Abstract
Background Human resources for health (HRH) represents an essential component for well-functioning health systems. In recent years, there has been increased attention on the determinants of health workers (HWs) motivation, and in particular the role of financial incentives. Some countries have embarked on reforms to increase salaries and revise incentive packages, for example introducing rural allowance and/or performance-based financing. Sierra Leone provides an interesting case as, since 2009, a series of HRH reforms have been introduced, linked with the Free Healthcare Initiative.
Highlights
Human resources for health (HRH) represents an essential component for well-functioning health systems
The HRH measures eventually interacted with the existing districtspecific incentive environment for health workers (HWs), affecting their performance in different ways
A survey of 266 HWs and in-depth interviews with 32 HWs were carried out in the same three districts. Making use of these data and policy analyses tools, the study looks in turn at (i) decision-making at central level, (ii) implementation of HRH policies in the districts, and (iii) impact on individual HWs incentives
Summary
Human resources for health (HRH) represents an essential component for well-functioning health systems. There has been increased attention on the determinants of health workers (HWs) motivation, and in particular the role of financial incentives. Sierra Leone provides an interesting case as, since 2009, a series of HRH reforms have been introduced, linked with the Free Healthcare Initiative. These changes are generally recognized, especially by actors at central level, as ‘successful’ in addressing some of the HRH challenges as well as contributing to the Free Healthcare Initiative. The number, type and focus of external organizations present in the districts created different ‘political economy’ dynamics and contexts for the implementation of the reforms, which influenced their functioning and effects. The HRH measures eventually interacted with the existing districtspecific incentive environment for HWs, affecting their performance in different ways
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