performance indicators spanning the full range of government Debt Management (DeM) functions. It is based on the principles set out in the International Monetary Fund (IMF) and World Bank guidelines for public debt management, initially published in 2001 and updated in 2003. It is modeled after the Public Expenditure and Financial Accountability (PEFA) framework for performance measurement of public financial management. The DeMPA has been designed to be a user-friendly tool to undertake an assessment of the strengths and weaknesses in government DeM practices. This guide provides additional background and supporting information so that a no specialist in the area of debt management may undertake a country assessment effectively. The guide can be used by assessors in preparing for and undertaking an assessment. It is particularly useful for understanding the rationale for the inclusion of the indicators, the scoring methodology, and the list of supporting documents or evidence required, and the questions that could be asked for the assessment.Publication The Mexican Social Protection System in Health(World Bank, Washington DC, 2013-01)With a population of 113 million and a per-capita Gross Domestic Product, or GDP of US$10,064 (current U.S. dollars), Mexico is one of the largest and highest-income countries in Latin America and the Caribbean (LAC). The country has benefited from sustained economic growth during the last decade, which was temporarily interrupted by the financial and economic crisis. Real GDP is projected to grow 3.8 percent and 3.6 percent in 2012 and 2013, respectively (International Monetary Fund, or IMF 2012). Despite this growth, poverty in the country remains high; with half of the population living below the national poverty line. The country is also highly heterogeneous, with large socioeconomic differences across states and across urban and rural areas. In 2010, while the extreme poverty ratio in the Federal District and the states of Colima and Nuevo Leon was below 3 percent, in Chiapas, Guerrero, and Oaxaca it was 25 percent or higher. These large regional differences are also found in other indicators of well-being, such as years of schooling, housing conditions, and access to social services. This case study assesses key features and achievements of the Social Protection System in Health (Sistema de Proteccion Social en Salud) in Mexico, and particularly of its main pillar, Popular Health Insurance (Seguro Popular, PHI). It analyzes the contribution of this policy to the establishment and implementation of universal health coverage in Mexico. In 2003, with the reform of the General Health Law, the PHI was institutionalized as a subsidized health insurance scheme open to the population not covered by the social security schemes. Today, the PHI covers all of its intended affiliates, about 52 million peoplePublication Classroom Assessment to Support Foundational Literacy(Washington, DC: World Bank, 2025-03-21)This document focuses primarily on how classroom assessment activities can measure students’ literacy skills as they progress along a learning trajectory towards reading fluently and with comprehension by the end of primary school grades. The document addresses considerations regarding the design and implementation of early grade reading classroom assessment, provides examples of assessment activities from a variety of countries and contexts, and discusses the importance of incorporating classroom assessment practices into teacher training and professional development opportunities for teachers. The structure of the document is as follows. The first section presents definitions and addresses basic questions on classroom assessment. Section 2 covers the intersection between assessment and early grade reading by discussing how learning assessment can measure early grade reading skills following the reading learning trajectory. Section 3 compares some of the most common early grade literacy assessment tools with respect to the early grade reading skills and developmental phases. Section 4 of the document addresses teacher training considerations in developing, scoring, and using early grade reading assessment. Additional issues in assessing reading skills in the classroom and using assessment results to improve teaching and learning are reviewed in section 5. Throughout the document, country cases are presented to demonstrate how assessment activities can be implemented in the classroom in different contexts.Publication Argentina Country Climate and Development Report(World Bank, Washington, DC, 2022-11)The Argentina Country Climate and Development Report (CCDR) explores opportunities and identifies trade-offs for aligning Argentina’s growth and poverty reduction policies with its commitments on, and its ability to withstand, climate change. It assesses how the country can: reduce its vulnerability to climate shocks through targeted public and private investments and adequation of social protection. The report also shows how Argentina can seize the benefits of a global decarbonization path to sustain a more robust economic growth through further development of Argentina’s potential for renewable energy, energy efficiency actions, the lithium value chain, as well as climate-smart agriculture (and land use) options. Given Argentina’s context, this CCDR focuses on win-win policies and investments, which have large co-benefits or can contribute to raising the country’s growth while helping to adapt the economy, also considering how human capital actions can accompany a just transition.Publication Crime and Violence in Central America : A Development Challenge - Main Report(World Bank, 2011-01-01)Crime and violence are now a key development issue for Central American countries. In three nations El Salvador, Guatemala, and Honduras crime rates are among the top five in Latin America. This report argues that successful strategies require actions along multiple fronts, combining prevention and criminal justice reform, together with regional approaches in the areas of drug trafficking and firearms. It also argues that interventions should be evidence based, starting with a clear understanding of the risk factors involved and ending with a careful evaluation of how any planned action might affect future options. In addition, the design of national crime reduction plans and the establishment of national cross-sectoral crime commissions are important steps to coordinate the actions of different government branches, ease cross-sectoral collaboration and prioritize resource allocation. Of equal importance is the fact that national plans offer a vehicle for the involvement of civil society organizations, in which much of the expertise in violence prevention and rehabilitation resides. Prevention efforts need to be complemented by effective law enforcement. The required reforms are no longer primarily legislative in nature because all six countries have advanced toward more transparent adversarial criminal procedures. The second-generation reforms should instead help deliver on the promises of previous reforms by: (i) strengthening key institutions and improving the quality and timeliness of the services they provide to citizens; (ii) improving efficiency and effectiveness while respecting due process and human rights; (iii) ensuring accountability and addressing corruption; (iv) increasing inter-agency collaboration; and (v) improving access to justice, especially for poor and disenfranchised groups. Specific interventions reviewed in the report include: information systems and performance indicators as a prerequisite to improve inter-institutional coordination and information sharing mechanisms; an internal overhaul of court administration and case management to create rapid reaction, one-stop shops; the strengthening of entities that provide legal counseling to the poor and to women; and the promotion of alternative dispute-resolution mechanisms and the implementation of community policing programs.