Kenya's latest doctor strike highlights a persistent issue: monopsony. In developing countries, government control over healthcare wages (monopsony) often leads to understaffed hospitals and frustrated patients.
But there's hope. Practical solutions like performance-based pay can empower workers and improve care. By working together, policymakers and healthcare workers can build a more sustainable system for everyone.
Imagine a scenario where a single large factory dictates apple prices to all the farmers in a town. That's akin to the monopsony power governments hold in public healthcare. Competitive markets typically lead to fairer wages, but monopsony creates an imbalance where government has all the power in setting wages. The good news is that low- and middle-income countries are pioneering solutions to break this grip.
Rwanda's pay-for-performance scheme stands as a government-led programme aimed at improving healthcare worker motivation and public health outcomes.
At an additional cost of only $0.30 (Sh39.90) per person per year, the result of higher administrative and verification costs, the initiative along with others has resulted in a 35 per cent decrease in maternal mortality, a 36 per cent decrease in infant deaths and a decrease in overall child deaths by 40 per cent. There are even more statistics that you could quote that show the significant improvement in overall healthcare that this scheme has brought in addition to making healthcare workers feel valued and paying them more.
While Rwanda's success story is inspiring, the global landscape requires diverse solutions. Some strategies to consider include performance-based incentives, empowering worker advocacy and public-private partnerships.
Performance-based incentives, as already evidenced by Rwanda’s P4P scheme, can be a powerful tool in motivating healthcare workers. Secondly, empowering worker advocacy is a useful tool. Healthcare workers are far from powerless. Strong unions and advocacy groups can play a crucial role in dismantling monopsony. Through collective bargaining, they can negotiate fair wages and working conditions, ensuring their voices are heard at the policy table.
However, effective worker advocacy requires a supportive environment. Governments can play a critical role by protecting worker rights, upholding freedom of association and the right to collective bargaining, allowing healthcare workers to organise and advocate their rights effectively.
We have seen recently in Kenya that doctors' freedom of association is far from guaranteed as evidenced by attacks on demonstrating doctors and their union leaders. The public has also shown apathy to the plight of doctors, viewing them more as “rich” noisemakers complaining about nothing.
Transparency and data sharing, providing healthcare workers with clear data on national healthcare budgets and wage structures empowers them to make informed arguments during negotiations. Dispute resolution mechanisms that establish fair and transparent mechanisms for resolving wage disputes foster trust and prevent unnecessary disruptions to healthcare services.
Again, by failing to implement negotiated agreements Kenya’s government has failed in this role. By fostering a climate that empowers worker advocacy, governments can create a more collaborative approach to wage setting, fostering solutions that benefit both healthcare workers and the healthcare system.
Public-private partnerships with strategic collaborations can leverage private sector efficiencies and innovations. They can address monopsony in several ways. For instance, partnering with private entities for specific non-core services, such as laundry or facility management, can free up public resources for competitive healthcare worker wages.
Additionally, public healthcare systems can benefit from the private sector's expertise in areas such as human resource management and technology implementation. This knowledge transfer can improve efficiency and potentially lead to cost savings that can be redirected towards higher wages.
Further, joint public-private investments can accelerate improvements in healthcare infrastructure and service delivery. Sharing the financial burden allows for more ambitious projects that can ultimately benefit patients and healthcare workers.
However, success with public-private partnerships hinges on robust regulatory frameworks to ensure quality of care. Private sector involvement must never compromise the quality of public healthcare services.
Rigorous quality control measures are essential. Transparency and accountability with clear partnership agreements and transparent financial reporting are crucial to prevent corruption and ensure that public resources are used effectively.
Breaking the monopsony grip on public healthcare requires a united front. By learning from successful initiatives like Rwanda's P4P programme and exploring adaptable solutions like performance-based pay and public-private partnerships, policymakers and healthcare workers can build a more equitable system.
Empowering worker advocacy through a supportive environment and ensuring responsible public-private partnerships are additional crucial elements. Ultimately, this collective effort will ensure fair wages for healthcare workers, attract and retain talent, and deliver the high-quality healthcare that patients deserve.