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84 Fighting the Diseases of Poverty
data, and measurements vary, as do level of provider, number of
observations within each provider unit and location. Chaudhury, et
al., (2004) use a single surprise visit to a nationally representative
sample of rural clinics in 5 countries; Banerjee, Deaton and Duflo
(2004) tracked absences in 143 government facilities in Udaipar
district in Rajasthan, India based on weekly visits over 18 months;
Lewis, LaForgia and Sulvetta (1996) used time and motion studies
during a two weeks period to track health provider attendance in a
single hospital in Santo Domingo, Dominican Republic; and, McPake
et al. (1999) directly observed clinics in 10 rural districts in Uganda
over the course of one week. Thus the reported absences are
captured using different time frames, samples and providers.
Absenteeism rates, measured in these particular studies, range
from a low in Mozambique and Papua New Guinea of 19 per cent to
over 60 per cent among physicians in a Dominican hospital, in rural
Bangladesh and Uganda, but cluster around 35–40 per cent for the
others. These results suggest a serious gap in health service
coverage due to absent staff, levels considerably above those from
similar studies in the same countries for teachers (Chaudhury et al.,
2004). As in Figure 2, these results rely on different types of surveys
over varying time periods and for a variety of services. What is noteworthy
are the range of methods, the lack of consistency and the
need to establish acceptable and regular means for tracking staff
absenteeism. Otherwise it will remain an ad hoc approach.
Lewis, La Forgia and Sulvetta’s (1992; 1996) time and motion
studies in inpatient, outpatient, surgery and emergency found that
not only did physicians only provide 12 per cent of contracted time,
nurses provided virtually no care outside of inpatient services, and
staff physicians, residents and interns provided only 7, 4, and 8 per
cent of their contracted time, respectively. As found in Uganda (see
below), absenteeism was lowest during the early morning hours
and in the outpatient department. In the DR, surgery was only conducted
before noon during the availability of surgeons, leaving the
facility idle for the remainder of the 24 hour day. Interns, residents
and auxiliary nurses received virtually no supervision from staff