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Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone
Exploring the entire set of formal and informal payments available to health workers (HWs) is critical to understand the financial incentives they face and devise effective incentive packages to motivate them. We investigate this issue in the context of Sierra Leone by collecting quantitative data t...
Autores principales: | , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013780/ https://www.ncbi.nlm.nih.gov/pubmed/27053639 http://dx.doi.org/10.1093/heapol/czw031 |
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author | Bertone, Maria Paola Lagarde, Mylene |
author_facet | Bertone, Maria Paola Lagarde, Mylene |
author_sort | Bertone, Maria Paola |
collection | PubMed |
description | Exploring the entire set of formal and informal payments available to health workers (HWs) is critical to understand the financial incentives they face and devise effective incentive packages to motivate them. We investigate this issue in the context of Sierra Leone by collecting quantitative data through a survey and daily logbooks on the incomes of 266 HWs in three districts, and carrying out 39 qualitative in-depth interviews. We find that, while earnings related to the HWs official jobs represent the largest share, their income is fragmented and composed of a variety of payments, and there is a large heterogeneity in the importance of each income source within the total remuneration. Importantly, each income has different features in terms of regularity, reliability, ease of access, etc. Our analysis also reveals the determinants of the incomes received and their level based on individual and facility characteristics, and finds that these are not in line with HRH policies defined at national level. Additionally, from their narratives, it emerges that HWs are ‘managing’, in the sense both of ‘getting by’ and of enacting financial coping strategies, such as mental accounting (spending different incomes differently), income hiding to shelter it from family pressures, and re-investment of incomes to stabilize overall earnings over time, in order to ensure their livelihoods and those of their families. These strategies question the assumption of fungibility of incomes and the neutrality of increasing or regulating one rather than another of them. Together, our findings on earning and income use patterns have important policy implications for how we go about (re)thinking financial incentive strategies. |
format | Online Article Text |
id | pubmed-5013780 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-50137802016-09-12 Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone Bertone, Maria Paola Lagarde, Mylene Health Policy Plan Original Articles Exploring the entire set of formal and informal payments available to health workers (HWs) is critical to understand the financial incentives they face and devise effective incentive packages to motivate them. We investigate this issue in the context of Sierra Leone by collecting quantitative data through a survey and daily logbooks on the incomes of 266 HWs in three districts, and carrying out 39 qualitative in-depth interviews. We find that, while earnings related to the HWs official jobs represent the largest share, their income is fragmented and composed of a variety of payments, and there is a large heterogeneity in the importance of each income source within the total remuneration. Importantly, each income has different features in terms of regularity, reliability, ease of access, etc. Our analysis also reveals the determinants of the incomes received and their level based on individual and facility characteristics, and finds that these are not in line with HRH policies defined at national level. Additionally, from their narratives, it emerges that HWs are ‘managing’, in the sense both of ‘getting by’ and of enacting financial coping strategies, such as mental accounting (spending different incomes differently), income hiding to shelter it from family pressures, and re-investment of incomes to stabilize overall earnings over time, in order to ensure their livelihoods and those of their families. These strategies question the assumption of fungibility of incomes and the neutrality of increasing or regulating one rather than another of them. Together, our findings on earning and income use patterns have important policy implications for how we go about (re)thinking financial incentive strategies. Oxford University Press 2016-10 2016-04-06 /pmc/articles/PMC5013780/ /pubmed/27053639 http://dx.doi.org/10.1093/heapol/czw031 Text en © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. http://creativecommons.org/licenses/by-nc/4.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contactjournals.permissions@oup.com |
spellingShingle | Original Articles Bertone, Maria Paola Lagarde, Mylene Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone |
title | Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone |
title_full | Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone |
title_fullStr | Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone |
title_full_unstemmed | Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone |
title_short | Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone |
title_sort | sources, determinants and utilization of health workers’ revenues: evidence from sierra leone |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5013780/ https://www.ncbi.nlm.nih.gov/pubmed/27053639 http://dx.doi.org/10.1093/heapol/czw031 |
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