Incentives and Dynamics in the Ethiopian Health Worker Labor Market

William Jack

Description

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.

Sujets

• Clinic
• Health care
• Hospital
• Immunodeficiency
• Pharmaceutical drug
• Mortality
• Physician
• Health

Informations

• Publié par: world-bank-publications
• Publié le: 07 juillet 2010
• Nombre de lectures: 30
• EAN13: 9780821383643
• Langue: English
• Poids de l'ouvrage: 1 Mo

Extrait

WORLD BANK WORKING PAPER NO. 192
AFRICA HUMAN DEVELOPMENT SERIES
Incentives and Dynamics
in the Ethiopian Health
Worker Labor Market
William Jack
Joose de Laat
Kara Hanson
Agnes Soucat
THE WORLD BANKWORLD BANK WORKING PAPER NO. 192
Incentives and Dynamics in
the Ethiopian Health Worker
Labor Market
William Jack
Joose de Laat
Kara Hanson
Agnes Soucat
Africa Region Human Development Department
WP192_EthiopiaHealth_Text.indb iWP192_EthiopiaHealth_Text.indb i 6/9/10 1:24:56 PM6/9/10 1:24:56 PMCopyright © 2010
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has not been prepared in accordance with the procedures appropriate to formally-edited texts.
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ISBN: 978-0-8213-8358-2
eISBN: 978-0-8213-8364-3
ISSN: 1726-5878 DOI: 10.1596/978-0-8213-8358-2
Library of Congress Cataloging-in-Publication Data has been requested.
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43333333333Contents
Foreword ...........................................................................................................................................v
Acknowledgments ....................................................................................................................... vii
Abstract ............................................................................................................................................ix
Acronyms and Abbreviations ......................................................................................................xi
1. Studying the Health Labor Market in Ethiopia: An Overview .......................................... 1
Introduction ............................................................................................................................... 1
Human Resources for Health in Ethiopia ............................................................................. 2
Empirical Methodology ........................................................................................................... 5
Descriptive Results: Facilities, People, and Jobs .................................................................. 8
Analytic Results: The Performance of the Physician Labor Market................................ 15
Predictive Results: Rural Health Care—How Much Does It Cost? ................................. 22
Bibliography ............................................................................................................................ 29
2. Long-Term Career Dynamics .................................................................................................. 30........... 30
Ethiopia’s Market for Physician Labor ................................................................................ 31
A Model of the Physician Labor Market ............................................................................. 32
Empirical Setup: Sampling, Data, and Model Validity ..................................................... 37
Short-Run Impacts of the Lo ery System on the Physician Labor Market .................... 44
Longer-Term Dynamics in the Physician Labor Market ................................................... 48
Conclusion ............................................................................................................................... 52
References ................................................................................................................................ 54
3. Designing Incentives for Rural Health Workers ................................................................ 55
Introduction ............................................................................................................................. 55
Data and DCE Methodology ................................................................................................ 57
Specifi cation and Estimation................................................................................................. 60
Interpretation of Estimated Coe cients ............................................................................. 61
A ribute Interactions ............................................................................................................. 62
Wage Equivalents ................................................................................................................... 63
Results ...................................................................................................................................... 65
Direct E ects Model ............................................................................................................... 68
Full Model with Characteristic and A ribute Interactions .............................................. 69
Policy Experiments ................................................................................................................. 72
Wage Equivalents ..... 73
Conclusions ............................................................................................................................. 75
References ....................................................................................................................................... 78
iii
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444WP192_EthiopiaHealth_Text.indb ivWP192_EthiopiaHealth_Text.indb iv 6/9/10 1:25:00 PM6/9/10 1:25:00 PMForeword
y international standards, the supply of health workers in Ethiopia is low. In addition, Bthose who do enter the profession and remain in the country disproportionately live
and work in the capital city, Addis Ababa. This story is repeated across the developing
world, and in particular in Sub-Saharan Africa, where shortages of health workers are
deemed chronic. Increasing the supply of health workers, and improving their geographic
distribution, requires an understanding of their responsiveness to changes in the incentives
and constraints they face, and the e cacy with which labor markets can be expected to
allocate scarce human resources for health (HRH).
This book presents evidence on these and other HRH issues from a new survey of
Ethiopian health workers. Detailed data was collected from nearly 1,000 health workers
which is used to answer some fundamental questions: (i) how do compensation levels vary
with location, training, experience, etc.?; (ii) what kinds of incentive packages are potentially
most e ective in a racting workers to under-served rural areas?; and (iii) what can we learn
about the health worker labor market from one of its unique institutional features, that is,
that new graduates are assigned to their fi rst jobs via a lo ery?
The rigorous study methodology and policy relevant fi ndings may be of interest to all
those working to improve the allocation of human resources for health in the developing
world. Ethiopia for one, has shown strong government commitment to the development
of its health workforce, and is determined to futher refi ne and strengthen policies to serve
the poor. Evidence on what motivates doctors and nurses to practice in remote rural areas
will support the government design and refi ne targeted interventions on HRH that will
accellerate progress towards the MDGs even further.
Yaw Ansu,
Sector Director, Human