Dominican Republic Improves Access to Health Services by Strengthening Human Resources Management

Nov 13, 2014
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In the Dominican Republic, the Ministry of Health is improving access to high-quality health services by focusing on the health workforce and, in particular, the systems used to manage these valuable human resources. One important outcome has been the discovery of a large number of people on the payroll who were no longer working. The money saved by cleaning the payroll is being reinvested in the health sector.

Dominican Republic health workersImproving management of the health workforce

Over the last several years a number of studies have described the Dominican Republic’s health workforce challenges. Weak human resources management systems were identified as a major issue.

CapacityPlus is helping the Ministry of Health refine the HR management systems needed to create an enabling environment for health workers to perform effectively. This includes strengthening a cadre of skilled HR managers who can develop, implement, and manage the necessary systems.

Reducing economic waste by cleaning up the payroll

As part of this work, CapacityPlus provided assistance to the Ministry of Health to analyze its payroll system. This revealed nearly 10,000 “ghost workers”—individuals who receive a salary but are not actually working—plus 2,259 people who had been in the process of retirement for over three years, representing a total of approximately 30% of the central budget and approximately $633,000 per month. That’s more than $7.5 million per year.

Highlights
  • Payroll analysis revealed 10,000 ghost workers, representing more than $7.5 million per year in economic waste.
  • The Ministry of Health eliminated 2,717 ghost workers in the first phases of payroll cleanup and fully retired 1,090 people—saving $6.2 million per year—and is reinvesting the savings to hire new health workers, provide a 10% salary increase for doctors and nurses, and raise health workers’ retirement benefits from 60% of their last salary level to 100%.
  • The newly-hired health workers are contributing to increased access to services. Coverage of early detection of HIV and syphilis, family planning (particularly for HIV-positive women), and access to prenatal care for HIV-positive women has already risen in various regions.
  • The Ministry of Health is completing the cleanup process and has eliminated the collection of user fees in public hospitals, which will make health services more accessible.

Since these ghost workers were not actually providing services, hospitals had to use their internal funds to hire additional staff in order to fill the gaps and provide sufficient health service coverage, rather than using the funds to purchase medications, equipment, and supplies, and provide HIV training and clinical support for existing staff.

In response, the Ministry eliminated 2,717 ghost workers in the first phases of payroll cleanup, and fully retired 1,090 people, resulting in a savings of $6.2 million per year. The Ministry is reinvesting the savings to increase access to health services at the primary level of care through the hiring of 2,511 doctors, nurses, and area coordinators to work in HIV and other health prevention services. In addition, the Ministry provided a 10% salary increase for doctors and nurses, and raised health workers’ retirement benefits from 60% of the last salary level to 100%.

The Ministry of Health is completing the cleanup process and has eliminated the collection of fees in public hospitals, which was commonly used to support parallel payroll systems allowing for hiring of excess support staff for political purposes.

Increasing access to health services

The coverage of health services—including early detection of HIV and syphilis, family planning (particularly for HIV-positive women), and access to prenatal care for HIV-positive women has risen in various regions of the country. As an example, Region IV (a poor area bordering Haiti with a large immigrant population at risk for HIV) received an influx of 234 new health workers (43 doctors, 21 nurses, and 170 health promoters) resulting in a 500% increase in the number of patient consultations for HIV and syphilis prevention, prenatal care, and family planning between 2012 and September 2013.

Increasing coverage of HIV-related services at the primary level results in improved coverage up the chain, with more HIV-positive individuals being referred for treatment and contraceptive options at the secondary level and more HIV-positive pregnant women and their infants being cared for to further the goal of an AIDS-free generation.

Once the payroll is completely cleaned, the significant central and local budget savings can be used more effectively to improve the quality of care. The government has shown great transparency in sharing the results of the Ministry of Health payroll cleanup and has demonstrated additional leadership in its commitment to apply similar payroll cleanups to other ministries.

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Photo by Wendy Tactuk (health workers in the Dominican Republic)