What evidence is there on which is the most effective method of supporting salaries of health staff in government clinics from a donor perspective? Specifically what evidence is there on the effectiveness of the different options below:
1 Donors don’t pay salaries (instead seeing this as a government responsibility)
2 Donors pay salaries through NGOs
3 Donors support salaries through government systems
This report gives the background and context of the situation regarding financing of human resources in developing countries. It then goes on to present papers on the different options.
• Donor Support Through Governments: Some experts have argued that this is the most effective, under some conditions. To do this, donors must provide some kind of budget support – general or health sector. This is the most vulnerable to fungibility. So, the final result may be that donors finance salaries, but that the governments of recipient countries reduce their support to the health sector. This report also presents a case study of donors supporting human resources through the Malawian government.
• Donors Don’t Pay Salaries: Next, it presents two papers arguing for and against donor support of salaries. The World Bank believes uncertain financing flows mean donors should not commit to permanent expenditures such as salaries. In his paper, Gorik Ooms argues that this position no longer makes sense, now that donors are involved in other long term recurrent costs, such as AIDS treatment. He also argues that without doing this you end up with ‘medicines without doctors’ but that donors should give via organisations such as the Global Fund to ensure consistency.
• Donors Support Salaries Through NGOs: Specialists gave more support to a system wide approach such as donating through government systems. Examples in the literature warn of ‘islands of excellence’ through using this method and it has also been suggested that it may lead to privatisation of health services. Additionally, this section gives case studies of Afghanistan and Liberia and Merlin’s experiences.
This report also presents evidence on different ways to pay salaries, sector wide approaches, the importance of human resources and has a section on comments from specialists.