SUPPORT Summaries
Evidence of the effects of health system interventions
for low- and middle-income countries
Evidence of the effects of health system interventions
for low- and middle-income countries
May, 2017 - SUPPORT Summary of a systematic review | print this article | download PDF
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.
People making decisions concerning the management of movement of health workers between public and private organizations.
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.
A summary of studies addressing a clearly formulated question that uses systematic and explicit methods to identify, select, and critically appraise the relevant research, and to collect and analyse data from the included studies.
SUPPORT – was an international project to support the use of policy relevant reviews and trials to inform decisions about maternal and child health in low- and middle-income countries, funded by the European Commission (FP6) and the Canadian Institutes of Health Research.
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.
| 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.
High: This research provides a very good indication of the likely effect. The likelihood that the effect will be substantially different† is low.
Moderate: This research provides a good indication of the likely effect. The likelihood that effect will be substantially different† is moderate.
Low: This research provides some indication of the likely effect. Howevver, the likelihood that it will be substantially different† is high.
Very low: This research does not provide a reliable indication of the likely effect. The likelihood that the effect will be substantially different† is very high.
* This is sometimes referred to as 'quality of evidence' or 'confidence in the estimate'.
† Substantially different = a large enough difference that it might affect a decision.
See last page for more information.
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:
Potential interventions to manage the movement of health workers between public and private organizations include:
| 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.
|
| 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.
|
| 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.
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*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 |
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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.
Cristian A Herrera. Department of Public Health, Pontificia Universidad Católica de Chile. Chile.
None declared. For details, see: www.supportsummaries.org/coi
This summary has been peer reviewed by: Liesl Grobler. We did not receive any comments from the review authors.
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.
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
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.
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.
