Full text PDF - International Policy Network

Corruption in public health 85
physicians and nurses. The resulting services were under-staffed
and reliant on untrained providers with virtually no supervision.
The abuses translated into high costs for the public sector with little
output, and undermined the quality of health care across the board
by relying on ill-trained providers for care and under investing in
the quality of future providers.
Residents and auxiliary nurses received virtually no supervision
from staff physicians and nurses. The resulting services were understaffed
and reliant on untrained providers with virtually no supervision.
The abuses translated into high costs for the public sector
with little output, and undermined the quality of health care across
the board by relying on ill-trained providers for care and under
investing in the quality of future providers.
McPake et al., (1999) recorded attendance and clinic openings.
Clinics only remained open for 2–3 hours in the morning with
partial coverage by health staff, often on a rotating basis. Doctors,
medical assistance, midwives and nurses were available for an
average of 12.9 hours per week while nursing aides, dressers and
pharmacy orderlies worked an average of 18.5 hours. The latter
group of lower level health workers provided 71 per cent of total
available hours of staff at the clinics compromising quality as well
as coverage. These estimates ignore the “ghost” workers who never
attend the facility, suggesting that the average attendance of contracted
staff is even lower than the estimates.
Chaudhury and Hammer’s (2004) study of absenteeism in rural
health clinics in Bangladesh recorded availability of doctors and
paramedics of filled positions. 4 On average 35 per cent of staff and
42 per cent of physicians were absent across the 60 clinics visited.
In eamining clinics by location, absenteeism in the most rural areas
was 74 per cent for doctors. Subsequent multivariate analysis
showed that living outside the service village, being female and
poor road access increased the likelihood of absenteeism among
physicians. Absenteeism was associated with clinics in disrepair as
well as with lower patient demand, suggesting that absenteeism
compromises quality and quantity of services.