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Investing in the health workforce: fiscal space analysis of 20 countries in East and Southern Africa, 2021-2026.
Asamani, James Avoka; Kigozi, Jesse; Sikapande, Brivine; Christmals, Christmal Dela; Okoroafor, Sunny C; Ismaila, Hamza; Ahmat, Adam; Nyoni, Jennifer; Nabyonga-Orem, Juliet; Mwinga, Kasonde.
  • Asamani JA; Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo Asamanij@who.int.
  • Kigozi J; Faculty of Health Sciences, Centre for Health Professions Education, North-West University - Potchefstroom Campus, Potchefstroom, South Africa.
  • Sikapande B; Health Economics Unit, University of Birmingham, Birmingham, UK.
  • Christmals CD; Monitoring and Evaluation Unit, Zambia Ministry of Health, Lusaka, Zambia.
  • Okoroafor SC; Faculty of Health Sciences, Centre for Health Professions Education, North-West University, Potchefstroom, South Africa.
  • Ismaila H; Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo.
  • Ahmat A; Office of the Director-General, Headquarters, Ghana Health Service, Accra, Ghana.
  • Nyoni J; Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo.
  • Nabyonga-Orem J; Health Workforce Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo.
  • Mwinga K; Health Financing and Investment Unit, Universal Health Coverage - Life Course Cluster, World Health Organization Regional Office for Africa, Brazzaville, Congo.
BMJ Glob Health ; 7(Suppl 1)2022 06.
Article in English | MEDLINE | ID: covidwho-1932713
ABSTRACT
BACKGROUND AND

OBJECTIVES:

The health workforce (HWF) is at the core of ensuring an efficient, effective and functional health system, but it faces chronic underinvestment. This paper presents a fiscal space analysis of 20 countries in East and Southern Africa to generate sustained evidence-based advocacy for significant and smarter investment in the HWF.

METHODS:

We adapted an established empirical framework for fiscal space analysis and applied it to the HWF. Country-specific data were curated and triangulated from publicly available datasets and government reports to model the fiscal space for the HWF for each country. Based on the current knowledge, three scenarios (business as-usual, optimistic and very optimistic) were modelled and compared.

FINDINGS:

A business-as-usual scenario shows that the cumulative fiscal space across the 20 countries is US$12.179 billion, which would likely increase by 28% to US$15.612 billion by 2026 but varies across countries-the highest proportional increases expected in Seychelles (117%) and Mozambique (69%) but lowest in Zambia (15%). Under optimistic assumptions, allocating an additional 1.5% of gross domestic product (GDP) to health even without further prioritising the proportional allocation to the wage bill could boost the cumulative fiscal space for HWF by US$4.639 billion. In a very optimistic scenario of a 1.5% increase in health expenditure as a proportion of GDP and further prioritisation of HWF within the health expenditure, the cumulative fiscal space for HWF could improve by some 105%-ranging from 24% in Zambia to 330% in Lesotho.

CONCLUSION:

Small increments in government health expenditure and increased prioritisation of HWF in funding in tandem with the 57% global average could potentially increase the fiscal space for HWF by at least 32% in 11 countries. Unless the HWF is sufficiently prioritised within the health expenditures, only increasing the overall health expenditure to even recommended levels would still portend severe underinvestment in HWF amid unabating shortages to deliver health services. Thus, HWF strategies and investment plans should include fiscal space analysis to deepen advocacy for sustainable investment in the HWF.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Health Expenditures / Health Workforce Limits: Humans Country/Region as subject: Africa Language: English Year: 2022 Document Type: Article Affiliation country: Bmjgh-2021-008416

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Health Expenditures / Health Workforce Limits: Humans Country/Region as subject: Africa Language: English Year: 2022 Document Type: Article Affiliation country: Bmjgh-2021-008416