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, Peru November 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 FinancingGovernanceStewardship HRH / HWF  Macro – links  Budget decisions / allocation  Provider  payments  Recruitment / contracting  Accreditation / Registration  Performance Management Systems  Monetary and non-monetary incentives  Career development / path  Planning  Regulation  M&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 assistance Examples:  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 InstrumentFinancing 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. TrainingOther HRHOthers 410 (8%)250 (5%)4,680 (87%) US$ million

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 assistance Examples:  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 247 HRH or workforce issues explicitly recognized947 Project supports research to understand HRH and workforce issues 347 Project addresses in one or another way HRH issues47 Project includes subcomponent to leverage health workforce performance 747

Strengthen Internal Capacity  Information system (data, good practices, consultants, TOR’s, etc.)  Toolkits  Virtual support team  Training  Newsletter