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The performance of health workers in Ethiopia - results from qualitative research

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  • Lindelow, Magnus
  • Serneels, Pieter
  • Lemma, Teigist

Abstract

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, a country with some of the poorest health outcomes in the world. It describes 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. The second part of the paper presents four structural reasons why these problems arise: (1) the ongoing transition from a health sector dominated by the public sector, toward a more mixed model; (2) the failure of government policies to keep pace with the transition toward a mixed model of service delivery; (3) weak accountability mechanisms and the erosion of professional norms in the health sector; and (4) the impact of HIV/AIDS. The discussions underline the need to base policies on a micro-analysis of how health workers make constrained choices, both in their career and in their day to day professional activities.

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Bibliographic Info

Paper provided by The World Bank in its series Policy Research Working Paper Series with number 3558.

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Date of creation: 01 Apr 2005
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Handle: RePEc:wbk:wbrwps:3558

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Keywords: Health Monitoring&Evaluation; Health Systems Development&Reform; Agricultural Knowledge&Information Systems; Housing&Human Habitats; Health Economics&Finance;

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  1. Franco, Lynne Miller & Bennett, Sara & Kanfer, Ruth, 2002. "Health sector reform and public sector health worker motivation: a conceptual framework," Social Science & Medicine, Elsevier, vol. 54(8), pages 1255-1266, April.
  2. Ensor, Tim, 2004. "Informal payments for health care in transition economies," Social Science & Medicine, Elsevier, vol. 58(2), pages 237-246, January.
  3. Belli, Paolo & Gotsadze, George & Shahriari, Helen, 2004. "Out-of-pocket and informal payments in health sector: evidence from Georgia," Health Policy, Elsevier, vol. 70(1), pages 109-123, October.
  4. Ensor, Tim & Witter, Sophie, 2001. "Health economics in low income countries: adapting to the reality of the unofficial economy," Health Policy, Elsevier, vol. 57(1), pages 1-13, July.
  5. McPake, Barbara & Asiimwe, Delius & Mwesigye, Francis & Ofumbi, Mathias & Ortenblad, Lisbeth & Streefland, Pieter & Turinde, Asaph, 1999. "Informal economic activities of public health workers in Uganda: implications for quality and accessibility of care," Social Science & Medicine, Elsevier, vol. 49(7), pages 849-865, October.
  6. Yach, Derek, 1992. "The use and value of qualitative methods in health research in developing countries," Social Science & Medicine, Elsevier, vol. 35(4), pages 603-612, August.
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Citations

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Cited by:
  1. Leonard, Kenneth L., 2009. "The cost of imperfect agency in health care: Evidence from rural Cameroun," Journal of Development Economics, Elsevier, vol. 88(2), pages 282-291, March.
  2. Juan Camilo Cardenas & Rajiv Sethi, 2010. "Resource Allocation in Public Agencies: Experimental Evidence," Journal of Public Economic Theory, Association for Public Economic Theory, vol. 12(4), pages 815-836, 08.
  3. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
  4. Marito Garcia & Andrew Sunil Rajkumar, 2008. "Achieving Better Service Delivery through Decentralization in Ethiopia," World Bank Publications, The World Bank, number 6362.
  5. Abigail Barr & Magnus Lindelow, 2005. "Strategy Choice and Cognitive Ability in Field Experiments," Economics Series Working Papers GPRG-WPS-034, University of Oxford, Department of Economics.
  6. Richard Andrew Iles, 2013. "Demand for primary healthcare in rural north India," 2013 Papers pil50, Job Market Papers.
  7. Danila Serra & Pieter Serneels & Magnus Lindelow & Jose G. Montalvo, 2010. "Discovering the Real World : Health Workers' Career Choices and Early Work Experience in Ethiopia," World Bank Publications, The World Bank, number 5936.
  8. Barr, Abigail & Lindelow, Magnus & Serneels, Pieter, 2009. "Corruption in public service delivery: An experimental analysis," Journal of Economic Behavior & Organization, Elsevier, vol. 72(1), pages 225-239, October.
  9. Pieter Serneels & Abigail Barr, 2005. "Understanding Geographical Imbalances in the Health Workforce," Economics Series Working Papers GPRG-WPS-018, University of Oxford, Department of Economics.
  10. 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.
  11. Pieter Serneels & Magnus Lindelow & José Garcia Montalvo & Abigail Barr, 2006. "For public service or money: Understanding geographical imbalances in the health workforce in Ethiopia," Economics Working Papers 989, Department of Economics and Business, Universitat Pompeu Fabra.
  12. 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.

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