Coping Strategies

Dual Job Holding by Public Sector Health Professionals in Highly Resource-Constrained Settings: Problem or Solution?

This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. It draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. [from abstract]

Managing Health Services in Developing Countries: Between the Ethics of the Civil Servant and the Need for Moonlighting: Managing and Moonlighting

We report on income generation and work mix among 100 civil servants who manage public health services in developing countries. Their salary puts these managers among the better-off in their countries. However, 87% of the respondents complement their salaries with other income-generating activities.

How Health Workers Earn a Living in China

The Chinese government has found it impossible to maintain uniform pay levels, particularly in the face of a radical devolution of its own financial management. Health workers have increasingly resorted to informal methods of earning an income. The government considers this to be unprofessional behavior and has used a combination of moral pressure and loss of professional privileges to discourage it.

Should Physicians' Dual Practice Be Limited? An Incentive Approach

We develop a principal-agent model to analyze how the behavior of a physician in the
public sector is affected by his activities in the private sector. We show that the physician will have incentives to over-provide medical services when he uses his public activity as a way of increasing his prestige as a private doctor. The health authority only benefits from the physician’s dual practice when it is interested in ensuring a very accurate treatment for the patient. Our analysis provides a theoretical framework in which some actual policies implemented to regulate physicians’ dual practice can be addressed.

Ghost Doctors: Absenteeism in Bangladeshi Health Facilities

The authors report on a study in which unannounced visits were made to health clinics in Bangladesh with the intention of discovering what fraction of medical professionals were present at their assigned post. This survey represents the first attempt to quantify the extent of the problem on a nationally representative scale. [from abstract]

Dual Practice in the Health Sector: Review of the Evidence

This paper reports on income generation practices among civil servants in the health sector, with a particular emphasis on dual practice. It first approaches the subject of public-private overlap. Thereafter it focuses on coping strategies in general and then on dual practice in particular. In this paper dual practice is approached from six different perspectives: what is meant by dual practice; typology of dual practices; prevalence; impact on personal income, the health care system and health status; reasons; and possible interventions. [adapted from author]

When Staff is Underpaid: Dealing with the Individual Coping Strategies of Health Personnel

Health sector workers respond to inadequate salaries and working conditions by developing various individual coping strategies; some, but not all, of which are of a predatory nature. The paper reviews what is known about these practices and their potential consequences (competition for time, brain drain and conflicts of interest).

Multiple Public-Private Jobholding of Health Care Providers in Developing Countries: An Exploration of Theory and Evidence

This review examines the systemic and individual causes of multiple job holding (MJH) and evidence on its prevalence. MJH should be seen as resulting initially from underlying system-related causes. These include overly ambitious efforts by governments to develop and staff extensive delivery systems with insufficient resources. Governments have tried to use a combination of low wages, incentives, exhortations to public service, and regulation to develop these systems.