Provider behaviour
Health assistance schemes are only part of the solution in improving access to and use of health care services. If appropriate and high quality services do not exist near to target populations, the effects of interventions could be reduced.
Complementary supply-side actions are needed to ensure that services are sufficient. A variety of health policy interventions have developed programmes aiming to improve the quality of staff skills, protocols of treatment, availability of supplies and the environment of health facilities.
Scant attention has been paid to the impact of health assistance schemes on health providers’ behaviour, which is influenced by a set of incentives. Evidence suggests that many health sector workers develop ‘‘coping strategies’’ when their expectations in terms of salaries or other working conditions are not met. These strategies may be harmful in terms of access to health care: either they are predatory (under-the-counter fees, sale of public drugs) or they affect the public service organisation (private practice, absenteeism due to training).
In When staff is underpaid: dealing with the individual coping strategies of health personnel Van Lerberghe et al. explores the reasons why different categories of health workers disregard their public work. Reasons include competition for time, brain drain and conflicts of interest. Governments have rarely been proactive in dealing with such problems, mainly because of their reluctance to address the issue openly. The paper calls for a more proactive approach, with systematic reflection about the consequences of policy initiatives on the individual behaviour of health workers.
Improving the performance and accountability of health workers is not only a matter of salary package and equipment, it also means carreer prospect, a social environment reinforcing professional ethics, empowerment of patients etc. Pay and non-pay incentives, performance and motivation (in Towards a global health workforce strategy) explores the diversity of pay and non-pay incentives, reviews their impact on provider behaviour and outlines some of the key factors in selecting the incentive and making it more effective according to the objective pursued. It illustrates the interrelations and mutual influences that may be created between the health workers, the health system and the health assistance mechanisms.
Complementary supply-side actions are needed to ensure that services are sufficient. A variety of health policy interventions have developed programmes aiming to improve the quality of staff skills, protocols of treatment, availability of supplies and the environment of health facilities.
Scant attention has been paid to the impact of health assistance schemes on health providers’ behaviour, which is influenced by a set of incentives. Evidence suggests that many health sector workers develop ‘‘coping strategies’’ when their expectations in terms of salaries or other working conditions are not met. These strategies may be harmful in terms of access to health care: either they are predatory (under-the-counter fees, sale of public drugs) or they affect the public service organisation (private practice, absenteeism due to training).
In When staff is underpaid: dealing with the individual coping strategies of health personnel Van Lerberghe et al. explores the reasons why different categories of health workers disregard their public work. Reasons include competition for time, brain drain and conflicts of interest. Governments have rarely been proactive in dealing with such problems, mainly because of their reluctance to address the issue openly. The paper calls for a more proactive approach, with systematic reflection about the consequences of policy initiatives on the individual behaviour of health workers.
Improving the performance and accountability of health workers is not only a matter of salary package and equipment, it also means carreer prospect, a social environment reinforcing professional ethics, empowerment of patients etc. Pay and non-pay incentives, performance and motivation (in Towards a global health workforce strategy) explores the diversity of pay and non-pay incentives, reviews their impact on provider behaviour and outlines some of the key factors in selecting the incentive and making it more effective according to the objective pursued. It illustrates the interrelations and mutual influences that may be created between the health workers, the health system and the health assistance mechanisms.
- When staff is underpaid: dealing with the individual coping strategies of health personnel
- ( W. Van Lerberghe; C. Conceição; W. Van Damme; P. Ferrinho / Bulletin of the World Health Organization : the International Journal of Public Health , 2002)
- 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. This paper in ...
- Pay and non-pay incentives, performance and motivation
- ( V. Hicks;O. Adams / Prince Leopold Institute of Tropical Medicine, Antwerp , 2003)
- This chapter in the book ‘Towards a Global Health Workforce Strategy’ provides an overview of the current evidence on the effect of pay and non-pay incentives on health workers’ perf...
