Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 Trends in remuneration and motivation

Conférence Inaugurale de l’Association Africaine d’économie et Politique de Santé (AfHEA)Accra - Ghana, 10 – 12 Mars 2009

Trends in remuneration and motivation of the health workforce in Burkina Faso

Fadima YAYA BOCOUM, S. KOUANDA, R. GUISSOU, B. SONDO


OUTLINE

Context Objectives Methods Results Lessons and perspectives


Basic facts about Burkina Faso Population = 13 730 258 (2006) Annual growth = 3,1 % Death rate general= 15,2 per thousand Life expectancy = 48 years HIV prevalence = 2% Inflation = 2,1% Living under the poverty line = 46,4%


Trends in number of health workers in Burkina Faso between 1995 and 2007

0

1 000

2 000

3 000

4 000

5 000

1 995 1 996 1 997 1 999 2 000 2 001 2 004 2 007

Nurses

Doctors

Midwives

Pharmacists5%

Human Resources for Health situation

Ratio: <1 doctor/ 10 000 , 5 nurse and midwife/ 10 000


Trends in public expenditure for HWs in Burkina Faso

between 1996 and 2006 in constant 2006 USD

05

10152025303540

Publicexpenditure forHW

11%

Human Resources for Health situation


Human Resources for Health situation Main problems for HRH: Lack of HRH ( quality, number) Inequity in distribution Low motivation Professional working in dual or triple jobs Lack in HRH management

Actions Policy for HRH development (2002) MOH study on motivation of HRH ( managers in

2003) Action plan for the motivation of HRH (2004)


Objectives

Analyse trend in salaries of health

workers from 1976 to 2006

Analyse the perception that the health workers have on their remuneration.


Methods Study design : cross-sectional study Study area: in 2 districts of Burkina

Faso urban (Pissy) and rural underserved

(Diapaga) Period: from December 2007 to

February 2008 Study population: medical doctor,

nurse,midwife,lab tech, Tools collection: questionnaire, in-

depth interview, document review,


MethodsSampling Questionnaires : 235 In-depth Interviews : 56 Health Workers 17 Key informant In total covering 17 health centres: 7 public 7 private 2 faith-based 1 NGO Analyze Deflation: year based 2006 Constant 2006 USD = 523 FCFA Proportion, mean


Trends in salariesTrends in salaries in real term

between 1975 -2005

0

100

200

300

400

500

6001975

1980

1985

1990

1995

2000

2005

year

am

ou

nt

GPs

Nurse

Lab technician

50%

GP in 1975 gain 2 more than GP in 2005


Trends in goods

Trends in goods in Burkina Faso between 1985 and 2005 in constant 2006 USD

0,00

0,20

0,40

0,60

0,80

1,00

1,20

1,40

1985 1990 1995 2000 2005

fuel

water

electricity

rice


Types and ranges of allowances

Function ( between 6 and 17 USD) Extra duty (between 13 and 89 USD) Accommodation (between 17 and 67 USD) Night Shift (between 4 and 56 USD ) Risk (all-inclusive 16 USD ) Revenue Bonus in National and Regional

hospital


Perception on salary level Perception on remuneration compared

to cost of living 60,6% low 24,7% very low 13,9 % satisfaction

Perception on remuneration by category and sector

GPs: NGO> Private > Public Nurse: NGO> Public > Private


Perception on adequacy of allowances Function (Doesn’t go with

workload and level of responsibility )

Extra duty (all-inclusive amount, doesn’t go with neither workload nor performances)

Bonus ( too low, depend on rate of services used)


Perception on adequacy of allowances Night shift (not link to

performance)

Risk ( low, doesn’t allow to cover risk (HIV))

Accommodation (doesn’t allow decent housing)


FLOWS OF MIGRATION

RURAL URBAN

PUBLIC

Profit facilities

Non profit facilities

InternationalOrganisations

NGO

ABROADPublic, private, health facilities ...

Other sectors


Reasons of migration

From rural to urban: - Lack of opportunities for

development - Difficult conditions of life From mission to public: - Low salary - Allowance not enough From public to private and international

organizations: - Financial motivation - Career development


Lessons and perspectives

Salary does not follow inflation

High mobility of the health workforce creates dysfunctions


Lessons and perspectives Questions for further researches What could retain HWs in: Rural Public Faith-based How can we regulate private

providers practice without affecting public provision of services?


Thank you for the attention

Documents

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 Trends in remuneration and motivation