Coping Strategies

Negotiating Markets for Health: An Exploration of Physicians' Engagement in Dual Practice in Three African Capital Cities

This study considered dual practice patterns in three African cities and the respective markets for physician services, with the objective of understanding the influence of local determinants on the practice. [from abstract]

Assessing Health Workers' Revenues and Coping Strategies in Nigeria: A Mixed Methods Study

This study examined the coping mechanisms of health workers in the public health sector of Nasarawa and Ondo states in Nigeria to supplement their salaries and benefits; it also estimated the proportionate value of the revenues from those coping mechanisms in relation to the health workers’ official incomes. [from abstract]

Absenteeism amongst Health Workers: Developing a Typology to Support Empiric Work in Low-Income Countries and Characterizing Reported Associations

The authors aimed to review the literature on absenteeism from a health system manager’s perspective to inform needed work on this topic and to develop a typology of definitions that might be useful to classify different forms of absenteeism and identify factors associated with absenteeism. [adapted from abstract]

Where Have They Gone? A Study on the Absenteeism of Doctors and Support Staff in Primary Health Care Centres

This study focused on the causes of absenteeism among doctors and paramedical staff in primary health care centres in Karnataka and loss of resources due to absenteeism and related issues, with a view to suggest ways and means of reducing absenteeism and maximising impact on the utilisation of public resources. [from summary]

Improving Service Delivery through Measuring Rate of Absenteeism in 30 Health Centres in Tonk District of Rajasthan, India

The objective of the study defined in this report was to evolve a community-based model of monitoring absenteeism in public health centres that can induce demand accountability of service providers, along with measuring the rate of their absenteeism and the satisfaction of the beneficiaries, and to do evidence-based advocacy for adopting the model and improving the service delivery. [from abstract]

Where Have They Gone? Using ICT to Address Health Worker Absenteeism in India

This 8 minute video highlights one solution to the problem of doctor absenteeism being deployed in the Karnataka region in southern India. When patients arrive at a primary health clinic and the doctor is absent, they can use their phones to text a central location which will record this data to allow the government to track and citizens to see which clinics are chronically understaffed. [from publisher]

Holding Health Workers Accountable: Governance Approaches to Reducing Absenteeism

This technical brief looks at the cost of absenteeism, examines governance issues, describes the various stakeholders, and offers a number of recommendations for strengthening governance to reduce absenteeism. [from publisher]

Struggling and Coping to Serve: The Zambian Health Workforce as Depicted in the Public Expenditure Tracking and Quality of Service Delivery Survey

This paper reports the findings of the Zambian study pertaining to human resources for health, including issues with high staff vacancies, high rates of absenteeism and tardiness, impact on patients and the coping mechanisms health workers are employing to augment their incomes. [adapted from summary]

Are You Moonlighting? Using an Item Count Technique to Measure the Prevalence of Dual Job Practice in the Health Sector: A Case Study from Benin

This presentation on moonlighting in the health sector in Benin presents the results of a study which measured the extent of dual job practice in the health sector. [adapted from author]

Is There a Doctor in the House? Medical Worker Absence in India

The authors present data from a nationally representative all-India survey which enumerators physically verify the attendance of providers during unannounced visits, and found that nearly 40% of doctors and medical service providers are absent from work on a typical day. [from abstract]

Valuing Health Workers in Cambodia

The objectives of the research are to come to a better understanding of why health workers adopt behaviours that impact negatively on patients and to look for solutions in policy and practice to improve staff motivation and morale. [from author]

Perceptions of Per Diem in the Health Sector: Evidence and Implications

This study details the perceived benefits, problems, and risks of abuse of per diems and allowances in developing countries. Drawing on 41 interviews with government and nongovernmental officials in Malawi and Uganda the report highlights how practices to maximize per diems have become a defining characteristic of many public institutions and influence how employees carry out their work. As per diems have become de facto top ups of salaries, more fundamental reform of health worker incentives and payment is also needed. [from abstract]

Missing in Action: Teacher and Health Worker Absence in Developing Countries

This paper reports results from surveys in which enumerators made unannounced visits to primary schools and health clinics in Bangladesh, Ecuador, India, Indonesia, Peru, and Uganda and recorded whether they found teachers and health workers in the facilities. Averaging across the countries, about 35 percent of health workers were absent. [from author]

Absenteeism of Health Care Providers in Machakos District, Kenya

This policy brief highlights results from unannounced visits made to a sample of public health facilities in Machakos District with the intention of documenting the proportion of critical health care workers who were absent from their stations of operation. It also presents policy options to address the problem of absenteeism of critical health providers in the health sector. [from author]

Getting by on Credit: How District Health Managers in Ghana Cope with the Untimely Release of Funds

District health systems in Africa depend largely on public funding. In many countries, not only are these funds insufficient, but they are also released in an untimely fashion, thereby creating serious cash flow problems for district health managers. This paper examines how the untimely release of public sector health funds in Ghana affects district health activities and the way district managers cope with the situation. [from abstract]

Performance of Health Workers in Ethiopia: Results from Qualitative Research

Insufficient attention has been paid to understanding what determines the performance of health workers and how they make labor market choices. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia. We describe performance problems identified by both health users and health workers participating in the focus group discussions including absenteeism and shirking, pilfering drugs and materials, informal health care provision and illicit charging, and corruption.

Vietnamese-Born Health Professionals: Negotiating Work and Life in Rural Australia

The two main objectives of this study were to examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse and identify key coping strategies used by them when in working in the rural context. [from abstract]

Inter-Country Comparison of Unofficial Payments: Results of a Health Sector Social Audit in the Baltic States

This article presents the results of a 2002 social audit of the health sector of three Baltic States. Comparisons were made of perceptions, attitudes and experience regarding unofficial payments in the health services of Estonia, Latvia and Lithuania. The findings can serve as a baseline for interventions and to compare each country’s approach to health service reform in relation to unofficial payments. [adapted from abstract]

Public Sector Doctors with Second Jobs

It is common for doctors working in the public sector to hold second jobs in private practice. Dual medical practice occurs in virtually all countries regardless of income. [author’s description]

Pilfering for Survival: How Health Workers Use Access to Drugs as a Coping Strategy

Coping strategies have, in some countries, become so prevalent that it has been widely assumed that the very notion of civil services ethos has completely – and possibly irreversibly – disappeared. This paper describes the importance and the nature of pilfering of drugs by health staff in Mozambique and Cape Verde, as perceived by health professionals from these countries. Their opinions provide pointers as to how to tackle these problems. [from abstract]

Reincentivizing: a New Theory on Work and Work Absence

Work capacity correlates weakly to disease concepts, which in turn are insufficient to explain sick leave behavior. With data mainly from Sweden, a welfare state with high sickness absence rates, our aim was to develop an explanatory theory of how to understand and deal with work absence and sick leave. In this paper we present a theory of work incentives and how to deal with work absence. [from abstract]

Providing Health Care Under Adverse Conditions: Health Personnel Performance and Individual Coping Strategies

This resulted in a collection of papers with very different viewpoints and formats, reflecting the different professional and geographical backgrounds of the participants. First a set of papers describes the performance of health personnel in a number of countries and attempts to improve it. A second part looks more closely at the various coping strategies health care workers, medical and paramedical, clinical and managerial, actually apply to deal with difficult working and living conditions.

Role of Regulation in Influencing Income-Generating Activities Among Public Sector Doctors in Peru

The objective of this article is to examine in Peru the nature of dual practice (doctors holding two jobs at once - usually public sector doctors with private practices), the factors that influence individuals decisions to undertake dual practice, the conditions faced when doing so and the potential role of regulatory intervention in this area. [from abstract]

Findings of the Egyptian Health Care Provider Survey

This report presents results from the Egypt Health Care Providers Surveys, the objectives of which were to: provide a comprehensive picture of all sources of health care services; provide policy relevant data on critical issues for health sector reform; and create a database on health care providers for use by the Ministry of Health and Population in developing policy reform proposals. Five separate surveys were conducted on health care institutions, private clinics, pharmacies, dayas (traditional birth attendants), and other practitioners. The sample of 10,048 providers was developed from a complete enumeration of all health care providers in sampling areas and data from the 1986 national census.

How and Why Public Sector Doctors Engage in Private Practice in Potuguese-Speaking African Countries

The objective of this article is to explore the type of private practice supplementary income-generating activities of public sector doctors in the Portuguese-speaking African countries, and also to discover the motivations and the reasons why doctors have not made a complete move out of public services. [objective]

How are Health Professionals Earning Their Living in Malawi?

The migration of health professionals from southern Africa to developed nations is negatively affecting the delivery of health care services in the source countries. Oftentimes however, it is the reasons for the out-migration that have been described in the literature. The work and domestic situations of those health professionals continuing to serve in their posts have not been adequately studied. The present study utilized a qualitative data collection and analysis method. This was achieved through focus group discussions and in-depth interviews with health professionals and administrators to determine the challenges they face and the coping systems they resort to and the perceptions towards those coping methods. [author’s description]

How to Monitor and Address Absenteeism in District Hospitals

Many health service managers are familiar with the problem of absenteeism in district hospitals. It affects the running of the hospital and can seriously compromise the quality of care which patients receive. For the purpose of this Kwik-Skwiz absenteeism is defined as staff taking time off that has not been scheduled or staff taking more leave than is necessary or reasonable. Clearly there are many legitimate reasons for taking sick or other types of leave. It is often debatable how much leave is reasonable. It often depends on the pattern and circumstances, rather than the actual total amount of leave that an individual takes. Managers have a responsibility to balance the rights and needs of individual staff members, with the needs of the hospital. High levels of absenteeism, both on the part of individuals or in the whole hospital, are often symptomatic of underlying problems. Addressing these issues can result in lower absenteeism levels that benefits staff, managers and patients. [author’s description]

Survival and Retention Strategies for Malawian Health Professionals

The broad objective of this paper is to contribute to the retention of health workers in Malawi by providing an enhanced understanding of health workers’ coping strategies, together with the identification of possible strategies that could impact on their retention. [from author]

Dual Practice of Public Sector Health Care Providers in Peru

To explore the extent, characteristics, incentives, effects and possible regulation of private medical practice in public facilities this study undertook a cross sectional quantitative

Dual Practice by Public Health Providers in Shandong and Sichuan Provinces, China

There are four types of health providers at present in China. These are defined in terms of differences in ownership. Private practice in the health sector was reintroduced from 1980, when China began its economic reform from a planned economy to a market economy. Dual practice (DP) is quite common and a major concern from the point of view of health policy-making as little is known about it. The aim of this study was to describe policies and regulations of DP, the current situation, its impact on access to services and physician behaviour, and to provide evidence for future policy decisions.