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Diversity in Career Preferences of Future Health Workers in Rwanda: Where, Why, and For How Much?

by Tomas Lievens Pieter Serneels Agnes Soucat Jean Damascene Butera

Relying on unique survey data, this paper analyzes the career preferences of future health workers in Rwanda, focusing on their sector preferences, their willingness to work in rural areas, their likelihood to migrate abroad, and their readiness to work in a high HIV prevalence environment. The findings show that health workers are not as uniform as is often thought, and can have very different preferences regarding wages, intrinsic motivation, and attitudes toward risk. But there are commonalities among future health workers, and the results highlight the importance of intrinsic motivation. To improve health policies, many governments have identified human resources in the health field as a policy priority. To improve policies, this paper provides evidence on health workers' choices and behavior, and it will be a valuable resource for government officials to design effective human resource policies. This working paper was produced as part of the World Bank's Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom, and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition, and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharmaceuticals, Governance and Service Delivery, and Infrastructure and ICT.

The Human Resources for Health Crisis in Zambia

by Christopher H. Herbst Monique Vledder Karen Campbell Mirja Sjöblom Agnes Soucat

'The Human Resources for Health Crisis in Zambia' is part of the World Bank Working Paper series. These papers are published to communicate the results of the Bank's ongoing research and to stimulate public discussion. Despite reporting some health gains since the 1990s, health outcomes remain poor in Zambia and it will be very challenging to achieve the health-related Millennium Development Goals by 2015. The Government of Zambia recognizes that the improvement of child and maternal health and the reduction in mortality from HIV/AIDs and malaria require better access to an appropriate number of wellperforming health workers or human resources for health (HRH). This paper compiles recent evidence on the Zambian health labor market and provides some baseline information on HRH to support the government address its HRH challenges. In addition, the paper analyzes the available evidence on the national health labor market to better understand the number, distribution, and performance of HRH in Zambia.The paper also explains HRH outcomes by mapping, assessing, and analyzing pre-service education and labor market dynamics and well as the core factors influencing these dynamics. This working paper was produced as part of theWorld Bank's Africa Region Health Systems for Outcomes (HSO) Program.The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom, and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems inAfrica to reach the poor and achieve tangible results related to Health, Nutrition, and Population.The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharmaceuticals, Governance and Service Delivery, and Infrastructure and ICT. More information as well as all the products produced under the HSO program can be found online at www.worldbank.org/hso .

Incentives and Dynamics in the Ethiopian Health Worker Labor Market

by William Jack Joost De Laat Agnes Soucat Kara Hanson

By international standards, health workers in Ethiopia are in short supply. In addition, those who do enter the health fields and remain in the country disproportionately live and work in the capital, Addis Ababa. This paper uses detailed data gathered from nearly 1,000 health workers to examine the incentives and constraints that health workers face when choosing where to work, the likely responses of workers to alternative incentive packages, and the longer term performance of the health worker labor market. This working paper was produced as part of the World Bank's Africa Region Health Systems for Outcomes (HSO) Program. The Program, funded by the World Bank, the Government of Norway, the Government of the United Kingdom and the Global Alliance for Vaccines and Immunization (GAVI), focuses on strengthening health systems in Africa to reach the poor and achieve tangible results related to Health, Nutrition and Population. The main pillars and focus of the program center on knowledge and capacity building related to Human Resources for Health, Health Financing, Pharmaceuticals, Governance and Service Delivery, and Infrastructure and ICT.

Reducing Geographical Imbalances of Health Workers in Sub-Saharan Africa: A Labor Market Perspective on What Works, What Does Not, and Why

by Agnes Soucat Christophe Lemiere Negda Jahanshahi Ellen Smith Christopher Herbst

The human resources crisis in the health sector has been gathering attention on the global stage. To date, however, most of this attention has focused on shortages of health human resources (HRH) at the national level. At least as important are problems at the sub-national level. Massive geographic and skill mix imbalances are reflected in the perilous undersupply of HRH in most rural areas. Virtually all Sub-Saharan African countries suffer from significant geographic imbalances. Very little substantive information or documentation exists on the problem. Even less is known about the lessons from policies aimed at addressing urban-rural human resource imbalances, let alone experiences of Sub-Saharan Africa countries, with such policies. There also appears to be a disconnect between the objectives and efforts of policymakers on the one hand and the functioning of national health labor markets and labor market behavior on the other hand. This disconnect hinders policy effectiveness and the efficient utilization of resources intended to narrow urban-rural inequities. In Sub-Saharan Africa government policies, often limited to the management of public sector vacancies, appear to be elaborated, prescribed, and implemented independently of labor market considerations. Partly as a result, they are unable to effectively address urban-rural imbalances, which are an outcome of labor market dynamics. This report discusses and analyzes labor market dynamics and outcomes (including unemployment, worker shortages, and urban-rural imbalances of categories of health workers) from a labor economics perspective. It then use insights from this perspective as a basis for elaborating policy options that incorporate the underlying labor market forces. The goal of the study is to address undesirable outcomes (including urban-rural HRH imbalances) more effectively. The book is thus suitable for researchers, policy analysts and policy makers with an interest in understanding and improving the allocation of human resources for health in the developing world.

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