Working practices and incomes of health workers : evidence from an evaluation of a delivery fee exemption scheme in Ghana

Background: This article describes a survey of health workers and traditional birth attendants (TBAs) which was carried out in 2005 in two regions of Ghana. The objective of the survey was to ascertain the impact of the introduction of a delivery fee exemption scheme on both health workers and those providers who were excluded from the scheme (TBAs). This formed part of an overall evaluation of the delivery fee exemption scheme. The results shed light not only on the scheme itself but also on the general productivity of a range of health workers in Ghana. Methods: A structured questionnaire was developed, covering individual and household characteristics, working hours and practices, sources of income, and views of the exemptions scheme and general motivation. After field testing, this was administered to 374 respondents in 12 districts of Central and Volta regions. The respondents included doctors, medical assistants (MAs), public and private midwives, nurses, community health nurses (CHNs), and traditional birth attendants, both trained and untrained. Results: Health workers were well informed about the delivery fee exemptions scheme and their responses on its impact suggest a realistic view that it was a good scheme, but one that faces serious challenges regarding financial sustainability. Concerning its impact on their morale and working conditions, the responses were broadly neutral. Most public sector workers have seen an increased workload, but counterbalanced by increased pay. TBAs have suffered, in terms of client numbers and income, while the picture for private midwives is mixed. The survey also sheds light on pay and productivity. The respondents report long working hours, with a mean of 54 hours per week for community nurses and up to 129 hours per week for MAs. Weekly reported client loads in the public sector range from a mean of 86 for nurses to 269 for doctors. Over the past two years, reported working hours have been increasing, but so have pay and allowances (for doctors, allowances now make up 66% of their total pay). The lowest paid public health worker now earns almost ten times the average gross national income (GNI) per capita, while the doctors earn 38.5 times GNI per capita. This compares well with average government pay of four times GNI per capita. Comparing pay with outputs, the relatively high number of clients reported by doctors reduces their pay differential, so that the cost per client – $1.09 – is similar to a nurse's (and lower than a private midwife's). Conclusion: These findings show that a scheme which increases demand for public health services while also sustaining health worker income and morale, is workable, if well managed, even within the relatively constrained human resources environment of countries like Ghana. This may be linked to the fact that internal comparisons reveal Ghana's health workers to be well paid from public sector sources.This work was undertaken as part of an international research programme – IMMPACT (Initiative for Maternal Mortality Programme Assessment) – funded by the Bill & Melinda Gates Foundation, the Department for International Development, the European Commission and USAID

Making Out-of-School Time Matter: Evidence for an Action Agenda

Presents findings from a review of literature that identifies and addresses the level of demand for OST services, the effectiveness of the offerings, quality in OST programs, how to encourage participation, and how to build further community capacity

The impact of technological changes on incentives and motivations to work hard

The diffusion of Information and Communication Technologies (ICT) associated with the diffusion of new work practices since fifteen years has raised concerns about the impact of these changes on productivity. Some recent studies underline a positive impact of ICT and of new work practices on firms' productivity. But as well known in the principal-agent literature agents are predisposed to shirking, so, in order to obtain productivity gains firms need to provide workers with sufficient incentives and to encourage motivations. Our main results, obtained with data collected in Luxembourg in 2004-2005, indicate that ICT permit to create a team spirit and an enriching work environment that influences positively pure intrinsic motivations of workers. These motivations, associated with positive incentives, can be substitutes for the direct monitoring introduced usually to obtain the effort of employees, but hard to be used in a context of increasing autonomy.Technologies ; Incentives ; Motivations

Removal of childbirth delivery fees : the impact on health workers in Ghana

id21 is hosted by IDS and supported by the UK Department for International Development

Systematic review of the use of financial incentives in treatments for obesity and overweight

Nine studies met the criteria for inclusion in this systematic review of randomized controlled trials of treatments for obesity and overweight involving the use of financial incentives, with reported follow-up of at least 1 year. All included trials were of behavioural obesity treatments. Justification of sample size and blinding procedure were not mentioned in any study. Attrition was well described in three studies and no study was analysed on an intention to treat basis. Participants were mostly women recruited through media advertisements. Mean age ranged from 35.7 to 52.8 years, and mean body mass index from 29.3 to 31.8 kg m−2. Results from meta-analysis showed no significant effect of use of financial incentives on weight loss or maintenance at 12 months and 18 months. Further sub-analysis by mode of delivery and amount of incentives although also non-statistically significant were suggestive of very weak trends in favour of use of amounts greater than 1.2% personal disposable income, rewards for behaviour change rather than for weight, rewards based on group performance rather than for individual performance and rewards delivered by non-psychologists rather than delivered by psychologists.The Health Services Research Unit is funded by the Chief Scientist Office of the Scottish Executive Health Department. The views expressed here are those of the authors. Alison Avenell is funded by a Career Scientist Award from the Chief Scientist Office of the Scottish Executive Health Departmen

Motivating Employee Owners in ESOP Firms: Human Resource Policies and Company Performance

What enables some employee ownership firms to overcome the free rider problem andmotivate employees to improve performance? This study analyzes the role of humanresource policies in the performance of employee ownership companies, using employeesurvey data from 14 companies and a national sample of employee-owners. Between-firmcomparisons of 11 ESOP firms show that an index of human resource policies, nominallycontrolled by management, is positively related to employee reports of co-workerperformance and other good workplace outcomes (including perceptions of fairness, goodsupervision, and worker input and influence). Within-firm comparisons in three ESOP firms,and exploratory results from a national survey, show that employee-owners who participatein employee involvement committees are more likely to exert peer pressure on shirking coworkers.We conclude that an understanding of how and when employee ownership workssuccessfully requires a three-pronged analysis of: 1) the incentives that ownership gives; 2)the participative mechanisms available to workers to act on those incentives; and 3) thecorporate culture which battles against tendencies to free ride.human resources, industrial relations, employee ownership

The Viability of Alternative Call Center Production Models

[Excerpt] The central question of this paper is whether a mass customization strategy coupled with high involvement work practices is an economically viable model for service and sales call centers. If so, under what conditions and why? To answer these questions, in the next section, we describe alternative models of call center management. In section III, we present a conceptual framework for understanding the relationship between management practices, workers reactions to those practices, and performance outcomes. We then review empirical evidence on these relationships, focusing primarily on studies of call centers or related service workplaces. In section IV, we draw on evidence from two recent quantitative studies of call centers to examine the performance outcomes of high involvement practices in this context. We close with a discussion and critique of existing evidence and suggestions for future research

Interventions to increase physical activity in disadvantaged communities: A review of behavioural mechanisms. ESRI Working Paper No. 646 December 2019

Physical inactivity is now a significant driver of health and social inequalities among socioeconomically disadvantaged communities and poses a major challenge to policymakers, worldwide. Although a vast amount of research has focused on designing and evaluating interventions to increase physical activity, there remains little consensus on which interventions are likely to work. In this narrative review, we build on previous reviews by not only examining what interventions tend to work but by trying to understand why certain interventions tend to work, while others do not, through the lens of behavioural science. We present a behavioural framework through which the existing body of physical activity research could be viewed, in order to identify potentially effective mechanisms that would be likely to work in their intended domain. Our analysis finds that while there is evidence that the physical and educational environment matter for increasing levels of physical activity, interventions are more likely to be successful where they involve a social component. We conclude that a behaviourally informed physical activity intervention would thus employ a set of focused educational and socially-mediated behavioural mechanisms, within an appropriate physical environment