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The Performance of Health Workers in Ethiopia Results from Qualitative Research

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  • Magnus Lindelow
  • Pieter Serneels
  • Teigist Lemma

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. 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. In the second part of the paper we present four structural reasons why these problems arise: (i) the ongoing transition from health sector dominated by the public sector, towards a more mixed model; (ii) the failure of government policies to keep pace with the transition towards a mixed model of service delivery; (iii) weak accountability mechanisms and the erosion of professional norms in the health sector; and (iv) 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.

Suggested Citation

  • 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.
  • Handle: RePEc:csa:wpaper:2005-06
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    References listed on IDEAS

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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. 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.
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    4. 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.
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    Citations

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    Cited by:

    1. 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.
    2. Mæstad, Ottar & Mwisongo, Aziza, 2011. "Informal payments and the quality of health care: Mechanisms revealed by Tanzanian health workers," Health Policy, Elsevier, vol. 99(2), pages 107-115, February.
    3. Marito Garcia & Andrew Sunil Rajkumar, 2008. "Achieving Better Service Delivery through Decentralization in Ethiopia," World Bank Publications, The World Bank, number 6362, August.
    4. Abigail Barr & Jose Garcia-Montalvo & Magnus Lindelow & Pieter Serneels, 2005. "Strategy choice and cognitive ability in field experiments," Framed Field Experiments 00113, The Field Experiments Website.
    5. 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.
    6. 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, August.
    7. repec:eee:jhecon:v:58:y:2018:i:c:p:188-201 is not listed on IDEAS
    8. Jones, Caroline & Abeku, Tarekegn A. & Rapuoda, Beth & Okia, Michael & Cox, Jonathan, 2008. "District-based malaria epidemic early warning systems in East Africa: Perceptions of acceptability and usefulness among key staff at health facility, district and central levels," Social Science & Medicine, Elsevier, vol. 67(2), pages 292-300, July.
    9. 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.
    10. Jayasuriya, Rohan & Jayasinghe, Upali W. & Wang, Qian, 2014. "Health worker performance in rural health organizations in low- and middle-income countries: Do organizational factors predict non-task performance?," Social Science & Medicine, Elsevier, vol. 113(C), pages 1-4.
    11. 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.
    12. Atsede D. Tegegne & Marianne Penker & Maria Wurzinger, 2016. "Participatory Demographic Scenarios Addressing Uncertainty and Transformative Change in Ethiopia," Systemic Practice and Action Research, Springer, vol. 29(3), pages 277-296, June.
    13. 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, August.
    14. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
    15. Pitchforth, Emma & Lilford, Richard J. & Kebede, Yigzaw & Asres, Getahun & Stanford, Charlotte & Frost, Jodie, 2010. "Assessing and understanding quality of care in a labour ward: A pilot study combining clinical and social science perspectives in Gondar, Ethiopia," Social Science & Medicine, Elsevier, vol. 71(10), pages 1739-1748, November.
    16. 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.
    17. Richard Andrew Iles, 2013. "Demand for primary healthcare in rural north India," 2013 Papers pil50, Job Market Papers.

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