Incentives for retaining and motivating health workers in Pacific and Asian countries

Abstract

This paper was initiated by the Australian Agency for International Development (AusAID) after identifying the need for an in-depth synthesis and analysis of available literature and information on incentives for retaining health workers in the Asia-Pacific region. The objectives of this paper are to: 1. Highlight the situation of health workers in Pacific and Asian countries to gain a better understanding of the contributing factors to health worker motivation, dissatisfaction and migration. 2. Examine the regional and global evidence on initiatives to retain a competent and motivated health workforce, especially in rural and remote areas. 3. Suggest ways to address the shortages of health workers in Pacific and Asian countries by using incentives. The review draws on literature and information gathered through a targeted search of websites and databases. Additional reports were gathered through AusAID country offices, UN agencies, and non-government organizations. The severe shortage of health workers in Pacific and Asian countries is a critical issue that must be addressed through policy, planning and implementation of innovative strategies--such as incentives--for retaining and motivating health workers. While economic factors play a significant role in the decisions of workers to remain in the health sector, evidence demonstrates that they are not the only factors. Research findings from the Asia-Pacific region indicate that salaries and benefits, together with working conditions, supervision and management, and education and training opportunities are important. The literature highlights the importance of packaging financial and non-financial incentives. Each country facing shortages of health workers needs to identify the underlying reasons for the shortages, determine what motivates health workers to remain in the health sector, and evaluate the incentives required for maintaining a competent and motivated health workforce. Decision-making factors and responses to financial and non-financial incentives have not been adequately monitored and evaluated in the Asia-Pacific region. Efforts must be made to build the evidence base so that countries can develop appropriate workforce strategies and incentive packages.

Figure 1

Density of health workers. Source: WHO Global Atlas of the Health Workforce (created on 4 July 2007) .

Figure 2

Density of health workers and child mortality. Source: WHO Global Atlas of the Health Workforce , and UNICEF Monitoring & Statistics (accessed and created 5/07).

Figure 3

Factors affecting health worker motivation and retention.

Figure 4

Counteracting informal user fees. Source: World Health Organization. The World Health Report 2006: Working Together for Health, 2006 [18].

Figure 5

Keeping Cambodian health workers in the public system: how much is needed?. Source: Ministry of Health, Cambodia. Cambodia Health Workers Incentive Survey. 2005 [40], and WHO Global Atlas of the Health Workforce .

Figure 6

Donor assistance for salaries and incentives in Malawi. Source: World Health Organization. The World Health Report 2006: Working Together for Health, 2006 [18].

Figure 7

The importance of good supervision and management. Source: World Health Organization. The World Health Report 2006: Working Together for Health, 2006 [18].

Figure 8

Can supervision improve health worker performance?. Source: Rowe AK, de Savigny D, Lanata CF, Victora CG: How can we achieve and maintain high-quality performance of health workers in low-resource settings? Lancet, 2005; 366:1026–35.

Figure 9

Female practitioners in the health workforce. Extracted from: Dussault et al. Not enough there, too many here: Understanding geographical imbalances in the distribution of the health workforce. Human Resources for Health, 2006 [47].

Figure 10

Performance-based incentives for health workers in Cambodia. Source: Soeters R, Griffiths F. Improving government health services through contract management: a case from Cambodia. Health Policy and Planning, 2003 [12].

Figure 11

Turning brain drain into brain gain – the Philippines. Excerpt: The World Health Report 2006: Working Together for Health. World Health Organization, 2006 [18].

Figure 12

Integrated strategies to tackle the inequitable distribution of doctors. Source: Wibulpolprasert S, Pengpaibon P. Integrated strategies to tackle the inequitable distribution of doctors in Thailand: four decades of experience. Human Resources for Health, 2003 [16].