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RwandaHealth Profile and HRH Crisis Rwanda ranks 158 out of 177 in the 2006 Human Development Index. The World Development indicators show that life expectancy has improved only slightly in the last 5 years, and not much has changed in terms of infant and child mortality rates. Without health systems that are able to absorb increased investment in health, health indicators and the Millennium Development Goals can not be achieved.
Addressing HRH At a recent international conference in Arusha, the government stressed the need for increased collaboration and investment in HRH in Rwanda. The WB HRH program is complementing Government activity, other Donor activity, and NGO activity to address the crisis. The following activities are organized and funded by the Banks HRH program, and are currently ongoing or have been completed. Activities are centered around 1) obtaining baseline information on HRH 2) developing strategy, policy and programs on HRH, 3) implementing strategy, policy and programs on HRH. Baseline Information and AnalysisComprehensive and Accurate data on health worker stock, profiles and distribution in Rwanda: Analysis of the BTC data. The Bank is conducting a detailed analysis of the recently collected (and as of yet un-analyzed) public and private sector health worker data, focusing in particular on a) the extent to which this data can be used to paint a comprehensive picture on health workers in Rwanda (by conducting a deep analysis of the data and computing all indicators of relevance), b) the extent to which any derived information can be considered accurate (paying particular attention to the sufficiency, quality and timeliness of data collected, and thus the data collection methodology, associated tools and data entry, and c) provide key recommendations on how a future initiative to collect, enter and analyze health worker data can improve the comprehensiveness and accuracy of any data provided (including key recommendations on how to institutionalize the process of updating data and information). Lead by Christopher Herbst. Expected to be completed in June, 2007. Study on Wage ceilings, contracting arrangements, and external funding of health worker salary:This study looks at health workers’ wage ceilings and the process determining the budgeted wage bill for health workers, contracting arrangements, and external funding of health worker salary and remuneration in Rwanda. Such information is important both for designing policies programs to manage outflows as well as for increasing the productivity of the existing stock of health workers. This proposed study will collect, analyze, and map out information on wage bill conditionalities and the process determining the budgeted health worker wage bill, public sector contracting arrangements, and donor funding of salaries in Rwanda. This process will identify problems and help “make the case” and pave the road for investments to improve health workforce performance and adequately manage and deal with outflows. Study to map bottlenecks to scaling up health worker production (Rwanda): A crucial piece of baseline information required to manage health worker inflows is information on the capacity in Rwanda to produce health workers. This study plans to assess quantitatively and qualitatively the current capacity of production of qualified health workers in Rwanda (doctors, nurses, dentists, pharmacists, technicians, and allied providers), and the factors which influence it. The study will look at the following dimensions of the production of health workers: policy environment, the regulation and functioning of training institutions, planning practices (i.e how many health workers can be employed in the public and private sectors), actual health worker training programs and locations, educational institution infrastructure, actual student population, quality of training, outputs (graduation rate, course development rate etc), and institutional ownership and funding (public and private), etc. Synthesis of Focus group discussions with Health Workers in Rwanda: Health workers form the foundation for health service delivery. Both their career choices and their on the job performance are important elements constituting effectiveness of a health system. Currently there is very little understanding about the microeconomics of health worker career choice and performance. To help fill this gap, this study carries out some qualitative research on the behavior and performance of health workers in Rwanda. This report summarizes the findings of a qualitative study on health workers’ performance and career in Rwanda. The study was commissioned by the Ministry of Health, and carried out by Tomas Lievens (University of Nottingham) and Pieter Serneels (Oxford University). Given the qualitative nature of the study, its findings should not be interpreted as representative in a statistical sense. Rather, they help to identify bottlenecks, strengths and shortcomings for human resources in the health sector, as perceived by both health workers and users of health services. The study seeks to provide descriptive and analytical information that will ultimately constitute potential input in the design of human resource policy, especially if complemented with quantitative operational research (see study below). The study was led by Pieter Serneels and Thomas Lievens. Study on health Worker Motivation (contingent valuation) (Rwanda): This study is intended to map the motivations of health workers in Rwanda and their responsiveness to various forms of incentives. The research collects data through self administered questionnaires, for a quantitative contingent valuation. The quantitative contingent valuation in Rwanda aims to make progress on a very specific domain and will try to give an idea of the wage-related costs of a more balanced distribution of health workers over the country. It will also contribute to explaining willingness to work in rural areas. Under the broad oversight of the Africa Health Workforce team in Washington, DC, the study team is lead by Tomas Lievens (Oxford Policy Management, OPM) and Time Ensor (OPM), and complemented by Alex Hurrel and Sabine Weinzierl (OPM). Financial and in-kind incentives to meet the HRH deployment objectives (Rwanda). The aim of this research is to investigate the size of financial and in-kind incentives that will be required to meet the government’s human resource deployment objectives. The study will evaluate the impact of an exogenous policy change on the labor supply decisions of physicians. The proposed policy changes are discrete and non-marginal increases in remuneration of physicians working in rural and remote areas, and the general goal is to assess the extent to which this policy change changes the supply of physician labor to these areas. Summary of research questions: 1. What is the geographic distribution of medical practitioners?2. What is the geographic distribution of medical practitioner vacancies? 3. What is the magnitude of the response of newly qualified doctors to a given package of financial and in-kind incentives? 4. What are the characteristics of those newly qualified doctors who are more sensitive to these incentives?5. How do the actual responses of newly qualified doctors compare with the responses one would expect to observe based on the stated preferences that similar individuals report? The study is to be lead by William Jack, Professor University of Georgetown. Study mapping and explaining productivity of Health workers in Rwanda.A worker productivity analysis is planned and modeled on a methodology and similar exercise carried out by Marko Vujicic in Ghana in May 2006. The study will allow the government to understand the factors explaining the variations in health worker productivity so that facilities or districts with lower staff productivity can benefit from lessons from the better performers. (readily collected data stored by the MOH is required for this). Christopher Herbst, Marko Vujicic and Ottar Mestaed will lead the study. Development of National Strategic Plans, Policies and ProgramsTBA Implementing Policy and ProgramsTBA | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
