Dominican Republic Takes Steps to Improve Management of the Health Workforce

In the Dominican Republic, the Ministry of Health is taking an active approach to improving health service delivery and meeting the population’s diverse health care needs. Critical to the country’s efforts to improve access to quality health services is a focus on the health workforce, and in particular the systems used to manage these valuable human resources.

Dominican Republic Ministry of HealthThe Ministry’s 2006-2015 Human Resources for Health Plan calls for new practices and approaches for the management and development of health workers in order to ensure the availability of a workforce with the professional and ethical competence needed to carry out its responsibilities.

Improving human resources management
Over the last several years a number of studies have described the Dominican Republic’s health workforce challenges. After reviewing the findings and recommendations, CapacityPlus found that the studies identified weak human resources management (HRM) systems as a major problem affecting the health workforce. HRM focuses on people—how they fit within a health system; how they are hired, trained, paid, and supported; and how they can be most productive.

CapacityPlus is helping the Ministry of Health refine the HRM systems needed to create an enabling environment for the health workforce to perform effectively. This includes work to strengthen and develop a cadre of skilled HR managers who are able to develop, implement, and manage the necessary HRM systems.

Reducing economic waste by cleaning up the payroll
As part of this work, CapacityPlus provided assistance to the Ministry to analyze its payroll system. This analysis revealed nearly 10,000 ghost workers—individuals who receive a salary but are not working—plus 863 workers who had been in the process of retirement for over three years, representing a total of approximately 30% of the central budget and approximately $633,000 per month (25 million Dominican pesos).

This wasteful spending was compounded by the fact that hospitals must use their internal funds to hire additional staff in order to fill the gaps and provide sufficient health service coverage. 

In response to this alarming situation, the Ministry quickly took action to stop direct payments to all 863 retired people, resulting in an immediate savings of over $50,000 per month (2 million Dominican pesos). These resources were redirected to hire new health workers who now provide much-needed services that the retirees once provided.

The Ministry of Health is continuing to purge its payroll of ghost workers, which will result in significant central and local budget savings that can be used more effectively to improve the quality of care.

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Photo by Sonia Brito-Anderson. (Dominican Republic Ministry of Health)