Financial Aspects

While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. [from abstract]

In this study, we aimed to determine the cost and cost-effectiveness of involving health extension workers in tuberculosis treatment in Southern Ethiopia. This paper presents an ancillary cost-effectiveness analysis of data from a randomized control trial. [adapted from introduction]

This paper identifies key considerations for countries and policymakers planning the financing of their health workforce, and is based on an extensive review and synthesis of the literature, research findings, and experience on the financing and economic aspects of health workforce scale-up and improvement. [from author]

This document explains seven financing and economic issues that matter for health workforce scale-up and financing. It then states twenty-nine actions that policy-makers could take right away to address the issues, independent of any long-term HRH interventions in progress. [from introduction]

This background paper to the World Health Report 2006 discusses the fiscal and macroeconomic implications associated with scaling up health workforce capacity. While these general issues and concepts are relevant in all setting, the focus of the discussion is on low-income countries and sub-Saharan Africa in particular. [from publisher]

Managing health workforce expenditure requires the generation of evidence in order to support informed policy decisions. This background paper for the World Health Report 2006 takes a step forward in exploring HRH expenditures and presents the results of a first measurement for the health workforce in WHO Member States in the years 1998–2003. [from publisher]

This paper reviews the costs and cost-effectiveness of vaccination programme interventions involving lay or community health workers. [from abstract]

Some critics have claimed that disease-specific global health initiatives (GHIs) burden health systems that are already fragile in countries with few resources, whereas others have asserted that weak health systems prevent progress in meeting disease-specific targets. We use a review and analysis of existing data, and 15 new studies to describe the complex nature of the interplay between country health systems and GHIs. There are sections that specifically address the human resources for health and health information systems impacts. [from author]

This book examines two key health workforce policy questions: the impact of government wage bill policies on the size of the health wage bill and on the health workforce staffing levels in the public sector; and if current human resource management policies and practices lead to strategic use of health wage bill resources in the public sector. [from foreword]

This paper aims to describe the design, methods and approaches used to assess the effectiveness and cost-effectiveness of the skilled care initiative in reducing pregnancy-related and perinatal mortality in Ouargaye district, Burkina Faso. [from summary]

This paper evaluates the effectiveness and cost-effectiveness of alternative training strategies for increasing access to emergency obstetric care in Burkina Faso. [adapted from abstract]

This report summarizes the key problems in the health sector and their implications on human resources for health and financing of the health sector; discusses the issues on human resources for health; explores options for improving the production, deployment, retention and management of these workers; analyzes the current state of financing in the health sector; explores options for the financing of essential health services and non-EHP services; and summarizes the way forward. [adapted from introduction]

This presentation was part of the WHO-OECD Hosted Dialogue on migration and other
health workforce issues in a global economy. It discusses the cost of providing the minimum number of health workers for developing countries in terms of increasing the production of health workers, taking into account the diversity and competencies of health workers, and augmenting financial rewards and improving the working environment. [adapted from author]

In response to the critical HRH shortages in Africa, DFID and Office of the US Global Aids Coordinator (OGAC) have been in discussion with a number of African countries to develop strategies and country level actions. The aim is to demonstrate the maximum flexibility of disease specific programmes to support broad based primary care in line with countries’ health plans.

This introductory presentation on maintaining economically sustainable staffing levels was offered during a dialogue hosted by the WHO and OECD.

Improving the capacity of developing countries to respond to emerging diseases and especially influenza pandemics is essential to reduce both transmission around the globe and the human toll of outbreaks in the developing world. Investing in this capacity in developing countries is thus increasingly seen as a shared concern within the global community. [from introduction]

This presentation discusses the various aspects of private providers as they pertain to contracting for health services. [from presentation]

This article outlines different efforts at making strategic HRH plans in the developing world. The article focuses on the financial aspects of HRH planning and provides some general guidelines on the best way to make these plans.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It details the financial issues involved in scaling up health worker training such as the cost of hiring additional staff, educating health workers and expanding training capacity. It also outlines the current and possible future sources of increasing expenditure for health worker training. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It reviews a study of how Rwanda, faced with constrained fiscal conditions, has implemented innovative reforms to create fiscal space for human resources and to make these resources more responsive to needs through an analysis of budget documents and policy and regulation changes and key informant interviews. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It talks about goverment spending policies on health worker wages and how they affect the health workforce.

This presentation was given at the First Forum on Human Resources for Health in Kampala. It breaks down current health spending including HRH resource needs and gaps, provides a critical assessment of HRH financing by some of the top donors and addresses campaiging for adequate and sustained donor financing. [adapted from author]

This presentation was given at the First Forum on Human Resources for Health in Kampala. It presents five questions on the financial concerns of scaling up the number of health workers to provide adequate health care.

The Health Sector Strategic Plan (HSSP) aims to ensure access to basic health care by the Ugandan population. This requires availability of well-trained health professionals. This study demonstrates that the Private-Not-For-Profit Health Training Institutions - the majority in Uganda - have remained grossly under-funded, which poses a threat to achievement of the HSSP. It is recommended that government increases and guarantees its support to these Health Training Institutions as a way of maintaining quality of health worker training. [from abstract]

Recent comments from the Global Fund suggest an intention to focus more on the three diseases, and to leave the strengthening of health systems and support for the health workforce to others. This could create a “Medicines without Doctors” situation in which the medicines to fight AIDS, tuberculosis, and malaria are available, but not the doctors or the nurses to prescribe those medicines adequately. [author’s description]

Health care organizations often do not know what their costs are and have no simple way of assessing costs on a regular basis… This cost analysis tool involves site administrators and service providers themselves in measuring recurrent direct costs of providing services. [author’s description]

This is the first in a series of three papers that examines the financing of services in developing countries. This paper focuses on external assistance in the form of aid and debt cancellation to finance the recruitement, training and salaries of health and education workers. It also discusses the factors that contribute to the critical shortage of these workers and explores some approaches to scaling-up the recruitment of health workers and teachers. [adapted from author]

This report will review the critical elements of quality assessment in Section 1. In the second section it will review the National Health Insurance Fund Act requirements for accreditation and the current means of registering and evaluating health providers. What is needed in accreditation, the options for Tanzania, and the potential problems there may be with accreditation. The final section provides practical guidance for implementing a short-term and longterm strategy for accreditation of NHIF providers and more broadly for all Tanzanian providers. Appendix A provides a practical tool: An Accreditation Survey Instrument for Hospitals.

The objective of this article was to compare the cost-effectiveness of the tuberculosis programm run by the Bangladesh Rural Advancement Committee, which uses community health workers (CHWs), with that of the government program which does not use CHWs. [adapted from author]

Home-based care (HBC) for HIV/AIDS is increasingly looked to as a more accessible and affordable alternative to more costly inpatient care, both for patients who are unable to travel to or pay for inpatient care as well as for governments that must fund inpatient facilities. Partners for Health Reformplus estimated the cost of HBC for HIV in Rwanda, based on a sample of eight programs offering care in early 2004. The sample comprised facility- and community-based programs. Both types of program implement the medical care recommended in the Ministry of Health guidelines for HBC. [from abstract]