71. Health Workers: Building and Motivating the Workforce


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Richard Lord, www.rlordphoto.com

Meeting health care policy goals depends on being able to recruit, train, and retain a staff with the necessary skills. Low– and middle–income countries (LMICs) typically face difficulties in persuading doctors and nurses to work in rural areas and in preventing emigration to wealthier countries. It also is common in LMICs for doctors to work in both the public and private sectors (dual practice), sometimes skimping on public health efforts, pilfering supplies, and inducing demand for their private services.

Many of these human resource problems are predictable from a simple labor market perspective. If key professionals are in short supply, higher salaries are needed to attract them. But many LMICs pay health workers on civil service salary scales intended to control government spending, further widening the gap between salaries for professionals and abroad.

Improving recruitment and retention requires either offering higher rewards that make alternative employment less attractive or making worker qualifications less "portable," that is, less likely to be recognized in other countries. Governments should realize that qualifications that are recognized internationally are likely to attract higher salaries and may be only partly suited to their needs for essential health services. However, interventions such as creating new professional groups or expanding the training offered to groups such as nurses often face organized resistance from existing professional groups that perceive the new groups as a threat.

When formulating policies and incentive structures, governments should link planned staffing to health policy goals, setting priorities and taking overall resources into account.