Reducing Geographical Imbalances of
            Health Workers in Sub-Saharan Africa : A Labor Market
            Perspective on What Works, What Does Not, and Why

Jahanshahi, Negda; Lemiere, Christophe; Smith, Ellen; Herbst, Christopher H.; Soucat, Agnes

Reducing Geographical Imbalances of Health Workers in Sub-Saharan Africa : A Labor Market Perspective on What Works, What Does Not, and Why

Autores

Jahanshahi, Negda

Lemiere, Christophe

Smith, Ellen

Herbst, Christopher H.

Soucat, Agnes

Editor

World Bank

Descripción

This report discusses and analyzes labor market dynamics and outcomes (including unemployment, worker shortages, and urban-rural imbalances of categories of health workers) from a labor economics perspective. It then uses insights from this perspective as a basis for elaborating policy options that incorporate the underlying labor market forces. The goal of the study is to address undesirable outcomes (including urban-rural HRH imbalances) more effectively. The study draws on an extensive inventory of policy options relevant to urban-rural labor force imbalance in Sub-Saharan Africa and the experiences with these imbalances to date. Given the limited documentation available on this topic through formal channels, the review relies heavily on 'gray literature' from policymakers in Sub-Saharan Africa and their development partners, especially the World Bank and the World Health Organization (WHO). The report is divided into five main sections. The first section focuses on economic policies related to Human Resources for Health (HRH) objectives. It argues that policymaking has ignored health labor market dynamics. The second section provides data showing the extent of urban-rural imbalances and describes how these imbalances affect health system outcomes. The third section uses a health labor market framework to explain these imbalances. The fourth section outlines policy options relevant to Sub-Saharan Africa for addressing market distortions and affecting labor market outcomes. It also reviews evidence on the policies, strategies, and programs designed to address geographic imbalances in Sub-Saharan Africa, highlighting what has been done, what has worked, and what has not. The last section provides a roadmap for policymakers.

Palabras clave

ACCESS TO HEALTH SERVICES, AUXILIARY NURSES, BIRTH ATTENDANTS, BIRTH RATES, BRAIN DRAIN, BURDEN OF DISEASE, CAESAREAN SECTIONS, CASH TRANSFERS, CHILDHOOD DISEASES, CLINICAL GUIDELINES, CLINICS, COMMUNITY HEALTH, COST EFFECTIVENESS, COST-EFFECTIVENESS, COUNSELING, DEATHS, DESCRIPTION, DISSEMINATION, ECONOMIC POLICIES, EQUILIBRIUM, EQUITABLE DISTRIBUTION OF RESOURCES, EXISTING RESOURCES, EXPOSURE TO HEALTH RISKS, FEASIBILITY STUDIES, FEMALE, FEMALES, FEWER YEARS OF EDUCATION, FISCAL CONSTRAINTS, FORMAL EDUCATION, GENDER, GENERAL PRACTITIONERS, GOVERNMENT POLICIES, GYNECOLOGY, HEALTH CARE, HEALTH CARE FACILITIES, HEALTH CARE SERVICES, HEALTH CARE SYSTEM, HEALTH CENTERS, HEALTH CLINICS, HEALTH EDUCATION, HEALTH EXTENSION, HEALTH FACILITIES, HEALTH INSURANCE, HEALTH INTERVENTIONS, HEALTH OFFICIALS, HEALTH POLICY, HEALTH PROBLEMS, HEALTH PROFESSIONALS, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SERVICES, HEALTH SYSTEM, HEALTH SYSTEMS, HEALTH TRAINING, HEALTH WORKERS, HEALTH WORKFORCE, HIV, HIV/AIDS, HOMES, HOSPITAL, HOUSEHOLDS, HOUSING, HUMAN RESOURCES, IMMIGRANT, IMMIGRANT HEALTH, IMMIGRATION, IMMIGRATION POLICIES, IMPORTANT POLICY, INCENTIVE SCHEMES, INCOME, INCOME DISTRIBUTION, INDEXES, INEQUALITY, INEQUITIES, INFANT, INFANT MORTALITY, INFANT MORTALITY RATE, INJURIES, INSERVICE TRAINING, JOB SECURITY, KEY HEALTH INTERVENTIONS, LAB TESTS, LABOR FORCE, LABOR MARKET, LABOR MARKETS, LABOR SHORTAGES, LABOR SUPPLY, LACK OF INFRASTRUCTURE, LEGAL STATUS, LIVE BIRTH, LIVE BIRTHS, LOCAL COMMUNITIES, LOCAL COMMUNITY, LOCAL GOVERNMENTS, MALARIA, MANAGEMENT SYSTEMS, MARRIED COUPLES, MATERNAL HEALTH, MATERNAL MORTALITY, MATERNAL MORTALITY RATES, MEDICAL CARE, MEDICAL SCHOOL, MEDICAL SUPPLIES, MIDWIFE, MIDWIVES, MIGRATION, MILLENNIUM DEVELOPMENT GOALS, MINISTRIES OF HEALTH, MINISTRY OF HEALTH, MORTALITY, MORTALITY LEVELS, MORTALITY RATE, NATIONAL LEVEL, NURSE, NURSES, NURSES TRAINING, NURSING, OBSTETRICAL COMPLICATIONS, PATIENT, PATIENTS, PEDIATRICS, PHYSICIAN, PHYSICIANS, POLICY MAKERS, POLITICAL INSTABILITY, POOR, POOR AREAS, POPULATION DENSITY, POPULATION GROUPS, POVERTY INDICATORS, PRIMARY HEALTH CARE, PRIMARY HEALTH CARE SERVICES, PRIVATE DOCTORS, PROBABILITY, PROGRESS, PUBLIC HEALTH, PUBLIC HEALTH INTERVENTIONS, REDUCING MATERNAL MORTALITY, REMOTE AREAS, REMOTE RURAL AREAS, RURAL, RURAL AREA, RURAL AREAS, RURAL CLINICS, RURAL COMMUNITIES, RURAL COMMUNITY, RURAL DIFFERENCES, RURAL DISTRICTS, RURAL EMPLOYMENT, RURAL GAP, RURAL GAPS, RURAL HEALTH, RURAL HEALTH CARE, RURAL LABOR, RURAL MARKETS, RURAL MEDICINE, RURAL PEOPLE, RURAL POLICY, RURAL POPULATIONS, RURAL PROVINCES, RURAL REGIONS, RURAL SERVICE, RURAL SERVICES, RURAL WORKERS, SAFETY, SCARCE RESOURCES, SKILL LEVEL, SOCIAL FACTORS, SPILLOVER, SPOUSE, SPOUSES, SURGERY, TARGETING, TRAINING OPPORTUNITIES, TRANSPORTATION, UNDER-FIVE MORTALITY, UNEMPLOYMENT, URBAN AREA, URBAN AREAS, URBAN HEALTH CARE, USER FEES, VILLAGES, VIOLENCE, WAR, WOMAN, WORKERS, WORKFORCE, WORKING CONDITIONS, WORLD HEALTH ORGANIZATION