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Working in Health

Working in Health addresses two key questions related to health workforce policy in developing countries:

  • What is the impact of government wage bill policies on the size of the health wage bill and on health workforce staffing levels in the public sector?
  • Do current human resources management policies and practices lead to effective use of wage bill resources in the public sector?

Working in Health

Health workers play a key role in increasing access to health services for poor people in developing countries. Global and country level estimates show that staffing levels in many developing countries—particularly in sub-Saharan Africa—are far below what is needed to deliver essential health services to the population.

One factor that potentially limits scaling up the health workforce in developing countries is the government overall wage bill policy which sometimes creates restrictions. Through a review of literature, analysis of data, and country case studies in Kenya, Zambia, Rwanda, and the Dominican Republic, this book examines the process that determines the health wage bill budget in the public sector, how this is linked to overall wage bill policies, how this affects staffing levels in the health sector, and the relevant policy options.

But staff numbers are not everything and more money for the health wage bill alone will not solve the health workforce problems of developing countries. Working in Health looks at how effectively governments use the available wage bill resources in the health sector and policy options. Policies and practices in recruitment, deployment, promotion, transfer, sanctioning, and remuneration for health workers are reviewed to identify their influence on budget execution rates, geographic distribution, and productivity of health workers.

The book can be ordered online, and an electronic versions can be downloaded using the links below. Also available are Powerpoint presentation summarizing each of the chapters, and a briefing note with ‘Key Messages’ for policy makers.


Table of Contents

Chapter 1. Overview (PDF 859kb)
The Wage Bill Budgeting Process in the Public Sector
The Effect of the Wage Bill Budgeting Process on the Health Workforce
Managing Health Wage Bill Resources in the Public Sector
Policy Options to Address Fiscal Constraints on the Health Wage Bill and to Improve Management of the Health Workforce in the Public sector
Presentation (PPT 2.29MB)

Chapter 2. Background Country Study for Kenya (PDF 773kb)
The Health Wage Bill in Kenya
Public Sector Employment of Health Workers
Key Messages
Presentation (PPT 1.80MB)

Chapter 3. Background Country Study for Zambia (PDF 792kb)
The Health Wage Bill in Zambia
Public Sector Employment of Health Workers
Key Messages
Presentation (PPT 1.54MB)

Chapter 4. Background Country Study for Rwanda (PDF 1.05MB)
The Health Wage Bill in Rwanda
Public Sector Employment of Health Workers
Donor Funding of Health and Education Workers' Salaries
Key Messages
Presentation (PPT 1.68MB)

Chapter 5. Background Country Study for the Dominican Republic (PDF 813kb)
The Health Wage Bill in the Dominican Republic
Public Sector Employment of Health Workers
Key Messages
Presentation (PPT 1.59MB)

Appendix A Comparative Analysis of Health Outcomes, Service Delivery, and Health Workforce Levels in Kenya, Zambia, Rwanda, and the Dominican Republic (PDF 474kb)

Appendix B Analysis of the Share of Government Health Expenditure Going to the Health Wage Bill: Some Stylized Facts (PDF 448kb)

Appendix C Decentralization and Human Resources for Health (PDF 171kb)

Appendix D Review of Alternative Compensation Methods for Health Workers (PDF 262kb)

Appendix E Review of GFATM Round 6 and GAVI HSS Round 1 Policies and Practices for Funding Health Worker Remuneration (PDF 336kb)