Academic journal article Bulletin of the World Health Organization

Health Worker Remuneration in WHO Member States/La Remuneration Des Travailleurs De la Sante Dans Les Etats Membres De l'OMS/El Salario del Personal Sanitario En Los Estados Miembros De la OMS

Academic journal article Bulletin of the World Health Organization

Health Worker Remuneration in WHO Member States/La Remuneration Des Travailleurs De la Sante Dans Les Etats Membres De l'OMS/El Salario del Personal Sanitario En Los Estados Miembros De la OMS

Article excerpt

Introduction

A sufficient number of motivated health workers of different types is a precondition for achieving universal health coverage (UHC). (1) The world health report 2006 refocused the world's attention on the acute shortage of health workers in many countries--a persistent problem--but it also made clear that governments need information on the costs of training, hiring, deploying and remunerating health workers when developing plans to improve the availability, distribution, capacity and performance of their health workforces. (1-7) Unfortunately, data of this sort are only available for selected countries. (8,9) According to a report from 48 African countries developed in the mid-1990s, the proportion of total health expenditure spent on health workers ranged from 17% to 74% and was 46% on average. (10) The World Health Organization (WHO) subsequently estimated the share of government expenditure devoted to paying health workers in 64 countries as ranging from 10 to 90% and being 42% on average.: This variability reflects differences across countries in accounting procedures, wages and the price of other health inputs, such as medicines. (11)

Despite the shortage of data, the information that exists has been used to estimate resource gaps and implement policies affecting the health workforce. For example, in the 64 countries identified as having the greatest health worker shortages, the yearly cost of training and employing an additional 3.5 million doctors, nurses and midwives and 2.8 million other workers was estimated at 17 800 million United States dollars (US$) in 2006. (3,4) If salaries were increased to try to retain the newly trained health workers, the costs would be substantially higher.

The data supporting the estimates just described pertain to a limited number of countries and only to medical and paramedical workers, since remuneration data for other types of health workers are not available. (12) Even for these categories, comparisons across studies and countries are made difficult by variations in payment modalities, statistical practices and in the definition of the different types of workers and their respective roles. (13) To obtain a complete picture, it makes sense to first identify and assess the data available from as many countries as possible using standardized definitions and accounting practices to facilitate comparisons. (14) This paper, based on the data available for 2000 and 2010, reports on the first attempt to do so for all 194 WHO Member States.

Methods

We searched for data on payments made to different types of health workers by conducting a documentary review and directly contacting officials from all WHO Member States. These officials included WHO focal points in charge of health accounts--appointed by health ministries--and staff in statistics offices responsible for national accounts reports. The data reported here follow the international standards developed for the entire health workforce, (14) which is defined as "all people engaged in actions whose primary intent is to enhance health". (7) This definition embraces anyone working towards promoting, restoring or maintaining health, including people in management and support jobs that are essential for health systems to function (e.g. health insurance personnel). We also report on the remuneration of government health workers.

General government health expenditure comprises all current and capital spending earmarked for the maintenance, restoration or enhancement of the health status of the population. Total health expenditure comprises all expenditure earmarked for the maintenance, restoration or enhancement of the health status of the population, regardless of the outcome of the goods and services consumed, and including public and private spending. (15) We used general government expenditure on health and total health expenditure as the denominators for our calculations. …

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