Health Workers Salaries in Low and Middle Income Countries
Health Worker Salaries and Benefits: Lessons from Bolivia, Chile and Peru.
Health workers are a critical component of any health system, and issues surrounding their remuneration can have large effects on the delivery of health care in a country. Many countries have difficulty attracting health workers to certain areas, and low pay can exacerbate problems of low motivation, morale, and retention. This study sought to collect and analyze data on norms and trends in health worker salaries in three Latin American countries: Bolivia, Chile and Peru. The results of this study will be of particular use in informing policy debates on health worker salaries in the region.
The most common problems related to Health Workers Salaries and Benefits (HWSB) in Bolivia, Peru and Chile are: i) a shortage of health workers and a disparity of skills (many specialized physicians, few general physicians or public heath specialists), ii) poor distribution of health workers, iii) inadequate working environments, including technological deficiencies; and, iv) low knowledge about the characteristics of HWSB, which impedes planning.
The data collected about Bolivia, Peru and Chile show that in general, the wages of doctors during the last fifteen years have increased more than the wages of other workers. The public sector continues to be, in these countries, the largest employer and in general has no major problems finding employees, with the exception of specific specialties that arise from time to time. Retention, however, is growingly difficult due to the fact that the private sector offers better working conditions.
Bolivia- The distribution of human resources for health is inequitable. In the municipalities of the two poorest quintiles, 63% of the personnel is nursing staff, whereas among the richest quintiles there are more physicians per inhabitant. The distribution of human resources is concentrated in urban areas, at the expense of rural areas, especially in terms of physicians and licensed nurses. The current salary system does not provide performance incentives or incentives to work in underserved areas.
Chile- There is a scarcity of certain health workers, such as specialist physicians, primary care physicians (PHC), medical technologists for radiology, specialized nurses, and emergency medicine physicians. Salaries of health workers are greater than those of the average Chilean workers, but lower than professionals in other areas. Similarly, although in recent years the real salaries of health workers have increased more rapidly than those of the average Chilean worker, they have increased more slowly than the real salaries of professionals in sectors such as education. Furthermore, there are large salary gaps among the various types of health workers. For example, salaries of physicians are nearly three times higher on average than those of their closest colleagues (university-educated nurses).
Peru- Salaries in the Peruvian health sector are not determined by an express policy but are the result of the evolution of various policies (fiscal austerity, mainly) or legislation (regarding public employment, professional regulations, etc.). This has meant that the supply of human resources is regressive in terms of the needs of the population (because there is no difference between salaries in urban and rural areas, human resources are concentrated in the cities, although there is a greater need for them in rural areas). Because of their fiscal impact, appointments, salary raises, and new bonuses have been prohibited. This has led health personnel to seek different mechanisms (including union strikes) for increasing their income, with an ever-decreasing margin for maneuvering as the state continues to control the situation.
Across all countries, physician salaries are markedly higher than both other health professions and other professions outside the health sector. However, the income range within these other health professions can be quite small. In general, salaries have been increasing over time, but not necessarily with a corresponding increase in real income. Private sector salaries are higher than those in the public sector, but in some cases the gap has been decreasing over time. Salary increases are governed in different ways in all countries, and usually manage to at least match inflation.
Available data was scarce and not reported in standardized forms. This makes it difficult to make comparisons across countries and make generalizable conclusions. Different countries prioritize certain indicators over others, and report spending using a mix of currencies from variable years. This partly reflects the complexity of salary policy, but also reflects the need for the standardization of indicators and methods of reporting data. Still, this information is now readily available, and could be useful as a reference point for starting policy dialogues in the future.
Project description
Programme:Health Workers Salaries in low and middle income countries
Research title:Health Worker Salaries and Benefits: Lessons from Bolivia, Peru and Chile
Thematic Research Area: Human Resources for Health
Grantee Country:Chile
Grantee Institution:Bitran & Asociados
Program Coordinator/Principle Investigator: Ricardo Bitran
Start date: June 2007
Status of grant: Completed in April 2008