title: Salaries and incomes of health workers in sub-Saharan Africa.
abstract: Public-sector health workers are vital to the functioning of health systems. We aimed to investigate pay structures for health workers in the public sector in sub-Saharan Africa; the adequacy of incomes for health workers; the management of public-sector pay; and the fiscal and macroeconomic factors that impinge on pay policy for the public sector. Because salary differentials affect staff migration and retention, we also discuss pay in the private sector. We surveyed historical trends in the pay of civil servants in Africa over the past 40 years. We used some empirical data, but found that accurate and complete data were scarce. The available data suggested that pay structures vary across countries, and are often structured in complex ways. Health workers also commonly use other sources of income to supplement their formal pay. The pay and income of health workers varies widely, whether between countries, by comparison with cost of living, or between the public and private sectors. To optimise the distribution and mix of health workers, policy interventions to address their pay and incomes are needed. Fiscal constraints to increased salaries might need to be overcome in many countries, and non-financial incentives improved.
authors.affiliation: Centre for International Health and Development, University College London, UK. Electronic address: d.mccoy@ucl.ac.uk.
authors.forename: David
authors.initials: D
authors.lastname: McCoy
authors.affiliation: Alliance for Health Systems and Policy Research, WHO, Geneva, Switzerland.
authors.forename: Sara
authors.initials: S
authors.lastname: Bennett
authors.affiliation: IMMPACT, University of Aberdeen, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Witter
authors.affiliation: World Health Organization, Geneva, Switzerland.
authors.forename: Bob
authors.initials: B
authors.lastname: Pond
authors.affiliation: Health GAP, Northeastern University School of Law, Boston, MA, USA.
authors.forename: Brook
authors.initials: B
authors.lastname: Baker
authors.affiliation: Health Economics and HIV/AIDS Research Division, University of Kwazulu-Natal, Durban, South Africa.
authors.forename: Jeff
authors.initials: J
authors.lastname: Gow
authors.affiliation: Centre for International Health and Development, University College London, UK.
authors.forename: Sudeep
authors.initials: S
authors.lastname: Chand
authors.affiliation: IMMPACT, University of Aberdeen, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Ensor
authors.affiliation: Queen Margaret University, Edinburgh, UK.
authors.forename: Barbara
authors.initials: B
authors.lastname: McPake
mesh_terms: D017954:Africa South of the Sahara; D006282:Health Personnel / Q000191:economics*; D006801:Humans; D007182:Income; D017150:Public Sector; D012456:Salaries and Fringe Benefits