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The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives

BACKGROUND: Human resources for health represent an essential component of health systems and play a key role to accelerate progress towards universal health coverage. Many countries in sub-Saharan Africa face challenges regarding the availability, distribution and performance of health workers, whi...

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Autores principales: Bertone, Maria Paola, Witter, Sophie
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2015
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517656/
https://www.ncbi.nlm.nih.gov/pubmed/26215040
http://dx.doi.org/10.1186/s12960-015-0058-7
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author Bertone, Maria Paola
Witter, Sophie
author_facet Bertone, Maria Paola
Witter, Sophie
author_sort Bertone, Maria Paola
collection PubMed
description BACKGROUND: Human resources for health represent an essential component of health systems and play a key role to accelerate progress towards universal health coverage. Many countries in sub-Saharan Africa face challenges regarding the availability, distribution and performance of health workers, which could be in part addressed by providing effective financial incentives. METHODS: Based on an overview of the existing literature, the paper highlights the gaps in the existing research in low-income countries exploring the different components of health workers’ incomes. It then proposes a novel approach to the analysis of financial incentives and delineates a research agenda, which could contribute to shed light on this topic. FINDINGS: The article finds that, while there is ample research that investigates separately each of the incomes health workers may earn (for example, salary, fee-for-service payments, informal incomes, “top-ups” and per diems, dual practice and non-health activities), there is a dearth of studies which look at the health workers’ “complex remuneration”, that is, the whole of the financial incentives available. Little research exists which analyses simultaneously all revenues of health workers, quantifies the overall remuneration and explores its complexity, its multiple components and their features, as well as the possible interaction between income components. However, such a comprehensive approach is essential to fully comprehend health workers’ incentives, by investigating the causes (at individual and system level) of the fragmentation in the income structure and the variability in income levels, as well as the consequences of the “complex remuneration” on motivation and performance. This proposition has important policy implications in terms of devising effective incentive packages as it calls for an active consideration of the role that “complex remuneration” plays in determining recruitment, retention and motivation patterns, as well as, more broadly, the performance of health systems. CONCLUSIONS: This paper argues that research focusing on the health workers’ “complex remuneration” is critical to address some of the most challenging issues affecting human resources for health. An empirical research agenda is proposed to fill the gap in our understanding.
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spelling pubmed-45176562015-07-29 The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives Bertone, Maria Paola Witter, Sophie Hum Resour Health Research BACKGROUND: Human resources for health represent an essential component of health systems and play a key role to accelerate progress towards universal health coverage. Many countries in sub-Saharan Africa face challenges regarding the availability, distribution and performance of health workers, which could be in part addressed by providing effective financial incentives. METHODS: Based on an overview of the existing literature, the paper highlights the gaps in the existing research in low-income countries exploring the different components of health workers’ incomes. It then proposes a novel approach to the analysis of financial incentives and delineates a research agenda, which could contribute to shed light on this topic. FINDINGS: The article finds that, while there is ample research that investigates separately each of the incomes health workers may earn (for example, salary, fee-for-service payments, informal incomes, “top-ups” and per diems, dual practice and non-health activities), there is a dearth of studies which look at the health workers’ “complex remuneration”, that is, the whole of the financial incentives available. Little research exists which analyses simultaneously all revenues of health workers, quantifies the overall remuneration and explores its complexity, its multiple components and their features, as well as the possible interaction between income components. However, such a comprehensive approach is essential to fully comprehend health workers’ incentives, by investigating the causes (at individual and system level) of the fragmentation in the income structure and the variability in income levels, as well as the consequences of the “complex remuneration” on motivation and performance. This proposition has important policy implications in terms of devising effective incentive packages as it calls for an active consideration of the role that “complex remuneration” plays in determining recruitment, retention and motivation patterns, as well as, more broadly, the performance of health systems. CONCLUSIONS: This paper argues that research focusing on the health workers’ “complex remuneration” is critical to address some of the most challenging issues affecting human resources for health. An empirical research agenda is proposed to fill the gap in our understanding. BioMed Central 2015-07-28 /pmc/articles/PMC4517656/ /pubmed/26215040 http://dx.doi.org/10.1186/s12960-015-0058-7 Text en © Bertone and Witter. 2015 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research
Bertone, Maria Paola
Witter, Sophie
The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives
title The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives
title_full The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives
title_fullStr The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives
title_full_unstemmed The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives
title_short The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives
title_sort complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4517656/
https://www.ncbi.nlm.nih.gov/pubmed/26215040
http://dx.doi.org/10.1186/s12960-015-0058-7
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