Financial Aspects

Value for Money, Sustainability and Accountability in Health: A New Governance Framework for Africa Towards and Beyond the MDGs: Financing Human Resources for Health

The health sector in Sub-Saharan Africa is most often unfunded, including the health workforce, but many countries do not meet the minimum health staffing levels to provide essential care. This brief outlines the the need for ministries of finance and health to allocate additional financial resources for HRH to maximize the efficiency and effectiveness of current capital and recurrent expenditures. [adapted from author]

Medical Students on Long-Term Regional and Rural Placements: What is the Financial Cost to Supervisors?

Medical student education is perceived as utilising significant amounts of preceptors’ time, negatively impacting on clinical productivity. This study triangulated practice financial data with the perspectives of clinical supervisors before and after regional/rural longitudinal integrated community-based placements of medical students to determine at what point students become financially beneficial to a practice. [adapted from abstract]

Programme Level Implementation of Malaria Rapid Diagnostic Tests (RDTs) Use: Outcomes and Cost of Training Health Workers at Lower Level Health Care Facilities in Uganda

This study describes the process and cost of training to attain competence of lower level health workers to perform malaria RDTs in a public health system setting in eastern Uganda. [from abstract]

Analysis of GAVI, the Global Fund and World Bank Support for Human Resources for Health in Developing Countries

This article reviewed the type of HRH-related activities that are eligible for financing within GAVI, Global Fund and the World Bank; reviewed the HRH-related activities that each agency is actually financing; and reviewed the literature to understand the impact that these investments in HRH have had on the health workforce in developing countries. [adapted from author]

Financial Cost of Doctors Emigrating from Sub-Saharan Africa: Human Capital Analysis

The goal of this research was to estimate the lost investment of domestically educated doctors migrating from sub-Saharan African countries to Australia, Canada, the United Kingdom, and the United States. [from abstract]

Financing Human Resources for Health

This presentation provides a background to HRH finance, identifies the key HRH cost components, the fiscal space for HRH and expanding the HRH fiscal space. [adapted from author]

More Money for Health - More Health for the Money: a Human Resources for Health Perspective

Central within the Global Strategy for Women’s and Children’s Health is the aim to leverage more resources for health financing while simultaneously generating more results from existing resources. This paper considers these ambitions from a human resources for health perspective. [adapted from abstract]

GAVI, the Global Fund and the World Bank Support for Human Resources for Health in Developing Countries

This report reviews the type of HRH-related activities that are eligible for financing within GAVI, the Global Fund, and the World Bank; the HRH-related activities that each agency is actually financing; and the literature to understand the impact that each agency’s investments in HRH have had on HRH in developing countries. [adapted from abstract]

Technical Framework for Costing Health Workforce Retention Schemes in Remote and Rural Areas

This paper reviews the evidence on costing interventions to improve health workforce recruitment and retention in remote and rural areas, provides guidance to undertake a costing evaluation of such interventions and investigates the role and importance of costing to inform the broader assessment of how to improve health workforce planning and management. [from abstract]

Desa Siaga Cost Analysis

The term “Desa Siaga” describes the concept of community members owning their own resources and capacities for preventing and overcoming their own health problems, health emergencies and disasters based on mutual support and in a spirit of togetherness. This cost analysis provides additional information for all stakeholders contributing to informed decision making regarding DS implementation and this from an economic perspective. [from executive summary]

Efficiency and Effectiveness of Aid Flows Towards Health Workforce Development: Exploratory Study Based on Four Case Studies from Ethiopia, the Lao People's Democratic Republic, Liberia and Mozambique

This paper reflects an initial review of aid effectiveness in relation to human resources for health. It asks whether the recent aid effectiveness agenda, as expressed in commitments made to the Paris Declaration, is responding appropriately to the specific needs of HRH and countries’ efforts to strengthen and scale up human resources. [from author]

Following the Funding Trail: Financing, Nurses and Teamwork in Australian General Practice

This paper begins with a review of general practice financing in Australia, and how nurses are currently funded. We then examine the influence on funding structures on the role of the nurse. We set out three dilemmas for policymakers in this area: lack of an evidence base for incentives, possible untoward impacts on interdisciplinary functioning, and the substitution/enhancement debate. [from abstract]

Zeroing In: AIDS Donors and Africa's Health Workforce

This report focuses on AIDS donors and on how they can better use their funding to address health workforce issues. It introduces the HRH crisis, the evolving approaches of AIDS donors, how these approaches to health workforce strengthening and development have played out in practice in Mozambique, Uganda, and Zambia and makes recommendations meant to inform the ongoing deliberations of AIDS donors as they work out the implementation details of their health system strengthening commitments. [adapted from author]

Doubling the Number of Health Graduates in Zambia: Estimating Feasibility and Costs

To address the HRH crisis, the Ministry of Health in Zambia plans to double the annual number of health training graduates in the next five years to increase the supply of health workers. This article determined the feasibility and costs of doubling training institution output through an individual school assessment framework. [adapted from abstract]

Systematic Review: Effects, Design Choices, and Context of Pay-for-Performance in Health Care

Pay-for-performance (P4P) is one of the primary tools used to support healthcare delivery reform. This paper summarizes evidence, obtained from studies published between January 1990 and July 2009, concerning P4P effects, as well as evidence on the impact of design choices, and contextual mediators on these effects. [from abstract]

Health Workforce Responses to Global Health Initiatives Funding: a Comparison of Malawi and Zambia

Shortages of health workers are obstacles to utilising global health initiative (GHI) funds effectively in Africa. This paper reports and analyses two countries’ health workforce responses during a period of large increases in GHI funds. [from abstract]

Costing the Scaling-Up of Human Resources for Health: Lessons from Mozambique and Guinea Bissau

This paper reports on two separate experiences of human resources development plans costing in Mozambique and Guinea Bissau to provide insight into the practice of costing exercises in information-poor settings and contribute to the existing debate on HRH costing methodologies. [adapted from abstract]

Human Resources for Health and Aid Effectiveness Study in Mozambique

This report presents the results and conclusions of a case study conducted within the broader context of assessing resource flows into the development of human resources for health (HRH). Using the example of Mozambique, it examines whether the emerging policy focus on aid effectiveness responds to the evident needs in scaling up HRH. [from publisher]

Human Resources for Health and World Bank Operations in Africa

The purpose of the present paper is to shed light on the treatment of health workforce issues under health sector investments by the World Bank and its African country borrowers and their project agencies. [from introduction]

Emerging Opportunities for Recruiting and Retaining a Rural Health Workforce through Decentralized Health Financing Systems

This paper looks at the potential for decentralization to lead to better health workforce recruitment, performance and retention in rural areas through the creation of additional revenue for the health sector; better use of existing financial resources; and creation of financial incentives for health workers. [from introduction]

Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey

While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. [from abstract]

Cost and Cost-Effectiveness of Smear-Positive Tuberculosis Treatment by Health Extension Workers in Southern Ethiopia: A Community Randomized Trial

In this study, we aimed to determine the cost and cost-effectiveness of involving health extension workers in tuberculosis treatment in Southern Ethiopia. This paper presents an ancillary cost-effectiveness analysis of data from a randomized control trial. [adapted from introduction]

Financing and Economic Aspects of Health Workforce Scale-Up and Improvement: Framework Paper

This paper identifies key considerations for countries and policymakers planning the financing of their health workforce, and is based on an extensive review and synthesis of the literature, research findings, and experience on the financing and economic aspects of health workforce scale-up and improvement. [from author]

What Countries Can Do Now: Twenty-Nine Actions to Scale-Up and Improve the Health Workforce

This document explains seven financing and economic issues that matter for health workforce scale-up and financing. It then states twenty-nine actions that policy-makers could take right away to address the issues, independent of any long-term HRH interventions in progress. [from introduction]

Macroeconomic and Fiscal Issues in Scaling Up Human Resources for Health in Low-Income Countries

This background paper to the World Health Report 2006 discusses the fiscal and macroeconomic implications associated with scaling up health workforce capacity. While these general issues and concepts are relevant in all setting, the focus of the discussion is on low-income countries and sub-Saharan Africa in particular. [from publisher]

Measuring Expenditure for the Health Workforce: Evidence and Challenges

Managing health workforce expenditure requires the generation of evidence in order to support informed policy decisions. This background paper for the World Health Report 2006 takes a step forward in exploring HRH expenditures and presents the results of a first measurement for the health workforce in WHO Member States in the years 1998–2003. [from publisher]

Are Vaccination Programmes Delivered by Lay Health Workers Cost-Effective? A Systematic Review

This paper reviews the costs and cost-effectiveness of vaccination programme interventions involving lay or community health workers. [from abstract]

Assessment of Interactions between Global Health Initiatives and Country Health Systems

Some critics have claimed that disease-specific global health initiatives (GHIs) burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. We use a review and analysis of existing data, and 15 new studies to describe the complex nature of the interplay between country health systems and GHIs. There are sections that specifically address the human resources for health and health information systems impacts. [from author]

Working in Health: Financing and Managing the Public Sector Health Workforce

This book examines two key health workforce policy questions: the impact of government wage bill policies on the size of the health wage bill and on the health workforce staffing levels in the public sector; and if current human resource management policies and practices lead to strategic use of health wage bill resources in the public sector. [from foreword]

Methods for Evaluating Effectiveness and Cost-Effectiveness of a Skilled Care Initiative in Rural Burkina Faso

This paper aims to describe the design, methods and approaches used to assess the effectiveness and cost-effectiveness of the skilled care initiative in reducing pregnancy-related and perinatal mortality in Ouargaye district, Burkina Faso. [from summary]