August, 2016 - SUPPORT Summary of a systematic review | print this article |

What is the impact of increasing salaries on improving the performance of health professionals in the public sector?

The performance of professionals employed in the public sector is crucial for delivering effective services in health, education, and the judiciary.

 

Key messages

  •  It is uncertain whether increasing the salaries of health professionals or other professionals in the public sector improves either the quantity or quality of their work.
  •  Rather than making assumptions about the intended or unintended effects of fixed salary reforms that increase the salaries of health professionals, such policies should be evaluated, if possible using randomized trials or interrupted time series studies.

Background

Basic salaries in the public sector for health professionals and teachers might be insufficient to motivate public servants to perform in the job. For example, they may not be motivated to turn up for work or to engage with the work itself. In addition, this could lead to involvement in diverse forms of moonlighting (in both teaching and health), seeking or accepting under-the-counter payments, and becoming part of the brain drain.

This review looked for studies of the effects of salary increases on the work performance of professionals employed in the public sector. It looked for studies of the effects of salary increases alone or as part of a remuneration package (pay and benefits combined). It focused on frontline professionals in health (doctors, nurses, and other cadre), education (teachers), and justice (judges).



About the systematic review underlying this summary

Review objectivesTo assess the available evidence of the impact of increasing salaries on the performance of public sector employees in the health, education and judicial sectors in low- and middle-income countries.

Type of What the review authors searched for What the review authors found

Study designs & interventions


Empirical research that used qualitative or quantitative methods to assess the effects of a change in salary or remuneration packages (pay and benefits combined)

One controlled before-after (“differences-in-differences”) study of increases in teachers’ wages

Participants


Public sector employees in health (nurses, doctors, and other cadres), education (teachers), or justice (judges)

Teachers

Settings


Low- and middle-income countries

Brazil

Outcomes


Measures of work performance including the quantity or quality of work

Student grades

Date of most recent search:  2010

Limitations: This was a well-conducted review, but the authors found only one study that met their inclusion criteria.

Carr SC, Leggatt-Cook C, Clarke M, et al. What is the evidence of the impact of increasing salaries on improving the performance of public servants, including teachers, doctors/nurses, and mid-level occupations, in low- and middle-income countries: Is it time to give pay a chance? EPPI Centre, Social Science Research Unit, Institute of Education, University of London 2011.

Summary of findings

Only one study met the inclusion criteria. The included study, conducted in Brazil, assessed the effects of increasing teachers’ wages on students’ grades in public schools. A comparison of state and municipal schools one year before and one year after an increase in wages (1997-99) found that the state schools, which had a higher average increase in salaries (36.4%), had greater improvements in students’ grades than municiple schools, which had a lower average increase in salaries (35.7%). However, it is uncertain whether the increased wages caused the improvements in grades.

  •  It is uncertain whether increasing teachers’ salaries improves their performance or the performance of their students because the certainty of this evidence is very low.
  •  No studies were found that evaluated the impact of increasing the salaries of health professionals in the public sector on their performance.

Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY
  •  Only one before-after study from Brazil of the effects of increases in teachers’ wages was found.
  •  It is uncertain whether raising the salaries of professionals in the public sector in low-income countries improves their performance.
EQUITY
  •  No evidence of the impacts of increases in salaries on equity was found.
  •  Increasing salaries in the public sector might reduce inequities between the public and private sector. If increasing salaries improved performance, increasing salaries might reduce inequities for disadvantaged populations served by the professonals who received the increase.
ECONOMIC CONSIDERATIONS
  •  No evidence of the costs of increasing salaries for professionals in the public sector was reported in the review. 
  •  The cost of increasing salaries depends on the size of the increase and the number of professionals affected. 
MONITORING & EVALUATION
  •  The impacts of increasing salaries for professionals in the public sector on performance is uncertain.
  •  If salaries are increased with an expectation that this will improve performance, performance should be monitored and, if possible, evaluated using randomized trials or interrupted time series studies.

*Judgements made by the authors of this summary, not necessarily those of the review authors, based on the findings of the review and consultation with researchers and policymakers in low-income countries. For additional details about how these judgements were made see: www.supportsummaries.org/methods

Additional information

Related literature

Witter S, Fretheim A, Kessy, FL, Lindahl AK. Paying for performance to improve the delivery of health interventions in low‐ and middle‐income countries. Cochrane Database of Systematic Reviews. 2012; Issue 2. Art. No.: CD007899.

 

Flodgren G, Eccles MP, Shepperd S, et al. An overview of reviews evaluating the effectiveness of financial incentives in changing healthcare professional behaviours and patient outcomes. Cochrane Database of Systematic Reviews 2011; Issue 7. Art. No.: CD009255.

 

This summary was prepared by

Leila H. Abdullahi, University of Cape Town, South Africa

Conflict of interest

None declared. For details, see: www.supportsummaries.org/coi

Acknowledgements

This summary has been peer reviewed by: Atle Fretheim and Stuart Carr

This review should be cited as

Carr SC, Leggatt-Cook C, Clarke M, et al. What is the evidence of the impact of increasing salaries on improving the performance of public servants, including teachers, doctors/nurses, and mid-level occupations, in low- and middle-income countries: Is it time to give pay a chance? EPPI Centre, Social Science Research Unit, Institute of Education, University of London 2011.

The summary should be cited as

Leila Hussein. What is the impact of increasing salaries on improving the performance of health professionals in the public sector? A SUPPORT Summary of a systematic review. August 2016. www.supportsummaries.org

Keywords

Salaries, remuneration, public servants, civil service, low-income countries, middle-income countries



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