Working in health. Financing and managing the public sector health workforce

The World Bank, book

The World Bank

Publication details

Number of pages: 304
Publication date: 2009
Languages: English
ISBN: 9780821378021


This book, authored by Marco Vujicic, Kalechi Ohiri and Susan Sparkes, examines two key health workforce policy questions: (1) What is the impact of government wage bill policies on the size of the health wage bill and on health workforce staffing levels in the public sector? (2) Do current human resource management policies and practices lead to strategic use of health wage bill resources in the public sector?

Through country case studies in Kenya, Zambia, Rwanda, and the Dominican Republic, this book demonstrates that an analysis of wage bill budget trends, budget execution rates, vacancies, and unemployment levels among health workers can be used to determine whether fiscal ceilings are preventing scaling up the health workforce.

The analysis found that wage bill restrictions were a significant constraint to scaling up the health workforce in only one of the four countries studied in depth. However, in all four cases, significant weaknesses were found in policies and practices related to recruitment, deployment, transfer, promotion, sanctioning, and payment methods of public sector health workers.

Recruitment processes are plagued by delays and not targeted to areas with staff shortages. Salaries and allowances are not being used to provide strong incentives for increasing rural practice and lowering absenteeism. Available wage bill resources are often not fully spent, and even when they are, considerable scope is available to use these resources more strategically. Thus, improving recruitment, deployment, transfer, promotion, and remuneration practices is just as important—and maybe more important—than expanding the health wage bill in addressing health workforce challenges.