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Economic & Sector Work :: Other Health Study

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

ACCOUNTING AGE STRUCTURE ALLOCATION ANNUAL BUDGET ANNUAL BUDGET PREPARATION ANNUAL BUDGETS ANNUAL REPORT ARTICLE BLOCK GRANT BLOCK GRANTS BUDGET CYCLE BUDGET ENVELOPE BUDGET EXECUTION BUDGET FRAMEWORK BUDGET LAW BUDGET MANAGEMENT BUDGET MANAGEMENT PROCESS BUDGET SUPPORT BUDGETARY ITEMS BUDGETING PROCESS CAPACITY CONSTRAINTS CENTRAL GOVERNMENT CIVIL SERVANTS CIVIL SERVICE CIVIL SERVICE REFORM CIVIL SERVICE SYSTEM COMMUNITIES CONDITIONALITY CONTRACTUAL ARRANGEMENTS DECENTRALIZATION DECENTRALIZATION POLICIES DECENTRALIZATION PROCESS DESCRIPTION DOCTORS DONOR AGENCIES DONOR COORDINATION DONOR FINANCING DONOR FUNDING DONOR FUNDS ECONOMIC DEVELOPMENT ECONOMIC GROWTH ECONOMIC POLICY EXPENDITURE CEILINGS EXPENDITURE CONSTRAINT EXPENDITURE LEVELS EXPENDITURES FINANCIAL INSTITUTIONS FINANCIAL RESOURCES FISCAL DECENTRALIZATION FISCAL DEFICIT GENDER GOVERNMENT BUDGET GOVERNMENT EXPENDITURE GOVERNMENT EXPENDITURES GOVERNMENT STRUCTURES GROSS DOMESTIC PRODUCT HEALTH BUDGETS HEALTH CARE HEALTH CARE WORKERS HEALTH CENTERS HEALTH EXPENDITURE HEALTH EXPENDITURES HEALTH FACILITIES HEALTH ORGANIZATION HEALTH OUTCOMES HEALTH PLANNING HEALTH PROFESSIONALS HEALTH PROVIDERS HEALTH SECTOR HEALTH SERVICE HEALTH SERVICE DELIVERY HEALTH SERVICES HEALTH SPENDING HEALTH SYSTEM HEALTH WORKERS HEALTH WORKFORCE HIV/AIDS HOSPITAL DISTRICTS HOSPITAL PERSONNEL HOSPITALS HOUSING HR HUMAN RESOURCE MANAGEMENT HUMAN RESOURCES INCENTIVE STRUCTURES INCOME LABOR MARKET LAWS LOCAL REVENUE LOW-INCOME COUNTRIES MACROECONOMIC POLICIES MANAGEMENT RESPONSIBILITIES MARKET DISTORTION MEDIUM TERM EXPENDITURE MEDIUM TERM EXPENDITURE FRAMEWORK MEDIUM-TERM EXPENDITURE MEDIUM-TERM EXPENDITURE FRAMEWORK MINISTRY OF ECONOMY MINISTRY OF FINANCE MISMANAGEMENT NATIONAL BUDGET NATIONAL HEALTH NATIONAL STRATEGY NET LENDING OPERATING EXPENDITURES ORGANIZATIONAL STRUCTURE PERFORMANCE CONTRACTS PERFORMANCE CRITERIA PERFORMANCE EVALUATION PERFORMANCE EVALUATIONS PERFORMANCE TARGETS POVERTY REDUCTION POVERTY REDUCTION STRATEGY PROBABILITY PROFESSIONAL ASSOCIATIONS PROGRAMS PUBLIC ADMINISTRATION PUBLIC EXPENDITURE PUBLIC EXPENDITURE REVIEW PUBLIC FUNDING PUBLIC HEALTH PUBLIC INFORMATION PUBLIC INSTITUTIONS PUBLIC INVESTMENTS PUBLIC SECTOR PUBLIC SECTOR EMPLOYMENT PUBLIC SECTOR MANAGEMENT PUBLIC SERVICE PUBLIC SERVICES QUALITY ASSURANCE QUALITY OF HEALTH RECURRENT EXPENDITURES REVENUE PROJECTIONS REVENUE SOURCES RURAL AREAS SALARY PAYMENTS SECTOR BUDGET SERVICE DELIVERY SERVICE EMPLOYMENT SERVICE PROVISION SHARE OF HEALTH EXPENDITURE SHARE OF HEALTH SPENDING SOCIAL SERVICES TOTAL EXPENDITURE TOTAL SPENDING TUBERCULOSIS URBAN AREAS WAGE EXPENDITURE WORKERS
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Washington, DC
Africa | Rwanda
2013-03-29T14:00:20Z | 2013-03-29T14:00:20Z | 2008-06-23

One of the main explanations put forth on why access to health workers is so low in developing countries is that there are insufficient resources within the public sector to pay the wage bill - the salary and allowance payments - of an expanded health workforce. In turn, the lack of wage bill resources for the health sector is thought to be a direct result of restrictive macroeconomic policies that limit the expansion of the overall public sector wage bill. The overarching message in this report is that, despite the relative contraction of the public sector wage bill, Rwanda has not only protected the health sector, but has succeeded through decentralization and the introduction of performance-based financing in linking salaries to performance in the health sector. The decentralization of budgets, along with the implementation of the performance-based grants scheme, has had two major effects. First, it has increased the resource envelope available for hiring health workers since there is a lot of flexibility in how the performance based grants can be used. Second, it has linked payments to health workers with performance, since the salary top amounts paid out of the grants are linked to service delivery results.

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