Research report. How and why public sector doctors engage in private practice in Portuguese-speaking African countries

Ferrinho, Paulo; Lerberghe, Wim Van; Julien, Manuel Romano; Fresta, E; Gomes, Aurelio; Dias, Francisco; Gonçalves, Aldina; Bäckström, Bárbara

doi:10.1093/heapol/13.3.332

Cited by 64 publications

(50 citation statements)

References 3 publications

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“…Case studies suggest that such factors may affect service delivery performance Van Lerberghe, 2000, 2002;Ferrinho et al, 1998;Tendler, 1997). However, case studies cannot support formal tests of hypotheses and are not replicable.…”

Section: Page 5 Of 38mentioning

confidence: 99%

Corruption in public service delivery: An experimental analysis

Barr

Lindelöw

Serneels

2009

Journal of Economic Behavior & Organization

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Abstract2 : To improve our understanding of corruption in service delivery, we use a newly designed game that allows us to investigate the effects of the institutional environment on the behavior of service providers and their monitors. We focus on the effect of four different factors: whether monitors are accountable to the service recipients, the degree of observability of service providers' effort, the providers' wages and the providers' professional norms. In accordance with theory, we find that service providers perform better when monitors are elected by service recipients and when their effort is more easily observed. However, there is only weak evidence that service providers perform better when paid more. Monitors are more vigilant when elected and when service providers are paid more. Playing the game with Ethiopian nursing students, we also find that those with greater exposure to the Ethiopian public health sector perform less well, either as provider or as monitor, when the experiment is framed as a public health provision scenario, suggesting that experience and norms affect behavior.

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Section: Page 5 Of 38mentioning

confidence: 99%

Corruption in public service delivery: An experimental analysis

Barr

Lindelöw

Serneels

2009

Journal of Economic Behavior & Organization

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“…Public health workers, especially in poorer countries, experienced catastrophic falls in the real value of their salaries in the 1980s and 1990s, to a point where their public income could cover only a small fraction of household needs (Noormahomed and Segall, 1994;Ferrinho et al, 1998). Not surprisingly this loss of income resulted in widespread demoralization, demotivation and cynicism among health personnel and a variety of undesirable practices followed, including charging patients underthe-table fees, stealing public service drugs and equipment, and moonlighting during working hours to practise privately or to follow other commercial activities.…”

Section: The Health Worker Is the Keymentioning

confidence: 99%

District health systems in a neoliberal world: a review of five key policy areas

Segall

2003

Int. J. Health Plann. Mgmt.

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SUMMARYDistrict health systems, comprising primary health care and first referral hospitals, are key to the delivery of basic health services in developing countries. They should be prioritized in resource allocation and in the building of management and service capacity.The relegation in the World Health Report 2000 of primary health care to a 'second generation' reform-to be superseded by third generation reforms with a market orientationflows from an analysis that is historically flawed and ideologically biased. Primary health care has struggled against economic crisis and adjustment and a neoliberal ideology often averse to its principles. To ascribe failures of primary health care to a weakness in policy design, when the political economy has starved it of resources, is to blame the victim.Improvement in the working and living conditions of health workers is a precondition for the effective delivery of public health services. A multidimensional programme of health worker rehabilitation should be developed as the foundation for health service recovery.District health systems can and should be financed (at least mainly) from public funds. Although in certain situations user fees have improved the quality and increased the utilization of primary care services, direct charges deter health care use by the poor and can result in further impoverishment. Direct user fees should be replaced progressively by increased public finance and, where possible, by prepayment schemes based on principles of social health insurance with public subsidization.Priority setting should be driven mainly by the objective to achieve equity in health and wellbeing outcomes. Cost effectiveness should enter into the selection of treatments for people (productive efficiency), but not into the selection of people for treatment (allocative efficiency).Decentralization is likely to be advantageous in most health systems, although the exact form(s) should be selected with care and implementation should be phased in after adequate preparation. The public health service should usually play the lead provider role in district health systems, but non-government providers can be contracted if needed. There is little or no evidence to support proactive privatization, marketization or provider competition. Democratization of political and popular involvement in health enhances the benefits of decentralization and community participation.Integrated district health systems are the means by which specific health programmes can best be delivered in the context of overall health care needs. International assistance should address communicable disease control priorities in ways that strengthen local health systems and do not undermine them. The Global Fund to Fight AIDS, Tuberculosis and Malaria should not repeat the mistakes of the mass compaigns of past decades. In particular, it should not set programme targets that are driven by an international agenda and which are achievable only at the cost of an adverse impact on sustainable health systems. Above al...

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“…Wages affect job and life satisfaction, employment, and working conditions as well as retention, attrition, or migration of professionals within and across countries. Wages are commonly perceived as a key factor affecting job satisfaction and migration of healthcare professionals within and across countries [1][2][3][4]. Wages are a main component of labor costs, which in turn determine local or regional health workforce composition decisions.…”

Section: Introductionmentioning

confidence: 99%