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Financial incentives for health workers, by Maria Paola Bertone

AEDES foundation is funding PhD research: Articles on financial incentives for health workers available here, by Maria Paola Bertone

Aligning financial incentives for health workers is critical to strengthen health systems performance and improve health outcomes. But what are the formal and informal incomes available to health workers? And what are the determinants and the consequences of this complex incentive structure from the perspective of the health workers? To answer these essential questions, the Fondation AEDES is funding Maria Paola Bertone’s PhD research which explores the issues in rural Sierra Leone. A series of publications is now available based on that research.

  • Bertone MP, Witter S (2015), The complex remuneration of Human Resources for Health in low-income settings: policy implications and a research agenda for designing effective financial incentives. Human Resources for Health, 13:62.

A first article sets out the proposed new research agenda on the complex remuneration, defines research approach and questions, and highlights the potential policy implications.

  • Bertone MP, Samai M, Edem-Hotah J and Witter S (2014), A window of opportunity for reform in post-conflict settings? The case of Human Resources for Health policies in Sierra Leone, 2002-2012. Conflict and Health, 8: 11.

The empirical work looks first at the historical patterns of policymaking on human resources to health in post-conflict Sierra Leone. These policies establish the formal incentive environment available for health workers, e.g. what is the level of their salary? what other financial incentives are available, such as performance-based payments and remote allowance for rural postings?

  • Bertone MP, Lagarde M (2016), Sources, determinants and utilization of health workers’ revenues: evidence from Sierra Leone. Health Policy and Planning

This article describes how much rural primary health workers in Sierra Leone earn from each of their formal and informal incomes. Then, going further in the exploration, it also analyzes the causes, or determinants, of receiving each income and higher amounts of it. Is it because of characteristics at individual (gender, age, cadre, role in facility), facility (type or size of facility) and district level? It then explores the views of health workers on each of their incomes and, critically, how health workers use their incomes and why this matters from a policy perspective.

  • Bertone MP, Witter S (2015), An exploration of the political economy dynamics shaping health worker incentives in three districts in Sierra Leone. Social Science and Medicine, 141: 56-63.

Dynamics at district level emerge to be a key driver of health workers incentive, which, as a result, vary between districts. This article explores the political economy dynamics between District Health Management Teams and the NGOs active at district level, and how these affect local health priorities and, in turn, the incentive structure for health workers. Health workers in one district may earn more than those in others because more training is offered and therefore higher per diem payments made, or they could receive higher PBF payments because more support to indicators included in PBF is provided, and so on.

The next step of this research will be to explore if and how the remunerations of health workers affect what they do. Do they focus on general clinical activities, or on disease-specific ones? Do they work within the facility, or work outside on outreach or training? Finally, the overall findings and policy implications of this body of work will be brought together and discussed in the PhD thesis.

For further information, contact Maria Paola Bertone (