As part of efforts to promote effective and efficient healthcare delivery across the country, the Government of Liberia (GOL), through the Civil Service Agency (CSA), Ministry of Finance and Development Planning and the Ministry of Health has adopted a new pay and grade policy for the recruitment and service of health workers in the country.
By Obediah Johnson
The policy, a copy which is in the possession of FrontPage Africa, shows that the total health sector workforce is nearly 17,000, with the Ministry of Health (MOH) accounting for about 10,000.
It unearthed that presently, 48% of MOH employees are clinical staff, affected by numerous challenges, bordering on condition of service.
The policy was adopted to help address multiple Human Resource issues across the public health care system and provide the appropriate salaries and incentives for health care workers.
It stemmed from the lack of an appropriate revised classification scheme for the various cadres of health workers as advances in areas of study and specialization have emerged over the years, the lack of clearly defined job profiles and growth requirements and paths for the various cadres of health workers and the corresponding pay scale adjustments, and the scarcity or limited supply of various critical and technical cadres of healthcare staff due to limited fiscal space for employment.
To address some of the challenges facing the health workforce and increase the motivation and performance of health care workers in the public health system, the Government of Liberia, through the Ministry of Health, in collaboration with the Civil Service Agency and the Ministry of Finance and Development Planning, undertook a policy review around employment, status, and pay for all cadres of health care workers in the country.
The goal of the Health Workforce Employment, Promotion, and Pay Policy is to attract and retain quality health care workers for the public health service as well as strengthen the efficiency and effectiveness of the system.
The main objectives of the policy is to among other things provide a career path for all cadres of public healthcare workers in the public health service; satisfy the financial needs of the public healthcare workforce; and guarantee fair and equitable pay across all cadres of the health workforce.
The development of the policy was based upon numerous related actions. Primarily among them include the conduct of a comparative salary survey.
The survey was preceded by numerous stakeholder engagements, involving the MoH, CSA, MFDP, professional bodies, regulatory bodies, and various heath workforce associations, to identify all cadres of health workers and their professional career paths, from entry level to the most senior professional.
It was also intended to support the new pay and grade structure in all categories as the career path structure also included the basic job descriptions and requirements for each position on the professional ladder of each cadre of the health workforce² doctors, nurses, etc.
It can be recalled that in September 2022, the Liberian government embarked on conducting internal salary survey within the health sector. It was intended to identify salary discrepancies and appropriate salary grades and structures, and adjusting where necessary, through a salary survey.
The survey focused on collecting information about employees’ compensation , including wages and benefits, in determining the salary levels for specific job categories, with a comparative analyses of regional health workers salaries and job classifications.
On employment, the adopted policy revealed that the automatic hiring of all newly licensed doctors and pharmacists from the AM Dogloitti College of Medicine and the School of Pharmacy, respectively, of the University of Liberia has become unsustainable, in the face of limited resources for compensation and the need to reduce the growing disproportionate distribution of compensation between doctors and all other health workers in the public health system.
While the compensation for doctors is fixed and set considerable high at all levels, the document maintained that nurses, midwives, and other health care workers still generally earn below the pay for their positions and grades and have to continue to settle for lower pay as new doctors and pharmacist automatically enter the workforce annually and command more of the already limited compensation resources available in the annual budget of the Ministry of Health.
It stated that without controlling this automatic flow of the high earners in health, amidst limited compensation for health workers, the disparity will widen and the discontent among nurses, midwives, and other cadres of health workers will continue to grow and undermine the stability and quality of the health care delivery system.
“To address this problem and improve pay equity as well as reduce growing discontent among the majority of health workers in the public health system, the Government of Liberia, through the Ministry of Health shall implement the following policies in the recruitment of new licensed doctors and pharmacists who successfully complete their internship programs with the LMDC and LPB, respectively.
“The Government of Liberia, through the Ministry of Health, shall, effective January 2023, discontinue the practice of automatically hiring all graduates of the AM Dogloitti College of Medicine and the School of Pharmacy of the University of Liberia. The Ministry shall, instead, recruit only newly licensed doctors (GPs) and pharmacists (GPs), based on the needs of the Ministry and its capacity to pay their compensation from existing fiscal resources.”
It disclosed that all interns who successfully complete their internship programs, shall be licensed by their respective regulatory bodies (LMDC and LPB), qualifying them to practice as Medical Doctors/Physicians (General Practitioners) and Pharmacists (General Practitioners).
It indicated that upon licensing the successful interns, the licensing bodies shall immediately and formally notify the Ministry of Health by submitting cover letters and the details (including full names, assignment details, period of service, NINs, License Numbers, internship score/rating, summary of school records) of all newly licensed physicians and pharmacists.
According to the policy, the LMDC and LPB shall effectively inform the MoH that the interns are now qualified to serve as General practitioners within the health system.
It maintained that newly licensed doctors and pharmacists who desire to seek employment with the GoL shall submit formal applications to the MoH for employment as GPs.
“The MoH shall receive and process applications as well as headhunt newly licensed doctors and pharmacists, where needed, and hire them as its needs and resources would permit.”
The new pay and grade policy disclosed that new doctors (GPs) and pharmacists (B/D-Pharm.), upon completion of internship and licensure by their respective boards, who are desirous of working in the government health sector, under the Ministry of Health, shall be subject to a new salary structure, set under this policy document by the Government of Liberia as part of a sector-wide revise pay and grade structure.
It emphasized that new specialists (doctors, pharmacists, others) in the employ of MoH, upon graduation, shall maintain current salary & shall receive an annual pay rise, pending performance appraisal, until they reach the maximum as other specialist.
The policy further called for Pharmacist in comparable professional categories as medical doctors, to earn 70 per cent of the compensation for medical doctors, adding that, “this shall also apply to intern pharmacists.”
“A Medical Doctor (General Practitioner) shall earn a minimum of US$1,500 and a maximum of US$2,398. Accordingly, General Practitioners shall be in three grades (GP 1, GP 2, and GP 3). This means that a newly licensed Medical Doctor/General Practitioner (MD/GP), accepted for employment (beginning 2023), following successful completion of MOH HR recruitment processes, shall be classified as MD/GP 1 and earn a gross monthly salary of US$1,500 (One Thousand, Five Hundred US Dollars). Progression from GP 1 to GP 4 shall come with upward adjustment in pay but based on GPs meeting basic requirements for promotion and successful annual performance appraisals. A GP shall reach the maximum pay for the grade after a minimum of four (4) years of successful service.”
It revealed that MD/GPs granted study leave by MOH and successfully completed post graduate study program/specialization, as of 2022, shall continue to make a gross monthly salary of US$2,398 with annual pay adjustment, pending performance appraisal, until they reach the maximum of US$3,004.27 over a period of 4 years.
It called for new licensed pharmacist (B-Pharm/D-Pharm) accepted for employment, following successful completion of MOH HR recruitment processes to make a gross monthly salary of US$900 with annual pay rise, pending PERFORMANCE APPRAISAL, until the maximum for B/D-Pharm of US$1,600 is reached in 4-years period.
The policy stated that as in the case of doctors and pharmacists, all other cadres of health workers will be hired based on a combination of need and the availability of fiscal resources to pay and continuously adjust compensation to the appropriate level for the grade of the employee.
It furthered that government shall implement the full reclassification model for all health cadres, developed with the input of all key stakeholders, with clearly defined positions, position categories, and corresponding pay scale across the sector, commencing FY 2024.
“The GoL shall increase salaries of all paramedics (nurses, midwives, physician assistants, lab technicians, etc.), based on the reclassification model and revised Pay and Grade Structure for Healthcare Workers. Based on the revised pay and grade structure, the compensation for all paramedics shall be adjusted to the minimum in the revised pay and grade structure for the public health sector beginning January 2024. Following the initial minimum adjustment in pay in FY 2024, there shall be performance-based annual adjustments in compensation until employees reach their maximum level of pay for their positions, as shown in Appendix 1 (Professional Categories and Grades, Pay, & Pay Adjustments Phases for All Cadres of Health Workers).”
The policy further mandates government to in addition to monthly salary, provide hardship allowances (HA) for MoH clinicians and administrative staff (MDs, B/D-Pharm., Specialists, RNs, MWs, PAs, Lab Techs., etc.) who are assigned in the hard-to-reach counties (Gbarpolu, Lofa, Nimba, Grand Gedeh, River Gee, Maryland, Grand Kru, Sinoe, & Rivercess) as long as physical barriers to travel to these areas remain.
It also added that incentives shall only apply to employees based on assignment. Thus, upon leaving any of these hard-to-reach areas, health workers shall lose same.
“Clinicians and/or administrative staff who are originally residents in said counties and hired locally shall be exempted. The MoH shall work to prioritize the practice of hiring locally to reduce the burden of allowances and staff turnover in hard-to-reach areas. The GoL shall budget for the construction of 20 staff quarters at county level, with priority given to hard-to-reach areas.”
The new pay and grade policy was adopted and signed by authorities of the Ministries of Health, Finance and Development Planning, CSA, the Liberia National Physician Assistant Board, Liberia Medical and Dental Council, Liberia Laboratory Technologist, Liberia Medical Imaging, Liberia Nursing Association, Liberia Nursing and Midwifery Board, Liberia Pharmacist Board, and Pharmacist Association of Liberia.