Money Matters! A New Costing Tool for Health Worker Retention

Subrata RouthI work on health systems strengthening, mostly for low-income countries. One major challenge is attracting and retaining health workers in rural and remote areas where health services are mostly scanty. Let me quote the recent WHO global policy recommendations for retention:

Approximately one half of the global population lives in rural areas, but these areas are served by only 38% of the total nursing workforce and by less than a quarter of the total physician workforce.

Which retention strategies should be pursued, and how much will they cost? Faced with multiple priorities and limited means, policy-makers want to know up-front what a recommendation will cost, to gauge the affordability of its implementation. Uganda, for instance, developed its Motivation and Retention Strategy back in 2008, but could not implement it because it didn’t know what the incremental costs would be.

In collaboration with WHO, CapacityPlus is designing a simple and user-friendly costing tool. Instead of depending on external technical assistance, HR managers or other health officials will be able to cost a retention strategy at the district, regional, or national level.

Historically, this kind of costing has been undertaken by health economists, which can be expensive. In contrast, our new tool is designed with the layperson in mind. You don’t need to be an economist to use it and understand the results. Read more »

Three Myths about Health Worker Retention

Maurice MiddlebergHow can we encourage health workers to take up and remain in rural postings? This is a key challenge for increasing access to health care. But as we address health worker retention in hard-to-reach areas, there are numerous myths afloat. Here are just a few.

Myth 1. Health workers leave rural posts because they want more money
To be sure, salaries are important. But it’s more complicated than that.

As my colleague Kate Tulenko has pointed out, health workers are consistently among the top wage earners in developing countries. And in terms of international migration, an OECD policy brief notes that while “wage differentials across countries play an important role,” that’s not the only reason health workers leave. Other factors are also at play.

In a South African study cited in Fatu Yumkella’s brief on retention, for example, doctors noted that improving their salary was one of the most important factors for rural retention—yet they also stated that salary alone would not retain them. Money is only one part of the picture.

Myth 2. International migration is the greatest threat
We often think that developing-country health workers’ migration to the US, UK, and elsewhere is the most pressing challenge we face in addressing the workforce shortage. But it’s less of a concern for rural health care than we might expect. Read more »

Building Local Health Systems with Information Systems

This post was originally published on the IntraHealth International blog.

HRIS in IndiaOn my trip to India last month, I didn’t plan to focus on maternal health care, but walking through the maternity ward in Bihar, I couldn’t help but worry about the long lines and hours that keep a woman waiting to see a doctor. The health officials I met with are incredibly committed to serving their communities. In one case, I actually had to walk through the maternity ward to reach my meeting with members of the chief surgeon’s office and the head of district medicine. I realized these men and women walk by the patients every day—women like the proud new mother who urged me to come over and take a photograph of her new daughter. Although the hospital I was in is among the nicest in the state, it lacks many of the essential information systems that can make a health system run efficiently and effectively. In practical terms, this might mean the women I walked by would not have to spend so long waiting to be seen. Read more »

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