The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives
The complex remuneration of human resources for health in low-income settings: policy implications and a research agenda for designing effective financial incentives
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DOI：
10.1186/s12960-015-0058-7
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发表时间：
2015-07-28
影响因子：
4.5
通讯作者：
Witter, Sophie
中科院分区：
文献类型：
--
作者：
Bertone, Maria Paola;Witter, Sophie
背景：卫生人力资源是卫生系统的重要组成部分，在加快实现全民健康覆盖方面发挥着关键作用。撒哈拉以南非洲的许多国家都面临着卫生工作者的供应、分配和绩效方面的挑战，这些问题可以通过提供有效的财政激励措施来部分解决。方法：基于对现有文献的概述，本文强调了低收入国家现有研究中探索卫生工作者收入不同组成部分的差距。然后，它提出了一种分析经济激励的新颖方法，并制定了研究议程，这可能有助于阐明这一主题。 研究结果：文章发现，虽然有大量研究分别调查卫生工作者可能赚取的每项收入（例如，工资、服务费用、非正式收入、“充值”和每日津贴、双重执业和非卫生活动），但缺乏关注卫生工作者“复杂报酬”的研究，这就是所有可用的财政激励措施。很少有研究同时分析卫生工作者的所有收入，量化总体薪酬并探讨其复杂性、其多个组成部分及其特征，以及收入组成部分之间可能的相互作用。然而，这种全面的方法对于充分理解卫生工作者的激励措施至关重要，方法是调查个人和系统层面的收入结构分散和收入水平波动的原因，以及“复杂薪酬”对动机和绩效的影响。这一主张对于制定有效的激励方案具有重要的政策意义，因为它要求积极考虑“复杂薪酬”在确定招聘、保留和激励模式以及更广泛的卫生系统绩效方面所发挥的作用。结论：本文认为，针对卫生工作者“复杂薪酬”的研究对于解决影响卫生人力资源的一些最具挑战性的问题至关重要。提出了一项实证研究议程来填补我们理解上的空白。
Background: Human resources for health represent an essential component of health systems and play a key role to accelerate progress towards universal health coverage. Many countries in sub-Saharan Africa face challenges regarding the availability, distribution and performance of health workers, which could be in part addressed by providing effective financial incentives.Methods: Based on an overview of the existing literature, the paper highlights the gaps in the existing research in low-income countries exploring the different components of health workers' incomes. It then proposes a novel approach to the analysis of financial incentives and delineates a research agenda, which could contribute to shed light on this topic.Findings: The article finds that, while there is ample research that investigates separately each of the incomes health workers may earn (for example, salary, fee-tor-service payments, informal incomes, "top ups" and per diems, dual practice and non health activities), there is a dearth of studies which look at the health workers' "complex remuneration", that is the whole of the financial incentives available. Little research exists which analyses simultaneously all revenues of health workers, quantifies the overall remuneration and explores its complexity, its multiple components and their features, as well as the possible interaction between income components. However, such a comprehensive approach is essential to fully comprehend health workers' incentives, by investigating the causes at individual and system level) of the fragmentation in the income structure and the variability in income levels, as well as the consequences of the "complex remuneration" on motivation and performance. This proposition has important policy implications in terms of devising effective incentive packages as it calls for an active consideration of the role that "complex remuneration" plays in determining recruitment, retention and motivation patterns, as well as, more broadly, the performance of health systems.Conclusions: This paper argues that research focusing on the health workers' "complex remuneration is critical to address some of the most challenging issues affecting human resources for health. An empirical research agenda is proposed to fill the gap in our understanding.