What is the evidence of the impact of increasing salaries on improving the performance of public servants, including teachers, nurses and mid-level occupations, in low- and middle-income countries: Is it time to give pay a chance?

Abstract

The Millennium Development Goals (MDGs) have stimulated a plethora of research on civil servant remuneration and poverty reduction through improved civil service performance and Decent Work (MDG1b). Since the year 2000 an emphasis on market forces has directed attention to output-based pay (or pay-for-performance) instead of paying decent/liveable fixed salaries that trust public servants to deliver \"performance-for-pay\", i.e., performance that is contingent on pay rather than vice-versa.

This systematic review covers the literature from 2000-2010 and focuses on frontline occupations in health (doctors, nurses, mid-level occupations) and in education (teachers), in low- and middle-income countries. It is based on a pre-prepared protocol and used extensive searches of multiple sources. During November and December 2010, we searched the Campbell Library; CINAHL; the Cochrane Database of Systematic Reviews; the Cochrane Central Register of Controlled Trials; EMBASE; Eric; Health Management Information Consortium; International Bibliography of the Social Sciences; MEDLINE; MEDLINE in process; PsycINFO; Science Citation Index; Sociological Abstracts; Social Services Abstracts; Social Science Citation Index; and the NHS Economic Evaluation Database; and checked the reference sections of potentially relevant articles. A minimum of two reviewers checked each record retrieved in the searches, and independently extracted data and assessed the quality of the potentially eligible studies. The searches had to be large and comprehensive because of the lack of any suitable index terms, and the desire to minimise the risk of missing eligible studies. We recognised that this would lead to the identification of vast numbers of irrelevant articles in our electronic searches, which would need to be screened out.

Findings: The electronic searches identified more than 28,000 records (some of which were multiple occurrences of the same article but in separate databases), including publications in the grey literature and articles found by checking reference lists. As expected, although the vast majority of these were not relevant for this systematic review, we found and summarised (in the Introduction and Discussion section of this report), 143 previous reviews of the evidence. We also identified 738 general background publications, with the most common type of article being a cross-sectional survey of satisfaction with pay (n = 115 articles). Using mostly subjective ratings or rankings, often with single items or themes, these studies do help to establish that pay-related job satisfaction is experienced as low for health workers (n = 89), and to some extent teachers (n = 20); with a further six studies including both groups (e.g., nursing educators). A total of 158 articles were eligible for appraisal, but 157 of these were judged to be ineligible for this review, chiefly on methodological grounds (Kappa for agreement between reviewers = 0.76). These reasons included inadequate measures of (i) pay (n = 34) and (ii) pay variation (n = 48), as well as (iii) lack of a control comparison (n = 28). The single included study reported a significant improvement in Brazilian students' grades when the base salaries of their teachers were higher, controlling for human and material resources. However the study did not explore intervening mediators or moderators such as job satisfaction or work justice. The most striking finding of our systematic review is the vast quantity of articles across many disciplines that discuss the issues we wished to address, but do so in an environment which is almost free of empirical evidence linking actual pay variation to actual work or service performance. The literature is therefore wholly inconclusive, at this stage.

Key implications for stakeholder groups: (1) Journal editors should cease accepting statements of the problem, which may add little to the research base needed to solve it; (2) Based on the research we found for the review, researchers are able to design studies that adequately evaluate performance-for-pay, and that may enable fairer comparisons with pay-for-performance; (3) To the extent that research has not yet evaluated the performance-for-pay policy-option, policy-makers as well as managers in organisations cannot rule out the potential for fixed salary reform to enhance public servant motivation and performance, reduce moonlighting and brain drain, and build local capacity. The core inference from our systematic review is that fixed salary reforms have yet to be evaluated conclusively.

Citation

Carr, S. C.; Leggatt-Cook, C.; Clarke, M.; MacLachlan, M.; Papola, T. S.; Pais, J.; Thomas, S.; McAuliffe, E.; Normand, C. What is the evidence of the impact of increasing salaries on improving the performance of public servants, including teachers, nurses and mid-level occupations, in low- and middle-income countries: Is it time to give pay a chance? EPPICentre, Social Science Research Unit, Institute of Education, University of London, London, UK (2011) 102 pp. ISBN 978-1-907345-24-1

What is the evidence of the impact of increasing salaries on improving the performance of public servants, including teachers, nurses and mid-level occupations, in low- and middle-income countries: Is it time to give pay a chance?

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