Financial and non-financial incentives

Incentives must be viewed in a broad context in order to understand the constraints and success factors of health systems. HRH needs to be seen as a complex and interrelated system where incentives aimed at one group of professionals will impact on the entire system.
In many developing country settings, and particularly in rural areas, the implementation of anything more than very rudimentary contracts for medical care providers, including public employees, is virtually impossible. Produced by the World Bank and George Town University, Designing incentives for rural health care providers in developing countries examines the kinds of policy levers that governments might conceivably have available to induce physicians to serve in rural areas. It assumes that sophisticated performance-based contracts are difficult to enforce in poorer countries.

Pay and non-pay incentives, performance and motivation (in Towards a global health workforce strategy) is an overview of the current evidence on the effect of pay and non-pay incentives on health workers’ performance and motivation. Incentives must be viewed in a broad context in order to understand constraints and success factors that affect their prospects of success. Health human resources should be seen as a complex and interrelated system where incentives aimed at one group of professionals will impact on the entire system.

Health sector workers respond to inadequate salaries and working conditions by developing various individual ‘‘coping strategies’’—some, but not all, of which are of a predatory nature. Van Lerberghe et al in the Bulletin of the World Health Organization article When staff is underpaid: dealing with the individual coping strategies of health personnel review what is known about these practices and their potential consequences (competition for time, brain drain and conflicts of interest). By and large, governments have rarely been proactive in dealing with such problems, mainly because of their reluctance to address the issue openly. The effectiveness of many of these piecemeal reactions, particularly attempts to prohibit personnel from developing individual coping strategies, has been disappointing.

Gerry Bloom et al in How health workers earn a living in China observe that under the command economy all government health workers in China earned similar salaries. Twenty years of transition to a socialist market economy, including liberalisation of the labour market, has led to growing income differences. This Institute of Development Studies working paper explores how this has affected health workers. The study suggests that the government needs to establish new payment systems and a regulatory framework that encourages health workers to provide effective and affordable health services while enabling them to earn a reasonable income.

The study Identifying factors for job motivation of rural health workers in North Viet Nam recommends that both non-financial and financial incentives for health workers should be considered. It describes and reports on the findings of a study that looked at the relation between the implementation of various human resource management tools in Viet Nam and the perception of health workers of these tools on their motivation. It aimed to describe the main factors influencing job motivation at commune and district health centres in rural areas of North Viet Nam and to recommend ways for improving motivation of health workers.