Negotiating markets for health: an exploration of physicians’ engagement in dual practice in three African capital cities

Abstract

Scarce evidence exists on the features, determinants and implications of physicians’ dual practice, especially in resource-poor settings. 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. Forty-eight semi-structured qualitative interviews were conducted in the three cities to understand features of the practice and the respective markets. A survey was carried out in a sample of 331 physicians to explore their characteristics and decisions to work in public and private sectors. Descriptive analysis and inferential statistics were employed to explore differences in physicians’ engagement in dual practice across the three locations. Different forms of dual practice were found to exist in the three cities, with public physicians engaging in private practice outside but also inside public facilities, in regulated as well as unregulated ways. Thirty-four per cent of the respondents indicated that they worked in public practice only, and 11% that they engaged exclusively in private practice. The remaining 55% indicated that they engaged in some form of dual practice, 31% ‘outside’ public facilities, 8% ‘inside’ and 16% both ‘outside’ and ‘inside’. Local health system governance and the structure of the markets for physician services were linked to the forms of dual practice found in each location, and to their prevalence. Our analysis suggests that physicians’ decisions to engage in dual practice are influenced by supply and demand factors, but also by how clearly separated public and private markets are. Where it is possible to provide little-regulated services within public infrastructure, less incentive seems to exist to engage in the formal private sector, with equity and efficiency implications for service provision. The study shows the value of analysing health markets to understand physicians’ engagement in professional activities, and contributes to an evidence base for its regulation.

Factors influencing time to diagnosis and treatment among pediatric oncology patients in Kenya

“…The lack of consistent availability of senior doctors also slows down the process as their opinion may be needed before treatment is started. [20][21] This study did not find a significant difference in the delays between the two genders. The sex of the child has been found not to influence diagnosis delay in different studies.…”

“…Dual physician practices and absenteeism could also be contributing factors. [20][21] Government should enforce policies to stop dual physician practices by raising government salaries and obligating doctors to work fulltime in public hospitals. Training on how to suspect and diagnose cancer among health-care workers could help to reduce the health-care system delay.…”

Analyzing Markets for Health Workers: Insights from Labor and Health Economics

“…Predictors of total income levels included age, time in practice, employment of own staff, and (negatively) employment in a primary health care facility. Russo et al (2013) (Praia, Cape Verde; Bissau, Guinea-Bissau; and Maputo, Mozambique) evaluate the factors associated with the decision to engage in dual practice and find significant associations with years as a physician, having a specialization, age, and period working outside the capital city.…”

“…Both Jumpa, Jan, and Mills (2007) and Russo et al (2013) identify categorization problems in different forms of private sector activity undertaken by public sector doctors, and the phenomenon of private sector activity within public sector premises. Russo et al (2013) conclude that where this option is available, it appears to limit dual practice in the form of private practice outside public sector premises, and is perhaps preferred because it removes the need to invest in separate private clinics.…”

“…Russo et al (2013) conclude that where this option is available, it appears to limit dual practice in the form of private practice outside public sector premises, and is perhaps preferred because it removes the need to invest in separate private clinics.…”