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More funding for human resources for health

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There is no doubt that more health workers are needed to achieve the health goals of countries, including the Millennium Development Goals. There are, however, some constraints to significantly expanding the health workforce in many low-resource countries:

1. The “fiscal space” to increase the size of the government payroll
2. The need of keeping a balance between the proportions of the budget allocated to salaries and to other goods and services essential for the provision of care.

Regarding the first point, several governments are having serious challenges to even keep the current number of employees and reasonable salaries.

In regard to the second point, there is increasing awareness that health workers need tools, drugs, and other medical supplies in order to provide effective care. Under limited-ceiling health budgets (e.g. without a net increase of the health budget), any additional expenditures in salaries can only come from the portion of the budgets for these essential other tools and supplies.

A study conducted several years ago, in 1087 (Margarita Petrera. Efficacy and Efficiency of the Social Security in Relationship with the Economic Cycle: The Peruvian Case. Bulletin of the Pan American Health Organization. 1987) empirically demonstrated that to achieve optimal productivity in the health services, there must be a certain proportion between the budgets for salaries and for other medical goods and services. Any departure from this balance leads to lower productivity (e.g. having part of the workforce idle or delivering “incomplete” care).

Several options have been proposed to overcome these challenges, such as involving the private sector, resort to community health workers, or doing a stronger advocacy for increasing health budgets. What is your opinion about or experience with any of these strategies?”

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