Review
Health worker shortages in Pacific and Asian countries
To leave or to stay in the health workforce?
Decision-making factors
Low salaries | Fiji, Samoa, Tonga, Vanuatu (WHO 2004) PNG (Bolger 2005) Vietnam (Dieleman 2005) Cambodia (Soeters 2003, Oum 2005) Thailand (Wibulpolprasert 2003) |
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Lack of adequate allowances | Fiji (WHO 2004) Vietnam (Dieleman 2005) |
Poor working conditions | Fiji (WHO 2004) PNG (Bolger 2005) Vietnam (Dieleman 2005) |
Inadequate facilities and shortages of drugs/equipment | Fiji, Samoa, Tonga, Vanuatu (WHO 2004) Cambodia (Oum 2005), Pakistan (Dussault 2006) |
Difficult transportation | Vietnam (Dieleman 2005) |
Weak support, supervision and management | Fiji, Tonga (WHO 2004) PNG (IMRG 2006) Vietnam (Dieleman 2005) Cambodia (Soeters 2003) |
Heavy workload | Fiji, Samoa (WHO 2004) Vietnam (Dieleman 2005) |
Mismatch in skills and tasks | Fiji, Vanuatu (WHO 2004) |
Limited opportunities for professional development | Tonga (WHO 2004) Vietnam (Dieleman 2005) |
Limited scope to upgrade qualifications | Fiji, Samoa, Tonga (WHO 2004) PNG (Bolger 2005) Vietnam (Dieleman 2005, Nguyen 2005) Pakistan (Adkoli 2006) |
Lack of job prospects | India, Sri Lanka (Adkoli 2006) |
Lack of promotion prospects/career structure | Fiji, Samoa (WHO 2004) |
Inadequate living conditions | PNG (Bolger 2005) |
Risk of violence/Lack of safety | PNG (Bolger 2005) |
Political instability | Fiji (WHO 2004), Pakistan (Adkoli 2006) |
Family members living abroad | Samoa (WHO 2004) |
Education prospects for children | Fiji (WHO 2004) |
Coping strategies
Incentives for health worker retention and performance
Financial incentives: does money matter?
Higher salaries
Salary supplements, benefits and allowances
Donor assistance for salaries and innovative financial incentives
Non-financial incentives: what else is needed?
Improved working and living conditions
Continuing education, training and professional development
Rural recruitment and placement
Rotation from rural and remote posts
Improved supervision and management
Job descriptions, criteria for promotion and career progression
Potential for dual practice
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the supply of health providers willing to work in the public sector is higher than it would be if the providers were not allowed to augment their low public salaries with private earnings,
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providers have an incentive to perform better in order to gain a good reputation and attract patients to their private practices, and
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providers may enhance their technical knowledge and skills through exposure to multiple practice settings.
Gender considerations
Approaches to incentives for health workers
Performance-based incentives
Strategies for return migration
Restrictive measures and sanctions
Packaging financial and non-financial incentives
Conclusion
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long-term political commitment and sustained effort at all levels
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a deep understanding of the cultural, social, political and economic context in which the incentives strategy is being developed
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involvement of key stakeholders – especially the health workers themselves – in developing the strategy, formulating policy and implementing initiatives
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integration of efforts between government sectors, donors, non-governmental organizations and the private sector to ensure the initiatives are sustainable
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packages of coordinated and linked financial and non-financial incentives that adequately respond to the needs of health workers
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monitoring and evaluation tools and systems
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strengthened supervision and management capacities
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performance management systems that link health worker performance to supportive supervision and appraisal, and
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continued research on what motivates health workers in order to adapt and adjust the incentives to the changing needs and desires of the workforce.