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
Author(s)
World BankKeywords
HEALTH SERVICE DELIVERYPOVERTY REDUCTION
SHARE OF HEALTH EXPENDITURE
REVENUE PROJECTIONS
HR
BUDGET FRAMEWORK
CIVIL SERVICE
SERVICE DELIVERY
HEALTH FACILITIES
ANNUAL REPORT
ANNUAL BUDGET
PERFORMANCE EVALUATION
WAGE EXPENDITURE
BUDGET CYCLE
PUBLIC SECTOR
HEALTH BUDGETS
DECENTRALIZATION POLICIES
FISCAL DECENTRALIZATION
PUBLIC HEALTH
PERFORMANCE TARGETS
NATIONAL BUDGET
DONOR FUNDING
MANAGEMENT RESPONSIBILITIES
COMMUNITIES
OPERATING EXPENDITURES
HEALTH CARE
DONOR AGENCIES
CAPACITY CONSTRAINTS
SHARE OF HEALTH SPENDING
ANNUAL BUDGETS
ALLOCATION
PUBLIC INFORMATION
HEALTH WORKFORCE
PROFESSIONAL ASSOCIATIONS
GENDER
HEALTH WORKERS
PERFORMANCE CRITERIA
MEDIUM-TERM EXPENDITURE FRAMEWORK
CONTRACTUAL ARRANGEMENTS
CIVIL SERVICE REFORM
HEALTH SPENDING
HEALTH PLANNING
HEALTH SERVICES
AGE STRUCTURE
INCENTIVE STRUCTURES
TUBERCULOSIS
HEALTH SECTOR
FISCAL DEFICIT
QUALITY ASSURANCE
MISMANAGEMENT
MARKET DISTORTION
CIVIL SERVICE SYSTEM
PUBLIC INVESTMENTS
PROBABILITY
EXPENDITURE CEILINGS
HEALTH SERVICE
PUBLIC EXPENDITURE
CONDITIONALITY
PERFORMANCE EVALUATIONS
HEALTH EXPENDITURE
HEALTH PROFESSIONALS
HEALTH OUTCOMES
DESCRIPTION
BUDGETARY ITEMS
ECONOMIC POLICY
HEALTH CARE WORKERS
MACROECONOMIC POLICIES
EXPENDITURE LEVELS
DONOR FUNDS
LAWS
TOTAL EXPENDITURE
QUALITY OF HEALTH
BLOCK GRANTS
ARTICLE
MEDIUM-TERM EXPENDITURE
CENTRAL GOVERNMENT
HOSPITAL DISTRICTS
BLOCK GRANT
HIV/AIDS
SERVICE PROVISION
MINISTRY OF FINANCE
ACCOUNTING
PUBLIC INSTITUTIONS
GOVERNMENT EXPENDITURE
PUBLIC SERVICES
NATIONAL HEALTH
TOTAL SPENDING
HEALTH EXPENDITURES
LOCAL REVENUE
CIVIL SERVANTS
HEALTH ORGANIZATION
HOSPITALS
EXPENDITURE CONSTRAINT
MEDIUM TERM EXPENDITURE FRAMEWORK
DOCTORS
DECENTRALIZATION
DONOR COORDINATION
RECURRENT EXPENDITURES
HOUSING
MEDIUM TERM EXPENDITURE
PROGRAMS
REVENUE SOURCES
SECTOR BUDGET
SERVICE EMPLOYMENT
GOVERNMENT STRUCTURES
PUBLIC EXPENDITURE REVIEW
HUMAN RESOURCE MANAGEMENT
SOCIAL SERVICES
EXPENDITURES
HEALTH CENTERS
HOSPITAL PERSONNEL
GOVERNMENT EXPENDITURES
INCOME
ANNUAL BUDGET PREPARATION
PUBLIC FUNDING
PUBLIC ADMINISTRATION
HEALTH PROVIDERS
BUDGET MANAGEMENT
WORKERS
FINANCIAL INSTITUTIONS
MINISTRY OF ECONOMY
RURAL AREAS
DONOR FINANCING
PUBLIC SECTOR EMPLOYMENT
ECONOMIC DEVELOPMENT
PERFORMANCE CONTRACTS
DECENTRALIZATION PROCESS
NET LENDING
GROSS DOMESTIC PRODUCT
BUDGET LAW
NATIONAL STRATEGY
ECONOMIC GROWTH
ORGANIZATIONAL STRUCTURE
GOVERNMENT BUDGET
HEALTH SYSTEM
BUDGET MANAGEMENT PROCESS
LABOR MARKET
SALARY PAYMENTS
PUBLIC SERVICE
POVERTY REDUCTION STRATEGY
BUDGET EXECUTION
PUBLIC SECTOR MANAGEMENT
URBAN AREAS
BUDGET SUPPORT
BUDGETING PROCESS
FINANCIAL RESOURCES
LOW-INCOME COUNTRIES
HUMAN RESOURCES
BUDGET ENVELOPE
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http://hdl.handle.net/10986/13063Abstract
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.Date
2013-03-29Identifier
oai:openknowledge.worldbank.org:10986/13063http://hdl.handle.net/10986/13063
Copyright/License
http://creativecommons.org/licenses/by/3.0/Collections
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