Beyond Wage Bill Ceilings : The Impact of Government Fiscal and Human Resource Management Policies on the Health Workforce in Developing Countries, Background Country Study for Rwanda

World Bank

Washington, DC

关键词: ACCOUNTING;    AGE STRUCTURE;    ALLOCATION;    ANNUAL BUDGET;    ANNUAL BUDGET PREPARATION;   

RP-ID  :  69333

学科分类：社会科学、人文和艺术（综合）

来源: World Bank Open Knowledge Repository

【 摘 要 】

One of the main explanations put forthon why access to health workers is so low in developingcountries is that there are insufficient resources withinthe public sector to pay the wage bill - the salary andallowance payments - of an expanded health workforce. Inturn, the lack of wage bill resources for the health sectoris thought to be a direct result of restrictivemacroeconomic policies that limit the expansion of theoverall public sector wage bill. The overarching message inthis report is that, despite the relative contraction of thepublic sector wage bill, Rwanda has not only protected thehealth sector, but has succeeded through decentralizationand the introduction of performance-based financing inlinking salaries to performanceinthe health sector. Thedecentralization of budgets, along with the implementationof the performance-based grants scheme, has had two majoreffects. First, it has increased the resource envelopeavailable for hiring health workers since there is a lot offlexibility in how the performance based grants can be used.Second, it has linked payments to health workers withperformance, since the salary top amounts paid out of thegrants are linked to service delivery results.