Beyond Wage Bill Ceilings : The Impact of Government Fiscal and Human Resource Management Policies on the Health Workforce in Developing Countries, Background Country Study for Rwanda
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One of the main explanations put forth
on why access to health workers is so low in developing
countries is that there are insufficient resources within
the public sector to pay the wage bill - the salary and
allowance payments - of an expanded health workforce. In
turn, the lack of wage bill resources for the health sector
is thought to be a direct result of restrictive
macroeconomic policies that limit the expansion of the
overall public sector wage bill. The overarching message in
this report is that, despite the relative contraction of the
public sector wage bill, Rwanda has not only protected the
health sector, but has succeeded through decentralization
and the introduction of performance-based financing in
linking salaries to performance in the health sector. The
decentralization of budgets, along with the implementation
of the performance-based grants scheme, has had two major
effects. First, it has increased the resource envelope
available for hiring health workers since there is a lot of
flexibility in how the performance based grants can be used.
Second, it has linked payments to health workers with
performance, since the salary top amounts paid out of the
grants are linked to service delivery results.
Palabras clave
ACCOUNTING, AGE STRUCTURE, ALLOCATION, ANNUAL BUDGET, ANNUAL BUDGET PREPARATION, ANNUAL BUDGETS, ANNUAL REPORT, ARTICLE, BLOCK GRANT, BLOCK GRANTS, BUDGET CYCLE, BUDGET ENVELOPE, BUDGET EXECUTION, BUDGET FRAMEWORK, BUDGET LAW, BUDGET MANAGEMENT, BUDGET MANAGEMENT PROCESS, BUDGET SUPPORT, BUDGETARY ITEMS, BUDGETING PROCESS, CAPACITY CONSTRAINTS, CENTRAL GOVERNMENT, CIVIL SERVANTS, CIVIL SERVICE, CIVIL SERVICE REFORM, CIVIL SERVICE SYSTEM, COMMUNITIES, CONDITIONALITY, CONTRACTUAL ARRANGEMENTS, DECENTRALIZATION, DECENTRALIZATION POLICIES, DECENTRALIZATION PROCESS, DESCRIPTION, DOCTORS, DONOR AGENCIES, DONOR COORDINATION, DONOR FINANCING, DONOR FUNDING, DONOR FUNDS, ECONOMIC DEVELOPMENT, ECONOMIC GROWTH, ECONOMIC POLICY, EXPENDITURE CEILINGS, EXPENDITURE CONSTRAINT, EXPENDITURE LEVELS, EXPENDITURES, FINANCIAL INSTITUTIONS, FINANCIAL RESOURCES, FISCAL DECENTRALIZATION, FISCAL DEFICIT, GENDER, GOVERNMENT BUDGET, GOVERNMENT EXPENDITURE, GOVERNMENT EXPENDITURES, GOVERNMENT STRUCTURES, GROSS DOMESTIC PRODUCT, HEALTH BUDGETS, HEALTH CARE, HEALTH CARE WORKERS, HEALTH CENTERS, HEALTH EXPENDITURE, HEALTH EXPENDITURES, HEALTH FACILITIES, HEALTH ORGANIZATION, HEALTH OUTCOMES, HEALTH PLANNING, HEALTH PROFESSIONALS, HEALTH PROVIDERS, HEALTH SECTOR, HEALTH SERVICE, HEALTH SERVICE DELIVERY, HEALTH SERVICES, HEALTH SPENDING, HEALTH SYSTEM, HEALTH WORKERS, HEALTH WORKFORCE, HIV/AIDS, HOSPITAL DISTRICTS, HOSPITAL PERSONNEL, HOSPITALS, HOUSING, HR, HUMAN RESOURCE MANAGEMENT, HUMAN RESOURCES, INCENTIVE STRUCTURES, INCOME, LABOR MARKET, LAWS, LOCAL REVENUE, LOW-INCOME COUNTRIES, MACROECONOMIC POLICIES, MANAGEMENT RESPONSIBILITIES, MARKET DISTORTION, MEDIUM TERM EXPENDITURE, MEDIUM TERM EXPENDITURE FRAMEWORK, MEDIUM-TERM EXPENDITURE, MEDIUM-TERM EXPENDITURE FRAMEWORK, MINISTRY OF ECONOMY, MINISTRY OF FINANCE, MISMANAGEMENT, NATIONAL BUDGET, NATIONAL HEALTH, NATIONAL STRATEGY, NET LENDING, OPERATING EXPENDITURES, ORGANIZATIONAL STRUCTURE, PERFORMANCE CONTRACTS, PERFORMANCE CRITERIA, PERFORMANCE EVALUATION, PERFORMANCE EVALUATIONS, PERFORMANCE TARGETS, POVERTY REDUCTION, POVERTY REDUCTION STRATEGY, PROBABILITY, PROFESSIONAL ASSOCIATIONS, PROGRAMS, PUBLIC ADMINISTRATION, PUBLIC EXPENDITURE, PUBLIC EXPENDITURE REVIEW, PUBLIC FUNDING, PUBLIC HEALTH, PUBLIC INFORMATION, PUBLIC INSTITUTIONS, PUBLIC INVESTMENTS, PUBLIC SECTOR, PUBLIC SECTOR EMPLOYMENT, PUBLIC SECTOR MANAGEMENT, PUBLIC SERVICE, PUBLIC SERVICES, QUALITY ASSURANCE, QUALITY OF HEALTH, RECURRENT EXPENDITURES, REVENUE PROJECTIONS, REVENUE SOURCES, RURAL AREAS, SALARY PAYMENTS, SECTOR BUDGET, SERVICE DELIVERY, SERVICE EMPLOYMENT, SERVICE PROVISION, SHARE OF HEALTH EXPENDITURE, SHARE OF HEALTH SPENDING, SOCIAL SERVICES, TOTAL EXPENDITURE, TOTAL SPENDING, TUBERCULOSIS, URBAN AREAS, WAGE EXPENDITURE, WORKERS