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Author

Marko Vujicic

Other affiliations: American Dental Association
Bio: Marko Vujicic is an academic researcher from World Bank. The author has contributed to research in topics: Workforce & Health policy. The author has an hindex of 14, co-authored 28 publications receiving 1001 citations. Previous affiliations of Marko Vujicic include American Dental Association.

Papers
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Journal ArticleDOI
TL;DR: Task shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost.
Abstract: Health workforce needs-based shortages and skill mix imbalances are significant health workforce challenges. Task shifting, defined as delegating tasks to existing or new cadres with either less training or narrowly tailored training, is a potential strategy to address these challenges. This study uses an economics perspective to review the skill mix literature to determine its strength of the evidence, identify gaps in the evidence, and to propose a research agenda. Studies primarily from low-income countries published between 2006 and September 2010 were found using Google Scholar and PubMed. Keywords included terms such as skill mix, task shifting, assistant medical officer, assistant clinical officer, assistant nurse, assistant pharmacist, and community health worker. Thirty-one studies were selected to analyze, based on the strength of evidence. First, the studies provide substantial evidence that task shifting is an important policy option to help alleviate workforce shortages and skill mix imbalances. For example, in Mozambique, surgically trained assistant medical officers, who were the key providers in district hospitals, produced similar patient outcomes at a significantly lower cost as compared to physician obstetricians and gynaecologists. Second, although task shifting is promising, it can present its own challenges. For example, a study analyzing task shifting in HIV/AIDS in sub-Saharan Africa noted quality and safety concerns, professional and institutional resistance, and the need to sustain motivation and performance. Third, most task shifting studies compare the results of the new cadre with the traditional cadre. Studies also need to compare the new cadre's results to the results from the care that would have been provided--if any care at all--had task shifting not occurred. Task shifting is a promising policy option to increase the productive efficiency of the delivery of health care services, increasing the number of services provided at a given quality and cost. Future studies should examine the development of new professional cadres that evolve with technology and country-specific labour markets. To strengthen the evidence, skill mix changes need to be evaluated with a rigorous research design to estimate the effect on patient health outcomes, quality of care, and costs.

484 citations

Journal ArticleDOI
TL;DR: It is argued for the need to incorporate more explicitly the behaviour of those who supply labour--doctors, nurses and other providers--those who demand labour, and how these actors respond to incentives when formulating health workforce policy.
Abstract: One of the most important components of health care systems is human resources for health (HRH)--the people that deliver the services. One key challenge facing policy makers is to ensure that health care systems have sufficient HRH capacity to deliver services that improve or maintain population health. In a predominantly public system, this involves policy makers assessing the health care needs of the population, deriving the HRH requirements to meet those needs, and putting policies in place that move the current HRH employment level, skill mix, geographic distribution and productivity towards the desired level. This last step relies on understanding the labour market dynamics of the health care sector, specifically the determinants of labour demand and labour supply. We argue that traditional HRH policy in developing countries has focussed on determining the HRH requirements to address population needs and has largely ignored the labour market dynamics aspect. This is one of the reasons that HRH policies often do not achieve their objectives. We argue for the need to incorporate more explicitly the behaviour of those who supply labour--doctors, nurses and other providers--those who demand labour, and how these actors respond to incentives when formulating health workforce policy.

74 citations

Journal ArticleDOI
TL;DR: It is found that the labor market for physicians in Vietnam is characterized by very little movement among both facility levels and geographic areas, and dual practice is also prominent, with over one-third of physicians holding a second job.

59 citations

Journal ArticleDOI
TL;DR: It is argued there is an opportunity for improved co-ordination between the three agencies at the country level in supporting HRH-related activities and existing initiatives, such as the International Health Partnership and the Health Systems Funding Platform, could present viable and timely vehicles for these three agencies to implement this improved co -ordination.
Abstract: Shortages, geographic imbalances and poor performance of health workers pose major challenges for improving health service delivery in developing countries. In response, multilateral agencies have increasingly recognized the need to invest in human resources for health (HRH) to assist countries in achieving their health system goals. In this paper we analyse the HRH-related activities of three agencies: the Global Alliance for Vaccines and Immunisation (GAVI); the Global Fund for Aids, Tuberculosis, and Malaria (the Global Fund); and the World Bank. First, we reviewed the type of HRH-related activities that are eligible for financing within each agency. Second, we reviewed the HRH-related activities that each agency is actually financing. Third, we reviewed the literature to understand the impact that GAVI, Global Fund and World Bank investments in HRH have had on the health workforce in developing countries. Our analysis found that by far the most common activity supported across all agencies is short-term, in-service training. There is relatively little investment in expanding pre-service training capacity, despite large health worker shortages in developing countries. We also found that the majority of GAVI and the Global Fund grants finance health worker remuneration, largely through supplemental allowances, with little information available on how payment rates are determined, how the potential negative consequences are mitigated, and how payments are to be sustained at the end of the grant period. Based on the analysis, we argue there is an opportunity for improved co-ordination between the three agencies at the country level in supporting HRH-related activities. Existing initiatives, such as the International Health Partnership and the Health Systems Funding Platform, could present viable and timely vehicles for the three agencies to implement this improved co-ordination.

55 citations

Book
22 Apr 2009
TL;DR: How well health wage bill resources are used in the public sector is looked at because despite the importance of fiscal constraints on the wage bill, and the persistent debate at the global level, very little documented evidence describes how health Wage bill budgets in thepublic sector are determined.
Abstract: The health workforce plays a key role in increasing access to health services for the poor in developing countries. Recent evidence has demonstrated an important link between staffing levels and both service delivery and health outcomes. Various global and country-level estimates have also shown that current staffing levels in developing countries, particularly in Sub-Saharan Africa, are often well below those required to deliver essential health services. This study focuses on two main aspects of health workforce policy. First, it examines how overall government wage bill policies affect the size of the health wage bill, the hiring of health workers in the public sector, and the related policy options. This focus is important because despite the importance of fiscal constraints on the wage bill, and the persistent debate at the global level, very little documented evidence describes how health wage bill budgets in the public sector are determined, how this action is linked to overall wage bill policies, and how it affects the ability of governments to increase staffing levels in the health sector. Second, this report looks at how well health wage bill resources are used in the public sector.

54 citations


Cited by
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Journal ArticleDOI
TL;DR: The pace of reform should be moderated to allow service providers to develop absorptive capacity, and independent, outcome-based monitoring and evaluation by a third-party are essential for mid-course correction of the plans and to make officials and providers accountable.

971 citations

Journal ArticleDOI
TL;DR: A system-level shift from maternal and newborn care focused on identification and treatment of pathology for the minority to skilled care for all is supported, which includes preventive and supportive care that works to strengthen women's capabilities in the context of respectful relationships.

936 citations

Journal ArticleDOI
TL;DR: In depth topics with major scientific challenges and institutional and cultural barriers that are slowing the development of the field are explored.

884 citations

Journal ArticleDOI
TL;DR: In this paper, the current state of human resources for mental health, needs, and strategies for action are reviewed, and the authors also discuss scale-up costs, human resources management, and leadership for Mental Health, particularly within the context of low-income and middle-income countries.

621 citations

Journal Article
TL;DR: In this article, the current state of human resources for mental health, needs, and strategies for action are reviewed, and the authors discuss scale-up costs, human resources management, and leadership of mental health in low-income and middle-income countries.

555 citations