Investigating the remuneration of health workers in the DR Congo: implications for the health workforce and the health system in a fragile setting
Investigating the remuneration of health workers in the DR Congo: implications for the health workforce and the health system in a fragile setting
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DOI：
10.1093/heapol/czv131
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发表时间：
2016-11-01
影响因子：
3.2
通讯作者：
Mutombo, Paulin Beya
中科院分区：
文献类型：
--
作者：
Bertone, Maria Paola;Lurton, Gregoire;Mutombo, Paulin Beya
卫生工作者的经济报酬是应对卫生挑战的人力资源的一个关键问题。在低收入环境中，探索保健工作者的收入来源、其决定因素以及这些报酬所要求的生计战略，对于更好地了解工人的动机及其对工作业绩和服务提供的影响至关重要。在刚果民主共和国这样的环境中，这一点更为重要，因为该国的特点是国家无法通过得到良好支持和资助的公共劳动力提供公共服务。本文基于对刚果民主共和国四个省1771名HWs的定量调查，研究了每项收入的水平和相对重要性。报告发现，刚果保健工作者通过各种来源谋生，并为自己的经济生存制定了不同的战略。主要收入是在设施中工作的人员的使用费份额，以及卫生区管理小组人员的每日津贴和外部机构的补贴（在这两种情况下，医生除外），而政府津贴则不太重要。还对个人和设施一级总收入的决定因素进行了建模，揭示了大多数收入的分配系统地有利于那些在已经有利的条件下工作的人（城市设施、行政职位和设施内的权威职位）。这可能会对HWs的动机和绩效及其分布模式产生负面影响。最后，我们的分析强调，卫生筹资和卫生人力改革修改的HWS的生计机会，其设计和实施超越技术方面，是政治上的必然。更好地考虑这些问题是必要的，以提出有背景和政治头脑的刚果民主共和国改革方法。
The financial remuneration of health workers (HWs) is a key concern to address human resources for health challenges. In low-income settings, the exploration of the sources of income available to HWs, their determinants and the livelihoods strategies that those remunerations entail are essential to gain a better understanding of the motivation of the workers and the effects on their performance and on service provision. This is even more relevant in a setting such as the DR Congo, characterized by the inability of the state to provide public services via a well-supported and financed public workforce. Based on a quantitative survey of 1771 HWs in four provinces of the DR Congo, this article looks at the level and the relative importance of each revenue. It finds that Congolese HWs earn their living from a variety of sources and enact different strategies for their financial survival. The main income is represented by the share of user fees for those employed in facilities, and per diems and top-ups from external agencies for those in Health Zone Management Teams (in both cases, with the exception of doctors), while governmental allowances are less relevant. The determinants at individual and facility level of the total income are also modelled, revealing that the distribution of most revenues systematically favours those working in already favourable conditions (urban facilities, administrative positions and positions of authority within facilities). This may impact negatively on the motivation and performance of HWs and on their distribution patters. Finally, our analysis highlights that, as health financing and health workforce reforms modify the livelihood opportunities of HWs, their design and implementation go beyond technical aspects and are unavoidably political. A better consideration of these issues is necessary to propose contextually grounded and politically savvy approaches to reform in the DR Congo.