1 / 38

Foggy Lens?: An Economist ’ s Take on The Global Health Workforce ‘ Crisis ’

Foggy Lens?: An Economist ’ s Take on The Global Health Workforce ‘ Crisis ’. Leonard Davis Institute, January 19 2007 Marko Vujicic Human Development Network The World Bank. Outline . An overview of global health workforce issues Why a labor economics approach?

aurora
Download Presentation

Foggy Lens?: An Economist ’ s Take on The Global Health Workforce ‘ Crisis ’

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Foggy Lens?: An Economist’s Take on The Global Health Workforce ‘Crisis’ Leonard Davis Institute, January 19 2007 Marko Vujicic Human Development Network The World Bank

  2. Outline • An overview of global health workforce issues • Why a labor economics approach? • Illustrations from developing countries

  3. Overview • Goal 1: Eradicate extreme poverty and hunger • Goal 2: Achieve universal primary education • Goal 3: Promote gender equality and empower women • Goal 4: Reduce child mortality • Goal 5: Improve maternal health • Goal 6: Combat HIV/AIDS, malaria and other diseases • Goal 7: Ensure environmental sustainability • Goal 8: Develop a Global Partnership for Development

  4. Overview • Global commitment to reduce poverty: MDGs • Health Related MDGs: • Goal 4: Child Mortality • Reduce by two thirds, between 1990 and 2015, the under-five mortality rate. • Goal 5: Maternal Mortality • Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. • Goal 6: HIV AIDS and Infectious Disease • Have halted by 2015 and begun to reverse the spread of HIV/AIDS. • Have halted by 2015 and begun to reverse the incidence of malaria and other major diseases

  5. Overview

  6. Overview

  7. Overview • Health care is a labor intensive field

  8. Overview

  9. Overview

  10. Overview • Positive relationship between health workforce availability and MDG-related health outcomes

  11. Overview Source: JLI, 2004

  12. Overview Tanzania: workforce availability versus requirements for MDG-related services Source: Kurowski et al , 2003

  13. Overview • WHO estimates global ‘shortage’ of 2.4 million skilled health workers – based on population ratio

  14. Overview • In many developing countries – particularly SSA - there are fewer health workers than required for delivering key services • In addition to ‘shortages’ other key health workforce issues are • Distribution • Geographic • Skill mix • Age • Performance • Productivity • Quality • But workforce is not the only issue in improving health systems!!!

  15. A Labor Market Approach • Traditional health workforce policy tended to focus on determining the health workforce level, distribution and skill mix that is required to meet the needs of the population. • Staffing norms for facilities • Per capita staffing level targets • Analysis of staffing requirements for MDG related interventions • Once this level was determined, training capacity was adjusted, posts assigned, with minimal regard for labor market dynamics

  16. A Labor Market Approach Education And Training Programs Health Care Facilities

  17. A Labor Market Approach • However, this approach ignores important behavioural characteristics of • health workers (supply side) • employers (demand side) • Health workers respond to economic, political incentives unrelated to population needs • Employers respond to economic, political incentives unrelated to population needs

  18. Supply of health workers • Health workers respond to incentives • Financial • Salaries • Bonuses/allowances • Car/housing loans • Non-financial • Working conditions (HIV risk, hours) • Satisfaction, being respected • Promotion criteria • Continuing education

  19. Demand for health workers • Need to distinguish between • “Needs-based” employment level: • the number, skill mix, distribution of health workers required to meet the health needs of the population • Demand for health workers: • the number, skill mix, distribution of health workers employers are willing to hire – funded positions • The demand for health workers depends on • government and household budget levels • wages in the health sector • donor aid • the political environment …all of which are independent of population need!!

  20. A Labor Market Approach Education And Training Programs Health Care Facilities

  21. Policies on enrolment Policies on selecting students Policies to draw health workers back into the health care sector Policies to retain health workers in remote areas Policies to govern dual practice Policies to improve productivity, quality of care Policies on skill mix Policies to mobilize unemployed health workers Policies to address inflows and outflows

  22. Policies on enrolment Policies on selecting students Policies to draw health workers back into the health care sector Policies to retain health workers in remote areas Policies to govern dual practice Policies to improve productivity, quality of care Policies on skill mix Policies to mobilize unemployed health workers

  23. Policies on enrolment Policies on selecting students Policies to draw health workers back into the health care sector Policies to retain health workers in remote areas Policies to govern dual practice Policies to improve productivity, quality of care Policies on skill mix Policies to mobilize unemployed health workers

  24. Policies to address inflows and outflows

  25. Policies to address inflows and outflows

  26. Policies to draw health workers back into the health care sector

  27. Many doctors know what to do but simply don’t do it, responding to their direct incentives: public doctors are on salary and have very little incentive to provide service and private doctors want repeat business. Would be a good start to consider incentives for public doctors to perform at higher levels (perhaps through “bonus” schemes or empowering local authorities to hire and fire). Policies to retain health workers in remote areas Policies to govern dual practice Policies to improve productivity, quality of care Policies on skill mix

  28. Productivity Analysis in Ghana • To develop an aggregate measure of workforce productivity • to monitored performance regularly at the sub-national level in Ghana • To be used as a basis for resource allocation • To identify factors that are correlated with workforce productivity • To build on previous analysis by • Testing the validity of different measures of workforce productivity • Examining trends in workforce productivity over time • To provide recommendations on further analytic work including improvements in data collection

  29. Productivity Analysis in Ghana • CSI : measure of health care services provided to the population • CHRH : measure of the quantity of human resources for health • Define the Service Unit • Define the Categories of Health Services to Include as Outputs in the Numerator • Determine a Method of Aggregating Different Categories of Health Services into a Composite Service Indicator • Define the Categories of Human Resources to Include as Inputs in the Denominator • Determine a Method of Aggregating Different Categories of Human Resources for Health into a Composite Staffing Indicator

  30. Productivity Analysis in Ghana = Total Wage Bill/1,000,000

  31. Productivity Analysis in Ghana

  32. Productivity Analysis in Ghana • Health Status: People may simply not need health care services because they enjoy relatively high health status. • Population Density: There may be relatively few people living in the service unit catchement area (i.e. population density may be low). • Effective Demand: People may need health care services but they simply do not use them, either because they prefer traditional medicine or home care or because they can not afford the services.

  33. Productivity Analysis in Ghana • The Availability of Other Inputs: Health workers need other inputs such as pharmaceuticals, beds and diagnostic equipment in order to produce health care services. Workforce productivity may be low because there are inadequate supplies of complementary inputs. • Quality of Care: Inpatients days and outpatient visits are not homogenous. In service units providing higher quality of care, workforce productivity may be low if high quality care requires more human resources for health inputs. • Skill Mix: The particular mix of personnel used in service units will have an impact on health care services produced as well as the human resources for health inputs. • Absenteeism: If absenteeism varies across service units, it will lead to variations in workforce productivity. Absenteeism can be controlled for by adjusting the relevant measure of human resources for health inputs is for total hours worked or total hours spent providing clinical care.

  34. Productivity Analysis in Ghana • Results: • No systematic predictors of workforce productivity for what we could measure • Availability of other inputs • Skill mix • Case complexity beyond our weighting scheme • Suggests a degree of • Randomness – believable! • Omitted variables • Demand (population density)

  35. Productivity Analysis in Ghana • Results independent of different weighting schemes • Decrease in productivity over time but suggests data quality issues

  36. Productivity Analysis in Ghana

More Related