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[afro-nets] HRH: Tackling the Human Resource Management Piece of the Puzzle (2)
- From: "Peter Burgess" <firstname.lastname@example.org>
- Date: Tue, 25 Aug 2009 11:40:26 -0400
I was glad to see the message submitted by Jennifer Solomon, from the The Capacity Project of IntraHealth International, a project of USAID.
One of the things that amazes me is how little key information is ever put into the public space by international consultants and donor agencies. The Technical Brief describes a problem, but without much associated data that will help get a handle on the problem.
The fact of the human resource crisis in the health sector is well known ... but the underlying core problem of remuneration ... salaries and benefits ... is referenced in passing without putting the key facts on the record. Specifically I am looking for simple tables that show the remuneration of health professionals of all grades from community health worker to senior medical MDs in different countries in different communities and in different organizations.
Such a tabulation will show that the remuneration of health professionals of all grades in Africa is modest compared to the pay available in the global NORTH ... and brain drain migration is going to happen with this circumstance. It will also show the differentials within areas in a country and between the different levels of the professional hierarchy. Some of this is fully justified ... some is not.
Most of us are aware that scarce development resources go to pay international experts at rates of remuneration that are quite good ... while health budgets in developing countries strain even to pay health staff their low remuneration. Good pay in donor funded "projects" distorts the pay systems ... and the distortion continues after the project has terminated and funding ends.
I am an old corporate cost and profit analyst ... with a good number of years experience in the international relief and development sector. The remuneration issue is at the heart of the HR problem in global health. Some people are getting well remunerated, and some organizations are earning high profits ... but most people are getting far less pay than they deserve and critical organizations like rural area hospitals and clinics are unsustainable because of the prevailing health economics.
Nothing much is going to change until the data are in clear view ... transparency that is meaningful. With such transparency we can start to have accountability ... and with this there may be a substantial improvement in the way global health resources are allocated.
I would also add that the global health industry has an appalling deficit in appropriate metrics for health performance ... some very sophisticated analysis gets done much of which tells very little ... while much of the very basic data needed for allocation of resources remains either uncollected or hidden from view.
I am, for example, very interested in the difference in health outcomes between a community with a health clinic and community health workers ... and a similar community where there is no clinic and no community health workers. The hypothesis I want to test is whether this would make a much bigger and more cost effective contribution to child health
Maybe I am out of the loop ... and these data are available and being used ... but my experience suggests that in the health industry, the last thing anyone in the establishment really wants to have to address is the effectiveness of resource use.
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