May, 2017 - SUPPORT Summary of a systematic review | print this article |

What is the impact of policies for managing the movement of health workers between public and private organizations?

Health workers move between public and private organizations in both urban and rural areas during the course of their career. This can result in imbalances in the number of healthcare providers available relative to the population receiving care from that sector. Different financial incentives and movement restriction interventions may manage this issue in low income countries.

Key message

  • No rigorous studies have evaluated the effects of interventions to manage the movement of health workers between public and private organizations.
  • There is a need for well designed studies to evaluate the impact of interventions that attempt to regulate health worker movement between public and private organizations in low income countries.

Background

Health workers move between public and private organizations in both urban and rural areas during the course of their career. Depending on the proportion of the population served by public or private organizations in a particular setting, this movement may result in imbalances in the number of healthcare providers available relative to the population receiving care from that sector.

 This review assessed the effects of financial incentives and movement restriction interventions to manage the movement of health workers between public and private organizations in low income countries.


 



About the systematic review underlying this summary

Review objectives: To assess the effects of financial incentives and movement restriction interventions to manage the movement of health workers between public and private organizations in low and middle income countries.
Type of What the review authors searched for What the review authors found
Study designs & interventions Randomised trials and non-randomised trials; controlled before after studies; controlled interrupted time series and interrupted time series studies without controls.
No studies were found eligible for inclusion in the review. Nine surveys, one review of government reports, one study of speeches in the national assembly, and one policy analysis paper were found.
Participants All health professionals.
No studies were found eligible for inclusion in the review.
Settings Any public or private sector organizations.
No studies were found eligible for inclusion in the review.
Outcomes

1. Change in the numbers or proportion of health workers entering or leaving the public or private sectors.

2. Duration of stay in a particular sector.

No studies were found eligible for inclusion in the review.
Date of most recent search: November 2012.
Limitations: This is a well conducted systematic review with only minor limitations.
Rutebemberwa E, et al. Financial interventions and movement restrictions for managing the movement of health workers between public and private organizations in low and middle income countries. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD009845.

Rutebemberwa E, et al. Financial interventions and movement restrictions for managing the movement of health workers between public and private organizations in low and middle income countries. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD009845.

Summary of findings

No studies met the inclusion criteria for the review.

The impacts of interventions to manage the movement of health workers between public and private organizations are uncertain. Potential impacts could include:

  • Improving the distribution of health workers between the public and private sectors according to the health needs of the population.
  • Increasing the duration of stay for health workers in a particular sector.
  • Improving work satisfaction among health professionals in the public and private sectors.
  • Improving the quality of healthcare.

Potential interventions to manage the movement of health workers between public and private organizations include:

  • Payment of special allowances to health workers working in the public or private sector.
  • Increasing salaries for public or private sector workers.
  • Bonding health workers for a number of years after training.
  • Bursary schemes where the recipients are required to work in the public or private sector.
  • Giving scholarships for specialization to health workers in public or private sector.
  • Giving lucrative terminal benefits to health workers who serve in the public or private sector for a mandatory number of years.
  • Hiring personnel on a contract basis. The high salaries for contract work would be comparable to the salaries paid in the other sector, which may be public or private.

Relevance of the review for low-income countries

Findings Interpretation*
APPLICABILITY
No studies met the inclusion criteria for the review.
Health worker availability remains one of the key barriers to strengthening health systems in low income countries. Effective interventions to manage the movement of health professionals could help to address this.
EQUITY
The review did not provide data on differential effects of the interventions for disadvantaged populations.

Interventions to manage the movement of health professionals between the public and private sectors could reduce inequities by increasing the proportion of professionals in the sector that serves disadvantaged populations or increase inequities by decreasing the proportion of professionals in the sector that serves disadvantaged populations.

 

  • These effects could vary across settings, for example between rural and urban areas, because the distribution of professionals across the public and private sectors may differ depending on the setting.
ECONOMIC CONSIDERATIONS
The review did not provide data on the cost of any of the interventions.

The balance between the benefit and harms of implementing interventions such as financial incentives (e.g. increased wages) is uncertain.

 

  • Although restrictions of movement may cost less than financial incentives to implement, the costs of potential inefficiencies are uncertain. For example, restrictions might adversely affect the motivation of professionals, or increase imbalances between the provision of healthcare and healthcare needs.
MONITORING & EVALUATION
No reliable evidence of the impacts or costs of interventions was found.

There is a need for careful monitoring of the impacts and costs of interventions to manage the movement of health workers between public and private organizations.

 

  • Consideration should be given to undertaking evaluations prior to scaling up interventions, using randomised trials or interrupted time series studies when randomised trials are not practical.

*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

Kiwanuka SN, Rutebemberwa E, Nalwadda C, et al. Interventions to manage dual practice among health workers. Cochrane Database Syst Rev 2011; (7):CD008405.

Grobler L, Marais BJ, Mabunda SA, et al. Interventions for increasing the proportion of health professionals practising in rural and other underserved areas. Cochrane Database Syst Rev 2009; (1):CD005314.

Basu S, Andrews J, Kishore S, et al. Comparative performance of private and public healthcare systems in low and middle income countries: a systematic review. PLoS Med 2012; 9(6):e1001244.

Saksena P1, Xu K, Elovainio R, Perrot J. Utilization and expenditure at public and private facilities in 39 low income countries. Trop Med Int Health 2012; 17(1):23-35.

McPake B, Russo G, Hipgrave D, et al. Implications of dual practice for universal health coverage. Bull World Health Organ 2016; 94(2):142-6.

El Koussa M, Atun R, Bowser D, Kruk ME. Factors influencing physicians' choice of workplace: systematic review of drivers of attrition and policy interventions to address them. J Glob Health 2016; 6(2):020403.

 

This summary was prepared by

Cristian A Herrera. Department of Public Health, Pontificia Universidad Católica de Chile. Chile.

 

Conflict of interest

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

 

Acknowledgements

This summary has been peer reviewed by: Liesl Grobler. We did not receive any comments from the review authors.

 

This review should be cited as

Rutebemberwa E, Kinengyere AA, Ssengooba F, Pariyo GW, Kiwanuka SN. Financial interventions and movement restrictions for managing the movement of health workers between public and private organizations in low and middle income countries. Cochrane Database of Systematic Reviews 2014, Issue 2. Art. No.: CD009845. DOI: 10.1002/14651858.CD009845.pub2.

 

The summary should be cited as

Herrera CA. What is the impact of policies for managing the movement of health workers between public and private organizations? A SUPPORT Summary of a systematic review. May 2017. www.supportsummaries.org

 

Keywords

All Summaries:

evidence informed health policy, evidence based, systematic review, health systems research, health care, low and middle income countries, developing countries, primary health care, public private movement of health professionals, public health sector, private health facilities.

 

This summary was prepared with additional support from:

The Health Policy and Systems Research Unit (UnIPSS) is a Chilean research collaboration for the generation, dissemination and synthesis of relevant knowledge about health policy and systems based at the School of Medicine of the P. Universidad Católica de Chile.

 

 

 



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