Informal economic activities of public health workers in Uganda: implications for quality and accessibility of care
AbstractThis paper reports the results of a study in Uganda of the 'informal' economic activities of health workers, defined as those which earn incomes but fall outside official duties and earnings. The study was carried out in 10 sub-hospital health facilities of varying size and intended role and used a variety of quantitative and qualitative methods. The paper focuses on those activities which are carried out inside public health facilities and which directly affect quality and accessibility of care. The main strategies in this category were the leakage of drug supply, the informal charging of patients and the mismanagement of revenues raised from the formal charging of patients. Few of the drugs supplied to health units were prescribed and issued in those sites. Most health workers who have the opportunity to do so, levy informal charges. Where formal charges are collected, high levels of leakage occur both at the point of collection and at higher levels of the system. The implications of this situation for the quality and accessibility of services in public health facilities were assessed. Utilisation levels are less than those expected of the smallest rural units and this workload is managed by a handful of the expected staff complement who are available for a fraction of the working week. Even given these few patients, drugs available after leakage were sufficient to cover less than half of those attending in most facilities. Evidence on staff motivation was mixed and better motivation was associated with better performance only in a minority of units. Informal charging was associated with better performance regarding hours worked by health workers and utilisation rates. Drug leakage was associated with worse performance with respect to both of these and unsurprisingly, with drug availability. Short term strategies to effect marginal performance improvements may focus on the substitution of strategies based inside health units (such as informal charging) for those based outside (facilitated by drug leakage). In the long term, only substantially higher funding of the sector can be expected to facilitate major change, but alone will be insufficient. Investment strategies supported by appropriate policy development has to be informed by understanding and monitoring of the 'informal' dimension of health sector activity.
Download InfoIf you experience problems downloading a file, check if you have the proper application to view it first. In case of further problems read the IDEAS help page. Note that these files are not on the IDEAS site. Please be patient as the files may be large.
Bibliographic InfoArticle provided by Elsevier in its journal Social Science & Medicine.
Volume (Year): 49 (1999)
Issue (Month): 7 (October)
Contact details of provider:
Web page: http://www.elsevier.com/wps/find/journaldescription.cws_home/315/description#description
You can help add them by filling out this form.
CitEc Project, subscribe to its RSS feed for this item.
- Pieter Serneels & Tomas Lievens, 2008.
"Institutions for Health Care Delivery: A Formal Exploration of What Matters to Health Workers Evidence from Rwanda,"
CSAE Working Paper Series
2008-29, Centre for the Study of African Economies, University of Oxford.
- Tomas Lievens & Pieter Serneels, 2008. "Institutions for Health Care Delivery A Formal Exploration of what Matters to Health Workers Evidence from Rwanda," Economics Series Working Papers WPS/2008-29, University of Oxford, Department of Economics.
- Abigail Barr & Magnus Lindelow & Pieter Serneels, 2004.
"To Serve The Community Or Oneself: The Public Servant'S Dilemma,"
Development and Comp Systems
- Abigail Barr & Magnus Lindelow, 2003. "To serve the community or oneself: the public servant`s dilemma," Economics Series Working Papers WPS/2003-11, University of Oxford, Department of Economics.
- Barr, Abigail & Lindelow, Magnus & Serneels, Pieter, 2004. "To serve the community or oneself - the public servant's dilemma," Policy Research Working Paper Series 3187, The World Bank.
- Abigail Barr & Magnus Lindelow & Pieter Serneels, 2003. "To serve the community or oneself: the public servant's dilemma," CSAE Working Paper Series 2003-11, Centre for the Study of African Economies, University of Oxford.
- Cherecheş, Răzvan M. & Ungureanu, Marius I. & Sandu, Petru & Rus, Ioana A., 2013. "Defining informal payments in healthcare: A systematic review," Health Policy, Elsevier, vol. 110(2), pages 105-114.
- Mokhtari, Manouchehr & Ashtari, Mamak, 2012. "Reducing informal payments in the health care system: Evidence from a large patient satisfaction survey," Journal of Asian Economics, Elsevier, vol. 23(2), pages 189-200.
- Hunt, Jennifer, 2007.
"Bribery in Health Care in Peru and Uganda,"
IZA Discussion Papers
2757, Institute for the Study of Labor (IZA).
- Jennifer Hunt, 2007. "Bribery in Health Care in Peru and Uganda," NBER Working Papers 13034, National Bureau of Economic Research, Inc.
- Hunt, Jennifer, 2007. "Bribery in Health Care in Peru and Uganda," CEPR Discussion Papers 6274, C.E.P.R. Discussion Papers.
- Jennifer Hunt, 2007. "Bribery In Health Care In Peru And Uganda," Departmental Working Papers 2007-02, McGill University, Department of Economics.
- Parkhurst, Justin Oliver & Penn-Kekana, Loveday & Blaauw, Duane & Balabanova, Dina & Danishevski, Kirill & Rahman, Syed Azizur & Onama, Virgil & Ssengooba, Freddie, 2005. "Health systems factors influencing maternal health services: a four-country comparison," Health Policy, Elsevier, vol. 73(2), pages 127-138, August.
- Eugen Dimant, 2013.
"The Nature of Corruption - An Interdisciplinary Perspective,"
70, University of Paderborn, CIE Center for International Economics.
- Dimant, Eugen, 2013. "The nature of corruption: An interdisciplinary perspective," Economics Discussion Papers 2013-59, Kiel Institute for the World Economy.
- Magnus Lindelow & Pieter Serneels & Teigist Lemma, 2005.
"The Performance of Health Workers in Ethiopia Results from Qualitative Research,"
CSAE Working Paper Series
2005-06, Centre for the Study of African Economies, University of Oxford.
- Lindelow, Magnus & Serneels, Pieter, 2006. "The performance of health workers in Ethiopia: Results from qualitative research," Social Science & Medicine, Elsevier, vol. 62(9), pages 2225-2235, May.
- Pieter Serneels, 2005. "The Performance of Health Workers in Ethiopia,Results from Qualitative Research," Economics Series Working Papers WPS/2005-06, University of Oxford, Department of Economics.
- Lindelow, Magnus & Serneels, Pieter & Lemma, Teigist, 2005. "The performance of health workers in Ethiopia - results from qualitative research," Policy Research Working Paper Series 3558, The World Bank.
- Hunt, Jennifer, 2010. "Bribery in health care in Uganda," Journal of Health Economics, Elsevier, vol. 29(5), pages 699-707, September.
- Tomini, Sonila & Groot, Wim, 2012. "Paying informally for public health care in Albania: scarce resources or governance failure?," MERIT Working Papers 070, United Nations University - Maastricht Economic and Social Research Institute on Innovation and Technology (MERIT).
- Onwujekwe, Obinna & Dike, Nkem & Uzochukwu, Benjamin & Ezeoke, Ogochukwu, 2010. "Informal payments for healthcare: Differences in expenditures from consumers and providers perspectives for treatment of malaria in Nigeria," Health Policy, Elsevier, vol. 96(1), pages 72-79, June.
- Tomini, Sonila & Groot, Wim, 2012. "Paying informally for public health care in Albania: scarce resources or governance failure?," UNU-MERIT Working Paper Series 070, United Nations University, Maastricht Economic and social Research and training centre on Innovation and Technology.
- Kaitelidou, Daphne Ch. & Tsirona, Christina S. & Galanis, Petros A. & Siskou, Olga Ch. & Mladovsky, Philipa & Kouli, Eugenia G. & Prezerakos, Panagiotis E. & Theodorou, Mamas & Sourtzi, Panagiota A. &, 2013. "Informal payments for maternity health services in public hospitals in Greece," Health Policy, Elsevier, vol. 109(1), pages 23-30.
- Abigail Barr & Magnus Lindelow, 2005. "Intrinsic motivations on the development frontline: Do they exist? Do they endure?," Economics Series Working Papers GPRG-WPS-033, University of Oxford, Department of Economics.
For technical questions regarding this item, or to correct its authors, title, abstract, bibliographic or download information, contact: (Zhang, Lei).
If references are entirely missing, you can add them using this form.