Health Labor Market Analyses in Low- and Middle-Income Countries Scheffler, Herbst, Lemiere, and Campbell
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Health Labor Market Analyses in Low- and Middle-IncomeHealth Labor Market in Low- Analyses Countries DIRECTIONS IN DEVELOPMENT Human Development Scheffler, Herbst, Lemiere, and Campbell Herbst, Lemiere, Scheffler, Health Labor Market Analyses in Low- and Middle-Income Countries An Evidence-Based Approach Richard M. Scheffler, Christopher H. Herbst, Christophe Lemiere, and Jim Campbell, Editors Health Labor Market Analyses in Low- and Middle-Income Countries DIRECTIONS IN DEVELOPMENT Human Development Health Labor Market Analyses in Low- and Middle-Income Countries An Evidence-Based Approach Richard M. Scheffler, Christopher H. Herbst, Christophe Lemiere, and Jim Campbell, Editors © 2016 International Bank for Reconstruction and Development / The World Bank 1818 H Street NW, Washington, DC 20433 Telephone: 202-473-1000; Internet: www.worldbank.org Some rights reserved 1 2 3 4 19 18 17 16 This work is a product of the staff of The World Bank with external contributions. 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Under the Creative Commons Attribution license, you are free to copy, distribute, transmit, and adapt this work, including for commercial purposes, under the following conditions: Attribution—Please cite the work as follows: Scheffler, Richard M., Christopher H. Herbst, Christophe Lemiere, and Jim Campbell, editors. 2016. Health Labor Market Analyses in Low- and Middle-Income Countries: An Evidence-Based Approach. Directions in Development. Washington, DC: World Bank. doi:10.1596/978-1-4648-0931-6. License: Creative Commons Attribution CC BY 3.0 IGO Translations—If you create a translation of this work, please add the following disclaimer along with the attribution: This translation was not created by The World Bank and should not be considered an official World Bank translation. The World Bank shall not be liable for any content or error in this translation. 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All queries on rights and licenses should be addressed to World Bank Publications, The World Bank Group, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights @ worldbank.org. ISBN (paper): 978-1-4648-0931-6 ISBN (electronic): 978-1-4648-0932-3 DOI: 10.1596/978-1-4648-0931-6 Cover image: iStock.com. Used with permission; further permission required for reuse. Cover design: Debra Naylor, Naylor Design, Inc. Library of Congress Cataloging-in-Publication Data has been requested. Health Labor Market Analyses in Low- and Middle-Income Countries http://dx.doi.org/10.1596/978-1-4648-0931-6 Contents Foreword xiii Foreword xv Acknowledgments xvii About the Contributors xix Abbreviations xxix Overview Tools and Data Needs to Guide Evidence-Based Policy Making on Human Resources for Health 1 Christopher H. Herbst, Jim Campbell, Richard M. Scheffler, and Christophe Lemiere Introduction 1 Chapter Summaries 3 Conclusion 8 References 9 Chapter 1 A Labor Market Framework for Human Resources for Health in Low- and Middle-Income Countries 11 Richard M. Scheffler Introduction 11 Forces Affecting HLM 15 Health Workers Labor Market and Health and Medical Services Market 16 Integrated Framework for the HLM 17 Technical Structure and Dynamics of the Impact of the HLM 19 Task Shifting in the HLM 22 Health Worker Productivity 23 Health Worker Performance 24 HLM Indicators 25 Development of a Future Health Workforce 26 Annex 1A: Preliminary List of Data Needed to Analyze the HLM 26 Health Labor Market Analyses in Low- and Middle-Income Countries v http://dx.doi.org/10.1596/978-1-4648-0931-6 vi Contents Notes 27 References 27 Chapter 2 Data Requirements for the Economic Analysis of Health Labor Markets 31 Anthony Scott, Edson C. Araújo, Genta Menkulasi, and Robert Cohen Introduction 31 Data Requirements for HLM Analysis 32 Identifying Data Sets for Review 37 Results of the Review of Data Sets 38 Recommendations for Collecting Health Workforce Data for HLM Analysis 40 Conclusions 42 Annex 2A: Data Sets Included in This Review 43 Annex 2B: International Standard Classification of Occupations: ISCO-08 22 Health Professionals 46 Notes 46 References 47 Chapter 3 Demand-Based and Needs-Based Forecasts for Health Workers 49 Tim Bruckner, Jenny Liu, and Richard M. Scheffler Introduction 49 Needs-Based Forecasts of Health Workers 50 Demand-Based Forecasts of Health Workers 58 Supply of Health Workers 60 Needs-Based and Demand-Based Forecast Comparisons and Shortage Calculations 62 Conclusions 64 Notes 66 References 66 Chapter 4 Measuring and Analyzing Production Supply 69 Kate Tulenko, Atef El Maghraby, Agnes Soucat, Alex Preker, and Tim Bruckner Introduction 69 Institutional Dynamics 70 Medical Education Transformation 71 Data Needs 74 Indicators That Measure Progress 75 Financing 76 Effective Regulation 77 Stakeholders 78 Health Labor Market Analyses in Low- and Middle-Income Countries http://dx.doi.org/10.1596/978-1-4648-0931-6 Contents vii Health Professional Schools 79 Health Facilities 79 Employers 79 Conclusions 81 Notes 81 References 81 Chapter 5 Health Worker Labor Supply, Absenteeism, and Job Choice 85 Pieter Serneels, Tomas Lievens, and Damas Butera Introduction 85 1. Framework for Analysis 86 2. Evidence 91 3. Ways Forward 110 Annex 5A: Cross-Country Data Set 120 Annex 5B: Equations and Variable Definitions for the Models 121 Notes 122 References 127 Chapter 6 Migration of Health Care Professionals from Sub-Saharan Africa: Issues, Data, and Evidence 135 Çag˘lar Özden Introduction 135 Reasons for Migration 137 Data Needed to Analyze Health Care Professional Migrations 139 Ways to Measure the Relative Importance of Migration Determinants 140 Ways to Measure the Impact of Migration 141 Data Availability for Africa 143 Determinants of Migration: Ghana as a Case Study 153 Impact of Migration 158 Conclusions 160 References 161 Chapter 7 Measuring the Performance of Health Workers 163 Kenneth Leonard and Ottar Mæstad Introduction 163 Performance Is Presence, Quality, and Productivity 164 Difficulties Inherent in the Measurement of Performance 166 Tools for Measuring Performance 171 Indicators 177 Annex 7A: Examples of Tools for Measuring Performance 183 Health Labor Market Analyses in Low- and Middle-Income Countries http://dx.doi.org/10.1596/978-1-4648-0931-6 viii Contents Notes 192 References 192 Chapter 8 Analyzing the Determinants of Health Worker Performance 195 Kenneth Leonard and Ottar Mæstad Indicators for Analyzing the Determinants of Performance 195 Ways of Understanding Process Quality Shortfalls 195 Ways of Understanding Productivity Shortfalls 203 Ways of Analyzing Motivation Shortfalls 207 Recommendations 209 Notes 211 References 211 Chapter 9 Measuring and Analyzing Salaries and Incentives 213 Wanda Jaskiewicz, Christophe Lemiere, David Phillips, Joanne Spetz, and Eric Keuffel Health Workers’ Actual Income 213 Official Income Sources 213 Unofficial Incomes of Health Workers and Their Side Effects 218 Methods for Measuring Official Income 221 Ways of Using Administrative Data from Government Agencies 226 Methods for Measuring Unofficial Income 227 Direct Health Worker Surveys 228 Sensitive Survey Techniques 229 Patient Surveys 232 Administrative Records 233 Direct Observation 233 Conclusions 234 Notes 234 References 236 Chapter 10 Survey Techniques to Capture Sensitive Information from Health Workers: An Example of Their Application in Liberia 241 David Phillips, Christopher H. Herbst, and Yah M. Zolia Introduction 241 Sensitive Survey Techniques 242 Item Count Technique 243 Aggregated Response (Sum Randomization) 245 Application of Sensitive Survey Techniques in Liberia 246 Testing Validity of Item Count and Aggregate Response Methods 248 Health Labor Market Analyses in Low- and Middle-Income Countries http://dx.doi.org/10.1596/978-1-4648-0931-6 Contents ix Results 248 Regular