Performance-Based Financing: Fact Sheet

Performance-based financing (PBF) is a powerful management approach to increase the quantity and quality of health services by providing incentives to service providers to improve performance. [from introduction]

Migration of South African Health Workers: The Extent to Which Financial Considerations Influence Internal Flows and External Movements

This study investigates the causes of migration focusing on the role of salaries and benefits. Health professionals from public, private and non-governmental health facilities located in selected peri-urban and urban areas in KwaZulu-Natal, South Africa were surveyed about their current positions and attitudes toward migration. [from abstract]

Health Workforce Remuneration: Comparing Wage Levels, Ranking, and Dispersion of 16 Occupational Groups in 20 Countries

This article explores remuneration in human resources for health, comparing wage levels, ranking and dispersion of 16 occupational groups in 20 countries is to examine to what extent the wage rankings, standardized wage levels, and wage dispersion are similar between the groups and across the selected countries and what factors can be shown to be related to the differences that emerge. [adapted from abstract]

Working Conditions of the Health Workforce in Nepal

This report examines working conditions of health workers in Nepal in relation to income and incentives, work supplies and equipment, issues on safety and security and the role of local authorities and the community. [from summary]

Health Worker Satisfaction and Motivation: An Empirical Study of Incomes, Allowances and Working Conditions in Zambia

In this study the authors examine the relationship between health worker incomes and their satisfaction and motivation. [from abstract]

Wages and Health Worker Retention in Ghana: Evidence from Public Sector Wage Reforms

This paper investigates whether governments in developing countries can retain skilled health workers by raising public sector wages using sudden, policy-induced wage variation, in which the Government of Ghana restructured the pay scale for government health workers. [adapted from abstract]

Ugandan Health Workers Speak: The Rewards and the Realities

This report is based on the accounts of 90 Ugandan health workers at the front line. The research explored with them the rewards and the challenges, explanations for perceived poor practices and promising solutions. The interim findings focus on the rewards of being a health worker and how low pay affects them. [from introduction]

Decent Pensions for Nurses

This monograph presents an analysis of the various factors that affect pension adequacy and sustainability in order to improve the understanding of the factors at stake and how they relate to the specific situation of nurses, particularly, though not exclusively, in advanced economies.­ [from summary]

Health Workers Wages: an Overview from Selected Countries

The overall objective of this background paper for the World Health Report 2006 is to describe variations in health worker wages across countries. However, where data are available, the authors explore variations within countries between health workers and comparable professionals. The main issues of standardization and comparability are discussed. The results are a first attempt to understand the nature of the variability of wages across settings. [from publisher]

Health Worker Salaries and Benefits: Lessons from Bolivia, Peru and Chile

The most common problems related to Health Workers Salaries and Benefits (HWSB) in Bolivia, Peru and Chile are shortage of health workers, disparity of skills, poor distribution of health workers, inadequate working environments and low knowledge about the characteristic of HWSB. This report collects data about these countries, showing that the wages of doctors during the last fifteen years have generally had to increase more than the wages of other workers. [adapted from executive summary]

Remuneration of General Practitioners and Specialists in 14 OECD Countries: What are the Factors Influencing Variations across Countries?

This paper provides a descriptive analysis of the remuneration of doctors in 14 OECD countries for which reasonably comparable data were available in OECD Health Data 2007 (Austria, Canada, the Czech Republic, Denmark, Finland, France, Germany, Hungary, Iceland, Luxembourg, Netherlands, Switzerland, the United Kingdom and the United States).

Salaries and Incomes of Health Workers in Sub-Saharan Africa

This article investigates pay structures for health workers in the public sector in sub-Saharan Africa; the adequacy of incomes for health workers; the management of public- and private-sector pay; and the fiscal and macroeconomic factors that impinge on pay policy for the public sector. The study finds that pay and income of health workers varies widely, whether between countries, by comparison with cost of living, or between the public and private sectors. To optimize the distribution and mix of health workers, policy interventions are needed. Fiscal constraints to increased salaries might need to be overcome in many countries, and non-financial incentives improved. [adapted from summary]

Nurse Wages and Their Context: Database Summary (North America, Western Europe and Japan)

These yearly summary reports provide information on nurse wages and the comparitive buying power of these wages in select countries in North America, Western Europe and Japan. The data are results from a survey of 10 National Nurses’ Associations. [from introduction]

How Should Doctors Be Paid? Lessons from Theory and Practice

For long now, doctors in Uganda have been complaining that their terms of service, particularly remuneration, are not commensurate with the years that they spend training and the amount of work that they do. This issue has persistently been raised at several fora over the years but with no definite resolution. But how should doctors be paid? This paper attempts to answer this question. In the developed world, policy makers attempt to answer the question of cost containment. In Uganda, due to limited financial resources, the overriding question is where will the extra resources to adequately pay doctors be found? [from introduction]

Medicines without Doctors: Why the Global Fund Must Fund Salaries of Health Workers to Expand AIDS Treatment

Recent comments from the Global Fund suggest an intention to focus more on the three diseases, and to leave the strengthening of health systems and support for the health workforce to others. This could create a “Medicines without Doctors” situation in which the medicines to fight AIDS, tuberculosis, and malaria are available, but not the doctors or the nurses to prescribe those medicines adequately. [author’s description]

Nurse Wages and Their Context: Database Summary (Asia)

These yearly summary reports provide information on nurse wages and the comparitive buying power of these wages in Hong Kong, Japan, Korea, Macau, Malaysia, Philippines, Singapore, Taiwan and Thailand. The data are results from a survey of 11 National Nurses’ Associations. [from introduction]

Working Practices and Incomes of Health Workers: Evidence from an Evaluation of a Delivery Fee Exemption Scheme in Ghana

This article describes a survey of health workers and traditional birth attendants (TBAs) which was carried out in 2005 in two regions of Ghana. The objective of the survey was to ascertain the impact of the introduction of a delivery fee exemption scheme on both health workers and those providers who were excluded from the scheme (TBAs).

How to Pay: Understanding and Using Incentives

Many countries have experimented with alternative ways of paying providers of health care services. This paper illustrates different methods, suggests some of the theoretic advantages and limitations of each, and provides a general theoretical framework for evaluating alternatives. Over the last two decades, new and more sophisticated payment systems have evolved, with a broadening of units of payment and setting of payments prospectively. The authors discuss the international experience of a number of payment systems, both traditional and more recently developed, including line-item budgeting, salary, fee-for-service, per diem, case-mix adjusted per episode, global budgets and capitation.

Medical Leave: the Exodus of Health Professionals from Zimbabwe

The study aimed to establish the magnitude of migration of health professionals, its causes and to document the associated impacts on service delivery. [author’s description]

Health Worker Benefits in a Period of Broad Civil Service Reform: The Philippine Experience

Developing countries that have to cope with pressures to reform their bureaucracies have to contend with increasing health worker benefits and salaries that are often intended to retain these health workers in government service. In the Philippines, national and local efforts in health have been forced to focus on guaranteeing some of these benefits, and local governments are feeling the financial limitations of their local funds. [from abstract]

Dual Practice by Public Health Providers in Shandong and Sichuan Provinces, China

There are four types of health providers at present in China. These are defined in terms of differences in ownership. Private practice in the health sector was reintroduced from 1980, when China began its economic reform from a planned economy to a market economy. Dual practice (DP) is quite common and a major concern from the point of view of health policy-making as little is known about it. The aim of this study was to describe policies and regulations of DP, the current situation, its impact on access to services and physician behaviour, and to provide evidence for future policy decisions.

HRM Resource Kit

This toolkit includes a collection of HRM resources and links assembled for the Global Health 2005 conference. Most of the resources are in Microsoft Word format and provide guidance on how to develop a variety of HRM documents or processes. Topics covered include supervision, hiring and recruitment, HR policies, and HIV Workplace Programs and training. [publisher’s description]

Community-Based Distribution in Tanzania: Costs and Impacts of Alternative Strategies to Improve Worker Performance

Donor funds may be inadequate to support the growing demand for services provided by community-based distribution (CBD) programs. One solution may be to reduce the remuneration of CBD agents, but this approach may lower their productivity. Programs also need to consider reducing other costs, including those for supervision and training. The cost per agent visit—including costs associated with payments to agents and to supervisors and the costs of training—was calculated for three CBD programs in Tanzania. The output measure was visits in which contraceptives were provided or referrals made for family planning services.

Developing a Salary Policy

Establishing a salary policy is a critical function of human resource administration which serves to support the organization’s most valuable asset, its human resources. A salary policy should be equitable, structured and clearly understood. By following these components of a salary policy and answering the questions posed, an organization can reflect on its past and present salary policy and establish a salary policy that is sound. [author’s description]

How Health Workers Earn a Living in China

The Chinese government has found it impossible to maintain uniform pay levels, particularly in the face of a radical devolution of its own financial management. Health workers have increasingly resorted to informal methods of earning an income. The government considers this to be unprofessional behavior and has used a combination of moral pressure and loss of professional privileges to discourage it.

Role of Wages in the Migration of Health Care Professionals from Developing Countries.

Several countries are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals. This trend has led to concerns that in many of the source countries—especially within Africa—the outflow of health care professionals is adversely affecting the health care system. This paper examines the role of wages in the migration decision and discusses the likely effect of wage increases in source countries in slowing migration flows. [from abstract]