The plan to use the UCS budget to redistribute the budget for salaries was partially
undermined because it ran counter to the existing civil service workforce
employment procedures. By law, civil service salaries are made in a separate
government allocation and cannot be used for other purposes, so that de facto
top-slicing of the salary component is unavoidable. The scope for using the UCS
to reallocate the workforce was further limited by the MOPH’s lack of a clear
policy on human resource distribution.
Problems were exacerbated by the restructuring of the MOPH in 2002, particularly
the termination of new posts for nurses and pharmacists who had government
bonding/compulsory service obligations; they became contract workers
employed independently by individual hospitals. Poorer hospitals have limited
capacity to employ staff, resulting in tensions due to high staff workloads. The
objective to improve the equity of the UCS budget allocation was hampered
by the inequity in the staff budget allocation (slightly more than half of the total
operating budget), an issue that in retrospect might have been addressed more
successfully by the gradual equalization of staff concentration across provinces
over several years.