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Analyzing Markets for Health Workers Mcpake, Scott, and Edoka the WORLD BANK Analyzing Markets for HealthWorkers DIRECTIONS IN DEVELOPMENT Human Development Analyzing Markets for Health Workers McPake, Scott, McPake, and Edoka Insights from Labor and Health Economics Barbara McPake, Anthony Scott, and Ijeoma Edoka THE WORLD THE BANK Analyzing Markets for Health Workers DIRECTIONS IN DEVELOPMENT Human Development Analyzing Markets for Health Workers Insights from Labor and Health Economics Barbara McPake, Anthony Scott, and Ijeoma Edoka © 2014 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 17 16 15 14 This work is a product of the staff of The World Bank with external contributions. The findings, interpreta- tions, and conclusions expressed in this work do not necessarily reflect the views of The World Bank, its Board of Executive Directors, or the governments they represent. The World Bank does not guarantee the accuracy of the data included in this work. The boundaries, colors, denominations, and other information shown on any map in this work do not imply any judgment on the part of The World Bank concerning the legal status of any territory or the endorsement or acceptance of such boundaries. Nothing herein shall constitute or be considered to be a limitation upon or waiver of the privileges and immunities of The World Bank, all of which are specifically reserved. Rights and Permissions This work is available under the Creative Commons Attribution 3.0 Unported license (CC BY 3.0) http:// creativecommons.org/licenses/by/3.0. 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: McPake, Barbara, Anthony Scott, and Ijeoma Edoka. 2014. Analyzing Markets for Health Workers: Insights from Labor and Health Economics. Directions in Development. Washington, DC: World Bank. doi: 10.1596/978-1-4648-0224-9. License: Creative Commons Attribution CC 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. Adaptations—If you create an adaptation of this work, please add the following disclaimer along with the attribution: This is an adaptation of an original work by The World Bank. Responsibility for the views and opinions expressed in the adaptation rests solely with the author or authors of the adaptation and are not endorsed by The World Bank. Third-party content—The World Bank does not necessarily own each component of the content con- tained within the work. The World Bank therefore does not warrant that the use of any third-party- owned individual component or part contained in the work will not infringe on the rights of those third parties. The risk of claims resulting from such infringement rests solely with you. If you wish to re-use a component of the work, it is your responsibility to determine whether permission is needed for that re-use and to obtain permission from the copyright owner. Examples of components can include, but are not limited to, tables, figures, or images. All queries on rights and licenses should be addressed to the Publishing and Knowledge Division, The World Bank, 1818 H Street NW, Washington, DC 20433, USA; fax: 202-522-2625; e-mail: pubrights@ worldbank.org. ISBN (paper): 978-1-4648-0224-9 ISBN (electronic): 978-1-4648-0225-6 DOI: 10.1596/978-1-4648-0224-9 Cover photo: © Chhor Sokunthea / World Bank. Used with permission. Further permission required for reuse. Library of Congress Cataloging-in-Publication Data McPake, Barbara, author. Analyzing markets for health workers : insights from labor and health economics / Barbara McPake, Anthony Scott, and Ijeoma Edoka. p. ; cm. — (Directions in development) Includes bibliographical references. ISBN 978-1-4648-0224-9 (paper: alk. paper) — ISBN 978-1-4648-0225-6 I. Scott, Anthony, 1967- author. II. Edoka, Ijeoma, author. III. World Bank, issuing body. IV. Title. V. Series: Directions in development (Washington, D.C.) [DNLM: 1. Health Manpower—economics. 2. Health Personnel—economics. W 76.1] RA410.7 331.7'6161069—dc23 2014008441 "OBMZ[JOH.BSLFUTGPS)FBMUI8PSLFST t IUUQEYEPJPSH Contents Preface vii Acknowledgments ix About the Authors xi Abbreviations xiii Overview 1 Chapter 1 Introduction 3 Structure of the Publication 6 References 7 Chapter 2 A Framework for Analysis 9 The Role of the Health Workforce in the Health Care System 9 Market Forces and Market Failure in Health Workers’ Labor Markets 12 References 16 Chapter 3 Policy Interventions and the Health Workforce: Economic Issues and Evidence 17 Demand for Health Workers 17 Supply and Productivity of the Health Workforce 27 Note 48 References 48 Chapter 4 Analytical Approaches 59 Descriptive Labor Market Analysis: The Nature and Extent of Disequilibrium 60 Causal Labor Market Analysis 65 Data Requirements 70 References 73 Chapter 5 Gaps and Future Research 75 Gaps by Topic 75 "OBMZ[JOH.BSLFUTGPS)FBMUI8PSLFST t IUUQEYEPJPSH v vi Contents Geographic Gaps 78 The Way Forward 78 Note 79 References 79 Boxes 1.1 Labor and Health Economics 4 2.1 Labor Productivity 11 3.1 Pay Flexibility—The Theory of Compensating Differences 19 4.1 MABEL Panel Survey of Doctors 72 Figures 1.1 Count of Studies in Countries Covered by the Review 7 2.1 The Role of the Health Workforce in the Health Care System 10 B4.1.1 Types of Data Collected by the MABEL Survey 72 "OBMZ[JOH.BSLFUTGPS)FBMUI8PSLFST t IUUQEYEPJPSH Preface Improving equitable access to quality health services is one of the main pillars of the World Bank Health, Nutrition, and Population Strategy. The Bank gives high priority to ensuring equitable and sustainable improvements in health outcomes with particular attention to enhancing the well-being of the poor and vulnerable population as part of its primary mission to reduce poverty and promote shared prosperity across the globe. Within this framework, the Bank supports the aspira- tions of developing countries toward universal health coverage as an important goal that will contribute to each country’ s efforts in ensuring inclusive and sus- tainable development. The Bank has identified the inadequate availability of health services and health workers, especially in rural and remote areas, as well as weak management and limited incentives—often not linked to performance—as some of the leading causes of the poor performance of health systems. The Human Resources for Health (HRH) program at the World Bank has been established to assist countries to carry out critical upstream analytic work that will inform health policy and improve the performance of health systems in an equitable and sustainable man- ner. The focus of the HRH program is on areas where the World Bank has a comparative advantage, including labor market analysis, the synergies between HRH and health financing policies, HRH budget and cost analysis, and assessment of health worker incentives and evaluation of performance-based pay policies. This publication is part of the Bank’s multiyear program to enhance its knowledge of HRH policies. The program’s ultimate objective is to strengthen knowledge and capacity to collect evidence, analyze, and evaluate the effective- ness of HRH interventions in the context of a country’s health system strength- ening strategy. It specifically addresses the theoretical and empirical evidence on health labor markets in low- and middle-income countries. Health labor market analysis has much to contribute to resolving globally wide- spread HRH problems, and continuing neglect of these problems provides some explanation for their persistence. Policy makers in countries promulgating or refin- ing strategies for achieving universal health coverage will find it important to understand how key elements in their health labor market are likely to interact and how these interactions could help—or hinder—progress toward universal health coverage. These interactions are complex and multidimensional, and this publica- tion highlights some areas where forces in the health labor market matter most. "OBMZ[JOH.BSLFUTGPS)FBMUI8PSLFST t IUUQEYEPJPSH vii Acknowledgments The authors would like to thank the following persons for their contributions to the publication: Edson Araújo (task team seader, Health, Nutrition, and Population [HNP] Global Practice, World Bank Group), Akiko Maeda (HNP Global Practice, World Bank Group), Christophe Lemiere (HNP Global Practice, World Bank Group), Giorgio Commeto (Global Health Workforce Alliance), and Atef El Maghraby (African Development Bank), Daniela Hoshino (HNP Global Practice, World Bank Group), and Jonathan Aspin (editor, World Bank consultant). The publication greatly benefited from comments received from Christopher Herbst (HNP Global Practice, World Bank Group), Michael Weber (Social Protection and Labor Global Practice, World Bank Group), and Wanda Jaskiewicz (Health Workforce Performance, CapacityPlus). The authors also thank participants at the Regional Workshop on Health Labor Market Analysis, Tunisia, March 2013, especially Dr. Atef El Maghraby and his team at the African Development Bank. This publication was supported by the generous grant provided by the Norwegian Ministry of Foreign Affairs
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