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Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau.

Tyrrell AK, Russo G, Dussault G, Ferrinho P - Hum Resour Health (2010)

Bottom Line: Global initiatives have also been launched recently to standardise costing methodologies and respective tools.In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems.It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of International Health, Instituto de Higiene e Medicina Tropical, Rua da Junqueira 100, Lisbon, 1349-0008 Portugal. grusso@ihmt.unl.pt.

ABSTRACT

Introduction: In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools.

Methods: This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved.

Results: From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process.

Conclusions: The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process.

No MeSH data available.


Illustration of the rationale of the Mozambique HRH costing model. Source: Tyrrell (2008) 12.
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Figure 1: Illustration of the rationale of the Mozambique HRH costing model. Source: Tyrrell (2008) 12.

Mentions: The set of detailed sheets was subsequently aggregated to present the summary of planned expenditure per area of HRH over the years. Figure 1 illustrates the rationale behind the costing model developed, and the table in Additional file 1 is the summary of cost components and sub-components identified and sources of information. Salaries and allowances (the wage bill) included workers' base salary and legal supplements, such as subsidies for working in remote areas, for management positions, working extra hours, etc. Additional incentives were considered to be those relating to civil servants also sponsored by donors. In the absence of a finalized incentives policy, the critical assumption was made that the value of incentives summed up at least 26% of the salary mass.


Costing the scaling-up of human resources for health: lessons from Mozambique and Guinea Bissau.

Tyrrell AK, Russo G, Dussault G, Ferrinho P - Hum Resour Health (2010)

Illustration of the rationale of the Mozambique HRH costing model. Source: Tyrrell (2008) 12.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2902408&req=5

Figure 1: Illustration of the rationale of the Mozambique HRH costing model. Source: Tyrrell (2008) 12.
Mentions: The set of detailed sheets was subsequently aggregated to present the summary of planned expenditure per area of HRH over the years. Figure 1 illustrates the rationale behind the costing model developed, and the table in Additional file 1 is the summary of cost components and sub-components identified and sources of information. Salaries and allowances (the wage bill) included workers' base salary and legal supplements, such as subsidies for working in remote areas, for management positions, working extra hours, etc. Additional incentives were considered to be those relating to civil servants also sponsored by donors. In the absence of a finalized incentives policy, the critical assumption was made that the value of incentives summed up at least 26% of the salary mass.

Bottom Line: Global initiatives have also been launched recently to standardise costing methodologies and respective tools.In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems.It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of International Health, Instituto de Higiene e Medicina Tropical, Rua da Junqueira 100, Lisbon, 1349-0008 Portugal. grusso@ihmt.unl.pt.

ABSTRACT

Introduction: In the context of the current human resources for health (HRH) crisis, the need for comprehensive Human Resources Development Plans (HRDP) is acute, especially in resource-scarce sub-Saharan African countries. However, the financial implications of such plans rarely receive due consideration, despite the availability of much advice and examples in the literature on how to conduct HRDP costing. Global initiatives have also been launched recently to standardise costing methodologies and respective tools.

Methods: This paper reports on two separate experiences of HRDP costing in Mozambique and Guinea Bissau, with the objective to provide an insight into the practice of costing exercises in information-poor settings, as well as to contribute to the existing debate on HRH costing methodologies. The study adopts a case-study approach to analyse the methodologies developed in the two countries, their contexts, policy processes and actors involved.

Results: From the analysis of the two cases, it emerged that the costing exercises represented an important driver of the HRDP elaboration, which lent credibility to the process, and provided a financial framework within which HRH policies could be discussed. In both cases, bottom-up and country-specific methods were designed to overcome the countries' lack of cost and financing data, as well as to interpret their financial systems. Such an approach also allowed the costing exercises to feed directly into the national planning and budgeting process.

Conclusions: The authors conclude that bottom-up and country-specific costing methodologies have the potential to serve adequately the multi-faceted purpose of the exercise. It is recognised that standardised tools and methodologies may help reduce local governments' dependency on foreign expertise to conduct the HRDP costing and facilitate regional and international comparisons. However, adopting pre-defined and insufficiently flexible tools may undermine the credibility of the costing exercise, and reduce the space for policy negotiation opportunities within the HRDP elaboration process.

No MeSH data available.