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Towards improved health workforce
performance:
The World Bank’s Approach & Work
Program
Christoph Kurowski and Yuki Murakami
VIII. Regional Meeting of the Observatories of Human Resources for Health in the
Americas
Lima, PeruNovember 20th, 2006
Outline
The World Bank’s approach to HRH The World Bank’s LAC HRH work
program Conclusions
The New World Bank Strategy for Health, Nutrition & Population
Improve health outcomes of the poor
Protect households from impoverishing effects of illness
Achieve sustainable financing
The New World Bank Strategy for Health, Nutrition & Population cont.
Renew focus on results
Increase contributions to health system strengthening
Strengthen inter-sector approaches
The Revised World Bank Strategy for Health, Nutrition & Population Cont.
Renew focus on results
Increase contributions to health system strengthening
Strengthen inter-sector approaches
HRH and Outcomes
Health system performance
Health workforce performance
Attitudes, behaviors and choices of current and future health workers
Improve health outcomes of the poor
Protect households from impoverishing effects of illness
Achieve sustainable financing
The Challenge of Strengthening Health Systems
The story of the six blind men …
Financing
Pharmaceuticals
HRH
Governance
Hospitals
Surveillance
The Revised World Bank Strategy for Health, Nutrition & Population cont.
Renew focus on results
Increase contributions to health system strengthening
Strengthen inter-sector approaches
?
The World Bank’s comparative advantage
Financing Governance Stewardship
HRH / HWF
Macro – linksBudget decisions / allocationProviderpayments
Recruitment / contractingAccreditation / RegistrationPerformance Management SystemsMonetary and non-monetary incentivesCareer development / path
PlanningRegulationM&E
Comprehensive Development Framework
Country Priorities / Demand
• Country Assistance Strategy• Project preparation• Project restructuring
The Approach - Summary
World Bank HRH Program =
Country Priorities / Demand +
Results +
Comparative Advantage
Outline
The World Bank’s approach to HRH The World Bank’s LAC HRH work
program Conclusions
The World Bank’s Work Program
Analytical work and technical assistance
(Knowledge Bank)
Lending
LAC: Analytical work and technical assistance
Objectives: Inform policy dialogue, provide technical assistanceExamples: Impact evaluation: Deployment of health
personnel under decentralization and HIPC initiative (Bolivia)
HRH performance studies (Brazil, Paraguay, Peru) Multi-country fiscal impact and contracting study
(Dominican Republic?) The political economy of HRH recruitment and
contracting Managed migration of nurses (CARICOM)
Lending Operations
Instrument Financing of salaries
Development Policy Lending Investment Lending () SWAp Output-disbursed lending Standard investment lending ()
LAC - Lending Operations (47)
Stewardship Planning (11) Legislation /
Regulation (5) Education / Training
curricula (4) M&E (2)
Training (47)
Physical work environment (38)
Governance Remuneration (9) Non-monetary incentives
(6) Licensing (2) Job descriptions (6) Performance
benchmarking (4) Career development (5)
LAC - Lending Operations cont.
Training Other HRH Others
410 (8%) 250 (5%) 4,680 (87%)
US$ million
Training
Other HRH
Others
Conclusions
World Bank HRH Program =
Country Priorities / Demand +
Results +
Comparative Advantage
Conclusions cont.
Health system performance
Health workforce performance
Attitudes, behaviors and choices of current and future health workers
Improve health outcomes of the poor
Protect households from impoverishing effects of illness
Achieve sustainable financing
Conclusions Cont.
Global Activities
Joint Learning Initiative Africa Health Labor Market Toolkit (with WHO,
USAID, NORAD and Gates Foundation) Health workforce performance knowledge and
support program (with NORAD and Gates Foundation)• Focus Africa• Fiscal constraints / budgeting processes• HRH and financial aid from development partners• Contracting• Productivity
Africa: Analytical work and technical assistance
Objectives: Inform policy dialogue, provide technical assistanceExamples: Health worker motivation study (Ethiopia) Multi-country retention study Impact evaluation of policies to redress
geographical imbalances (Ethiopia, Ghana) HRH census support (Ethiopia, Ghana, Malawi,
Ruanda, Zambia) HRH strategy development support (Ethiopia,
Ghana, Liberia, Malawi, Ruanda, Zambia)
LAC: Lending Operations
Project includes component to leverage health workforce performance
2 47
HRH or workforce issues explicitly recognized 9 47
Project supports research to understand HRH and workforce issues
3 47
Project addresses in one or another way HRH issues 47 47
Project includes subcomponent to leverage health workforce performance
7 47
Strengthen Internal Capacity
Information system (data, good practices, consultants, TOR’s, etc.)
Toolkits Virtual support team Training Newsletter