Little is known about how health workers are paid in developing countries, in particular how wages compare across countries and regions and how governments fund the public sector “wage bill”. Therefore the new book “Working in Health: Financing and Managing the Public Sector Health Workforce” by Marko Vujicic, Kelechi Ohiri, and Susan Sparks at the World Bank makes a substantial contribution to our knowledge base. The book can be downloaded for free from the World Bank website.

Here are some insights from the book:

1. The share of government health expenditure devoted to paying health
workers varies considerably across countries, ranging from below 10 percent
to above 80 percent.

2. There is a weak positive relationship between the share of government
health expenditure going to the wage bill and health spending and a weak
positive relationship also exists between the share of expenditure going
to the wage bill and the gross domestic product. Richer countries pay devote a larger share of their total government expenditures to health worker wages.

3. The share of government health expenditure devoted to the wage bill
varies considerably by region, and this is a strong predictor of the variation across countries. It seems that customs persist within regions, which I think is a very interesting finding and begs some really interesting questions.

4. A weak negative relationship exists between the share of government
health expenditure devoted to the wage bill and the level of donor assistance. Of course it is hard to paint a causal story here, but it does says that countries that receive a lot of aid devote less money to health workers, which is potentially troubling.

There are also some interesting outliers, and the book explores some of these outliers in interesting case studies. Ghana, for example, now spends about 90 percent of government health expenditure on wages.

I look forward to reading the whole book, and you should too.

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