Human Resources Management

Community Characteristics that Attract Physicians in Japan: a Cross-Sectional Analysis of Community Demographic and Economic Factors

Population size is often correlated with the number of physicians in a community, and is conventionally considered to represent the power of communities to attract physicians. However, associations between other demographic/economic variables and the number of physicians in a community have not been fully evaluated. This study seeks other parameters that correlate with the physician population and show which characteristics of a community determine its attractiveness to physicians. [adapted from abstract]

Is it (Not) High Time to Introduce Performance-Based Pay in Uganda's Health System?

This article describes the issues facing Uganda’s health system and presents arguments for and against instituting a performance-based pay system.

Level and Determinants of Incentives for Village Midwives in Indonesia

Since the early 1990s Indonesia has attempted to increase the level of skilled attendance at birth by placing rural midwives in every village in an effort to reduce persistently high levels of maternal mortality. Yet evidence suggests that there remains insufficient incentive to ensure an equal distribution across areas while the poor in all areas continue to access skilled attendance much less than those in richer groups.

Retention Strategies for Swaziland's Health Sector Workforce: Assessing the Role of Non-Financial Incentives

This country study in Swaziland thus sought to map and assess incentives for retaining heath workers, particularly non-financial incentives. Specifically it sought to identify existing policies and measures for incentives for retention of health workers, their relevance to current factors driving exit and retention, and propose inputs for guidelines for introducing and managing incentives for health worker retention to maximize their positive impact. [from summary]

Lay Workers in Directly Observed Treatement (DOT) Programmes for Tuberculosis in High Burden Settings: Should They Be Paid? A Review of Behavioural Perspectives

The current global tuberculosis (TB) epidemic has pressured health care managers, particularly in developing countries, to seek for alternative, innovative ways of delivering effective treatment to the large number of TB patients diagnosed annually. One strategy employed is direct observation of treatment for all patients. In high-burden settings innovation with this strategy has resulted into the use of lay community members to supervise TB patients during the duration of anti-TB treatment.

Motivation and Retention of Health Professionals in Developing Countries: a Systematic Review

Health worker retention is critical for health system performance and a key problem is how best to motivate and retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of financial and non-financial incentives on motivation and retention. [from abstract]

Retention Incentives for Health Workers in Zimbabwe

This paper investigates the impact of the framework and strategies to retain critical health professionals (CHPs) that the Zimbabwean government has put in place, particularly regarding non-financial incentives, in the face of continuing high out-migration. [from summary]

Incentives for Retaining and Motivating Health Workers in Pacific and Asian Countries

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]

Payment for Performance (P4P): International Experience and a Cautionary Proposal for Estonia

Incentives such as P4P can be very powerful in their effects. Caution in their design and deployment is essential. However, ignoring their potential would be unwise, as they offer the possibility of improving value for money for taxpayers and patients. The first section of the paper will review evidence of common provider problems in all health care systems and their implications for introducing a P4P system. This will be followed by a review of P4P reforms in the United Kingdom and United States in particular. [from author]

Incentive Systems for Health Care Professionals

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]

Guidelines: Incentives for Health Professionals

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]

Financial Incentives, Healthcare Providers and Quality Improvements: a Review of the Evidence

This study reviews the healthcare literature that examines the effect of financial incentives on the behaviour of healthcare organisations and individuals with respect to the quality of care they deliver to consumers. Its purpose is to provide guidance to policy-makers in government and decision-makers in the private sector in their efforts to improve quality of care through payment reforms. [adapted from summary]

Selecting Effective Incentive Structures in Health Care: a Decision Framework to Support Health Care Purchasers in Finding the Right Incentives to Drive Performance

This article discusses the development of a decision framework to assist policymakers in choosing and designing effective incentive systems. The researchers identified several models that have proven to be effective in changing or enabling a health provider’s performance.

Assessment of the Additional Duties Hours Allowance (ADHA) Scheme: Final Report

The original purpose of the ADHA scheme was to compensate doctors for hours worked beyond the standard 40 hours per week or 160 hours per month. This study investigated how the scheme impacted a number of human resources (HR) factors associated with health worker recruitment, deployment, retention and performance - specifically, how the significantly higher income levels resulting from the ADHA scheme influenced job satisfaction, motivation, workplace climate and the relationship between clinical and administrative staff, as well as productivity. The study provides a detailed chronology of the ADHA scheme and explores lessons learned from the way in which the GOG implemented and administered the scheme.

Block Granting, Perfomance Based Incentives and Fiscal Space Issue: the New Generation of HRH Reforms in Rwanda

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]

Financial Incentives and Mobility of the Health Workforce in Burkina Faso

This presentation was given at the First Forum on Human Resources for Health in Kampala. It describes a study done to analyze health worker perceptions of renumeration and determine the factors that affect the mobility of the health workforce in Burkina Faso

Human Resources Retention Scheme: Qualitative and Quantitative Experience from Zambia

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]

How Can Employment-Based Benefits Help the Nurse Shortage?

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.

Monitoring the Effect of the New Rural Allowance for Health Professionals

The aim of the project was to evaluate the effect of the new rural allowance on the short-term career choices of health professionals in rural areas. A longitudinal cohort study design was used, before and after the introduction of the new allowance.

Getting Clinicians to Do Their Best: Ability, Altruism and Incentives

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.

Turnover of Health Professionals in the General Hospitals in West Nile Region

The study whose summary is presented here tried to compare the attrition rates in three Private Not For Profit and three Government General Hospitals in West Nile Region over a period of five years. It also examined the destination to which the health professionals were lost, the source of the new staff that replaced those lost by the hospitals, the reasons for attrition as perceived by the existing staff in the hospitals, what kept some of the staff working for longer period than others who chose to leave, and the incentives that were in place for attraction and retention of health professionals in these hospitals.

Performance-Based Incentives for Health: Six Years of Results from Supply-Side Programs in Haiti

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]

Performance-Based Incentives for Health: a Way to Improve Tuberculosis Detection and Treatment Completion?

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

Reincentivizing: a New Theory on Work and Work Absence

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]

Design of Incentives for Health Care Providers in Developing Countries: Contracts, Competition and Cost Control

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

Review of Non-Financial Incentives for Health Worker Retention in East and Southern Africa

A growing body of evidence suggests that the quality of a health system depends greatly on highly motivated health workers who are satisfied with their jobs, and therefore stay at their stations and work. This paper reviewed evidence from published and grey literature on the use of non-financial incentives for health worker retention in sixteen countries in east and southern Africa. [adapted from author]

Attracting and Retaining Nurse Tutors in Malawi

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]

Community Health Worker Incentives and Disincentives: How They Affect Motivation, Retention and Sustainability

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.

Development of a Framework for the Development of a Benefit and Motivation Package for Rural Health Workers in Voluntary Agencies (VA) Owned Hospitals: Based on Finding in the Lake Zone

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It discusses the human resources for health situation in Tanzania in general, and specific findings from the Lake zone in terms of health workers in church health institutions. The author proposes options for a motivation package to address the issues of retention for these workers.

Zambia Pilot Study of Performance-Based Incentives

This study evaluates an intervention to raise healthcare provider morale and retention. Two different incentives-cash and a trophy, awarded to facilities rather than individuals-were tested in two districts. The program was implemented district-wide. Health centers and other small health facilities competed for the awards and were scored on the basis of management system indicators. Interviews with staff in both districts measured the effect of the awards on staff motivation and satisfaction. [publisher’s description]