Analyzing Markets For Health Workers

This publication is part of the Banks multiyear program to enhance its knowledge of HRH policies. The programs ultimate objective is to strengthen knowledge and capacity to collect evidence, analyze, and evaluate the effectiveness of HRH interventions in the context of a countrys health system strengthening 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 widespread HRH problems, and their continuing neglect provides some explanation for their persistence. Policy makers in countries promulgating or refining 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 helpor hinderprogress toward universal health coverage. These interactions are complex and multidimensional, and this publication highlights some areas where forces in the health labor market matter most.The purpose of this publication is to provide an overview of the key issues when attempting to apply economics to the analysis of health workers labor markets. Though much has been written and planned about health human resources, a major weakness with most of this analysis is that it does not use an economic perspective. The use of an explicit economic framework applied by trained economists moves the focus away from simplistic but costly policy responses such as training more doctors and nurses, toward understanding more carefully the role of incentives, productivity, and the distribution of health workers. The health workforce is but one part of the health system and a focus of analysis on only the health workforce is insufficient to be able to determine the optimal number of health workers. Market forces cannot be relied upon to solve health worker shortages or mal-distribution, due to well recognized market failures in health care. This also has implications for how labor economics and labor market analysis can be applied and used successfully in the health care sector.

Achieving universal health care requires understanding health labor markets dynamics to overcome constaints in human resources for health. This book helps to understand how key elements in health labor markets interact and how these interactions can help or hinder significant progress in health care coverage.

This book, produced jointly by the World Bank, the University of California, Berkeley, and the WHO, aims to provide decision-makers at sub-national, national, regional and global levels with additional insights into how to address their workforce challenges rather than describe them. In order to optimize and align HRH investments and develop targeted policy responses, a thorough understanding of unique, country-specific labor market dynamics and determinants of these dynamics is critical. Policies need to take into account the fact that workers are economic actors, responsive to different levels of compensation and opportunities to generate revenue found in different sub-labor markets. Policies need to take into account the behavioral characteristics of the individuals who provide health care, but also the individuals who consume health care services and the institutions that employ health personnel. In other words, it is necessary to understand the determinants of both the supply (numbers of health workers willing to work in the health sector) and the demand for health workers (resources available to hire health workers), how these interact, and how this interaction varies in different contexts. This interaction will determine the availability of health personnel, their distribution as well as their performance levels, thus ensuring stronger health systems capable to deliver universal health coverage. The book is structured to be of use to researchers, planners, and economists who are tasked with analyzing key areas of health labor markets, including overall labor market assessments as well as and more narrow and targeted analyses of demand and supply (including production and migration), performance, and remuneration of health workers. The chapters, written by a number of internationally renowned experts on Human Resources for Health, discuss data sources and empirical tools that can be used to assess health labor markets across high-, middle- or low-income countries, but draws primarily from examples and case-studies in LMICs.

The human resources crisis in the health sector has been gathering attention on the global stage. To date, however, most of this attention has focused on shortages of health human resources (HRH) at the national level. At least as important are problems at the sub-national level. Massive geographic and skill mix imbalances are reflected in the perilous undersupply of HRH in most rural areas. Virtually all Sub-Saharan African countries suffer from significant geographic imbalances. Very little substantive information or documentation exists on the problem. Even less is known about the lessons from policies aimed at addressing urban-rural human resource imbalances, let alone experiences of Sub-Saharan Africa countries, with such policies. There also appears to be a disconnect between the objectives and efforts of policymakers on the one hand and the functioning of national health labor markets and labor market behavior on the other hand. This disconnect hinders policy effectiveness and the efficient utilization of resources intended to narrow urban-rural inequities. In Sub-Saharan Africa government policies, often limited to the management of public sector vacancies, appear to be elaborated, prescribed, and implemented independently of labor market considerations. Partly as a result, they are unable to effectively address urban-rural imbalances, which are an outcome of labor market dynamics. This report discusses and analyzes labor market dynamics and outcomes (including unemployment, worker shortages, and urban-rural imbalances of categories of health workers) from a labor economics perspective. It then use insights from this perspective as a basis for elaborating policy options that incorporate the underlying labor market forces. The goal of the study is to address undesirable outcomes (including urban-rural HRH imbalances) more effectively. The book is thus suitable for researchers, policy analysts and policy makers with an interest in understanding and improving the allocation of human resources for health in the developing world.

Sub-Saharan Africa has only 12 percent of the global population, yet this region accounts for 50 percent of child deaths, more than 60 percent of maternal deaths, 85 percent of malaria cases, and close to 67 percent of people living with HIV. Sub-Saharan Africa, however, has the lowest number of health workers in the world-significantly fewer than in South Asia, which is at a comparable level of economic development. The Labor Market for Health Workers in Africa uses the analytical tools of labor markets to examine the human resource crisis in health from an economic perspective. Africa's labor markets are complex, with resources coming from governments, donors, the private sector, and households. Low numbers of health workers and poor understanding of labor market dynamics are major impediments to improving health service delivery. Yet some countries in the region have developed innovative solutions with new approaches to creating a robust health workforce that can respond to the continent's health challenges. As Africa grows economically, the invaluable lessons in this book can help build tomorrow's African health systems.

This volume investigates the relationship between a nation's health policies, employee health, and the resulting labor market outcomes. Containing nine original and innovative articles, it is a fundamental text for anyone interested in labor economics.

The formation of health professionals is critical for the health system to function and to achieve its universal health coverage (UHC) goals, and this is well recognized by the majority of governments that plan to ensure enough training places and aim to regulate in order to ensure quality. But the importance of market forces is often overlooked, resulting in interventions and regulations that often fail to achieve their intended effects. This publication aims to inform the design of health professionals' education policies to better manage health labor market forces toward UHC. It documents what is known about the influence of market forces on the health-professional formation process. The report sought to answer the following questions: - What have been the large global and regional trends in the development of health professions? - How have these trends affected the career decisions of current and potential health professionals? - What is the evidence base on the value and effectiveness of health professional education of different types? - How has the market for health professional education evolved, and with what interrelationships with the health labor and health care markets? The contexts of the market for health professional training have been subject to important changes in recent decades, in particular: the growing extent of employment of mid-level cadres of health professionals; changes in technology and the associated growth of high skilled occupations; the increasing interconnectedness of national health systems through globalization, with its implications for international health professional mobility; and the greater complexity of the public-private mix in employment options. There is a need to ensure that market forces align with the intentions of planning and regulation and the needs of UHC goals. This publication provides recommendations to support the design of policies that help to achieve these.