Analyzing markets for health workers : insights from labor and health economics

Abstract

Improving equitable access to quality health services is one of the main pillars of the World Bank Health, Nutrition, and Population Strategy. The Bank gives high priority to ensuring equitable and sustainable improvements in health outcomes with particular attention to enhancing the well-being of the poor and vulnerable population as part of its primary mission to reduce poverty and promote shared prosperity across the globe. Within this framework, the Bank supports the aspirations of developing countries toward universal health coverage as an important goal that will contribute to each country's efforts in ensuring inclusive and sustainable development. The Bank has identified the inadequate availability of health services and health workers, especially in rural and remote areas, as well as weak management and limited incentives-often not linked to performance-as some of the leading causes of the poor performance of health systems. The Human Resources for Health (HRH) program at the World Bank has been established to assist countries to carry out critical upstream analytic work that will inform health policy and improve the performance of health systems in an equitable and sustainable manner. The focus of the HRH program is on areas where the World Bank has a comparative advantage, including labor market analysis, the synergies between HRH and health financing policies, HRH budget and cost analysis, and assessment of health worker incentives and evaluation of performance-based pay policies. This publication is part of the Bank's multiyear program to enhance its knowledge of HRH policies. The program's ultimate objective is to strengthen knowledge and capacity to collect evidence, analyze, and evaluate the effectiveness of HRH interventions in the context of a country's 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 continuing neglect of these problems 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 help-or hinder-progress 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.