Incentives

This paper reviews the situation and trend in human resources for health and its priority problems in Thailand. It also highlights the issue of the inequitable distribution of doctors. Through several brainstorming sessions among stakeholders, it summarizes a package of recommendations for the future continuous and sustainable knowledge-based human resources for health development. [from abstract]

This paper focuses on the scheme by the Malawi Ministry of Health (MOH) to retain nurse tutors in collaboration with the Christian Health Association of Malawi (CHAM). It chronicles the scheme’s successful elements for purposes of eventual replication, suggests how to address some of the challenges and identifies effective incentives, including salary supplements. [from executive summary]

This paper, which was prepared as background for the Working Group on Performance Based Incentives, looks at a particular type of financing intervention that has been applied in several different ways around the world to address the joint problems of underutilization and low quality of health services. The focus is on demand- and supply-side financial and material (examples: food, travel vouchers) incentives that can be used to improve utilization and quality of ambulatory health care services, especially for the poor. [from introduction]

This paper examines the experience with using various incentives to motivate and retain community health workers (CHWs) serving primarily as volunteers in child health and nutrition programs in developing countries.

This presentation was part of the ECSA Workforce Observatory Meeting in Arusha. It describes an incentive scheme to help retain certain critical staff in the rural areas and to attract health workers to areas with inadequate staff.


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This paper examines the design and limitations of incentives for health care providers to serve in rural areas in developing countries. [from summary]

In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity.

This presentation was part of the ECSA Workforce Observatory Meeting in Arusha. It discusses health labor force dynamics including how traditional workforce planning does not consider key issues, incentive issues and mapping workfoce productivity in Ghana.


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Using incentives and disincentives to direct individuals’ energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas.

The Committee of Enquiry into National Health Insurance (NHI) in South Africa recommended in 1995 that formally employed individuals and their employers be required to fund at least a minimum package of hospital coverage for workers and their dependents. This has recently been echoed in a Department of Health Policy paper on Social Health Insurance. This research aims to define and cost a minimum package of essential hospital care for competing (public and private) health insurers in South Africa. [abstract]

Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. This study presents a unique exploration of how the factors affect the performance of primary reproductive health providers (nurse-midwives) in two regions of Armenia. [from abstract]

By measuring the ability and actual practice of a sample of clinicians in Tanzania and examining the terms of employment for these clinicians, we show that both ability and motivation are important to quality.

This paper was commissioned by the health professions with the support of the Global Health Workforce Alliance to provide an overview of the use of incentives for health care professionals. It describes some of the different approaches taken and presents characteristics shared by effective incentive schemes. The paper also suggests some approaches to their development and implementation. [from introduction]

The human resource (HR) problem in the health sector in sub-Saharan Africa has worsened to an extent that it has reached crisis proportions in some countries. Although the gravity of the problem varies across the continent, the situation in some of the countries is so grave that urgent action is needed. A complex set of factors has contributed to this problem, some exogenous, such as the austere fiscal measures introduced by structural adjustment, often resulting in cutbacks in the number of health workers. But endogenous factors are also to blame, including misdirected human resource and training policies, weak institutions, and possibly even inappropriate structures. Section I of the paper lays out the key features of the HR crisis as gathered from a review of available data and reports and interviews with health program managers, health officers and project task managers in east and southern Africa. Section II of the paper gathers a few good practices and mechanisms that have been tried to ease the HR problems in the region. It highlights some opportunities for reform and cites the continuing challenges and risks. [adapted from author]

During a labor shortage, employment-based benefits can be used to recruit and retain workers. This paper provides data on the availability of benefits to registered nurses (RNs), reports on how health care leaders are approaching the provision of employment-based benefits for nurses, and considers what nurses have to say in focus groups about benefits. Because of the ongoing nurse shortage, many employers are trying to enhance the benefits they offer to support recruitment and retention efforts. We offer recommendations for health care leaders that follow from our findings about the current state of nurses’ employment-based benefits.

Many countries have experimented with alternative ways of paying providers of health care services. This paper illustrates different methods, suggests some of the theoretic advantages and limitations of each, and provides a general theoretical framework for evaluating alternatives. Over the last two decades, new and more sophisticated payment systems have evolved, with a broadening of units of payment and setting of payments prospectively. The authors discuss the international experience of a number of payment systems, both traditional and more recently developed, including line-item budgeting, salary, fee-for-service, per diem, case-mix adjusted per episode, global budgets and capitation.

The main purpose of the report was to review the current situation on human resource for health and the mobilization of medical doctors to work at commune level in Vietnam…Although Vietnam has established an extensive network and plentiful supply of health personnel, the distribution of health workers is significantly imbalanced, especially at the commune level. In order to improve accessibility and quality of health care for population especially for the poor, the appropriate policies are needed to motivate health worker, especially medical doctors to work at commune level. [abstract]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It discusses the Zambia Health Workers Retention Scheme, an incentive program targeting key health worker cadres primarily in rural district to decrease attrition rates of critical service providers. [adapted from author]

Rewards are important in attracting, motivating and retaining the most qualified employees, and nurses are no exception to this rule. This makes the establishment of an efficient reward system for nurses a true challenge for every hospital manager. A reward does not necessarily have a financial connotation: non-financial rewards may matter too, or may even be more important. Therefore, the present study examines nurses’ reward perceptions, in order to identify potential reward options. [abstract]

As part of the High-Level Forum on the Health Millennium Development Goals, this issue paper discusses improving health workforce performance as a key factor in meeting MDGs. The required scaling up of interventions towards the MDGs depends on effective health services delivery systems (HSDS). The availability, the skills, the attitudes, motivation, and behaviors of health workers are key to well-functioning HSDS. [adapted from author]

Staffing problems are common to most low- and middle-income countries. It is often difficult to persuade doctors to work in remote rural areas. And those who do take such posts typically do not remain long. [author’s description]

This document provides a brief overview of some issues concerning health worker staffing, including brain drain, substitute health workers and incentives.

Health human resources are now a high priority on the political agenda. It is within this context that policy makers, planners and managers have turned their attention to identifying and implementing incentive systems which will be effective in improving the recruitment and retention of health care personnel. [from abstract]

The objectives of this paper are to highlight the situation of health workers in Pacific and Asian countries to gain a better understanding of the contributing factors to health worker motivation, dissatisfaction and migration; examine the regional and global evidence on initiatives to retain a competent and motivated health workforce, especially in rural and remote areas; and suggest ways to address the shortages of health workers in Pacific and Asian countries by using incentives. [from abstract]

This paper provides an overview of evidence of the effects of incentives on the performance and motivation of independent health professionals and health workers.

This study was implemented as part of the EQUINET theme work on Human Resources for Health coordinated by Health systems Trust. The study set out to explore and describe the influence of conditions of service on the movement and retention of the health professionals in Namibia. It is a qualitative study targeting mainly professional nurses, doctors, social workers and health inspectors at both operational and managerial levels, in public and private sectors. [from executive summary]

This paper analyzes the use of financial and material incentives for patients and healthcare providers to improve tuberculosis detection and successful completion of treatment.

Remarkable improvements in key health indicators have been achieved in the six years since payment for performance was phased in. Although it is difficult to isolate the effects of performance-based payment on these improved indicators from the efforts aimed at strengthening NGOs and other factors, panel regression results suggest that the new payment incentives were responsible for considerable improvements in both immunization coverage and attended deliveries. [from abstract]

This paper offers a conceptual framework for considering the many layers of influences upon health worker motivation. It suggests that worker motivation is influenced not only by specific incentive schemes targeted at workers, but also by the whole range of health sector reforms which potentially affect organizational culture, reporting structures, channels of accountability, etc.

This presentation was part of the ECSA Workforce Observatory Meeting in Arusha. It describes an evaluative study to determine issues and causes of health worker problems and shortages done in Rwanda to aid in informing policy reform.


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Work capacity correlates weakly to disease concepts, which in turn are insufficient to explain sick leave behavior. With data mainly from Sweden, a welfare state with high sickness absence rates, our aim was to develop an explanatory theory of how to understand and deal with work absence and sick leave. In this paper we present a theory of work incentives and how to deal with work absence. [from abstract]