Health Worker Incentives Survey (HWIS)

Abstract

One of the most important components of maternal health services is adequate, skilled human resources (Campbell and Graham, 2006; WHO, 2006). Paying and motivating this key resource is just as important as ensuring that enough workers are in place to provide the service. At the same time, health financing policy implementation especially in low-income countries requires hard decisions about priorities for channelling limited resources, and the use of staff incentives may come into competition with other claims for resource prioritization (Ensor and Ronoh, 2005). It is important, therefore, to be able to produce evidence for the desirability and expected efficacy of offering financial incentives to staff. A methodology to assess the incentives to deliver maternal health services was developed out of three Immpact evaluations of maternal health care interventions in Ghana, Indonesia and Burkina Faso. Although in each of the initial Immpact evaluations (see Module 2 and Module 3 for more information) the effect on human resources was considered important, the initial development of this tool was undertaken during a project in Cambodia which examined the restructuring of the medical workforce in a context of very low public spending on wages. A key question in that study was to determine how great a financial incentive is required to ensure that public sector health workers remain in their posts rather than spending part of their working hours in private practice, leaving the public sector entirely, or engaging other activities to boost their income - alternative opportunities that often motivate public health workers in many, if not most, low- and middle-income countries. Immpact's experience showed also that financial incentives are particularly useful when scaling up a public health policy intervention, when there is a need to attract skilled staff to less popular areas of work (for instance in remoter locations) in order to be able to implement the policy comprehensively and effectively.