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.)

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