Conférence Inaugurale de lAssociation Africaine déconomie 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

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 OUTLINE Context Objectives Methods Results Lessons and perspectives

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 Basic facts about Burkina Faso Population = (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%

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars % Human Resources for Health situation Ratio: <1 doctor/ , 5 nurse and midwife/

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars % Human Resources for Health situation

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

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 Objectives Analyse trend in salaries of health workers from 1976 to 2006 Analyse the perception that the health workers have on their remuneration.

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

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 Methods Sampling 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

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 Trends in salaries 50% GP in 1975 gain 2 more than GP in 2005

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

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

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

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 Perception on adequacy of allowances Function (Doesnt go with workload and level of responsibility ) Extra duty (all-inclusive amount, doesnt go with neither workload nor performances) Bonus ( too low, depend on rate of services used)

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 Perception on adequacy of allowances Night shift (not link to performance) Risk ( low, doesnt allow to cover risk (HIV)) Accommodation (doesnt allow decent housing)

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 FLOWS OF MIGRATION RURAL URBAN PUBLIC Profit facilities Non profit facilities International Organisations NGO ABROAD Public, private, health facilities... Other sectors

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

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 Lessons and perspectives Salary does not follow inflation High mobility of the health workforce creates dysfunctions

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 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?

Conférence Inaugurale de lAssociation Africaine déconomie et Politique de Santé (AfHEA) Accra - Ghana, 10 – 12 Mars 2009 Thank you for the attention