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86 Fighting the Diseases of Poverty
The studies in Uganda and Rajasthan, India added a search for
absent primary health care workers. Over the course of 18 months
Indian nurses were only to be found in villages served by the subcenter
12 per cent of the time, and all were assigned to staff the
clinic on a regular basis. The pattern of absences, and therefore
closure of facilities, followed no pattern meaning that patients’ likelihood
of finding a provider was unpredictable (Banerjee, Deaton
and Duflo, 2004). Health workers were often found at home in
Uganda, although some employees simply never attended the
facility and were designated as “ghost” workers (McPake et al.,
1999). The costs represented by absent staff are not insignificant
given the higher levels absenteeism, which are consistently higher
than those found in education.
Absenteeism based on perceptions provide some orders of magnitude
of nonattendance, but may be less objective than the
recorded observations or surprise visits discussed above. Nonetheless
they are instructive.
Absenteeism is considered the most serious corruption problem
in Colombia, but perception of absenteeism varies across the six
Latin American countries for which qualitative survey data are available
(Giedion, Morales and Acosta, 2001). Surveys of hospital nurses’
perceptions of the frequency of chronic absenteeism among doctors
reported rates of 98 per cent in Costa Rica, 30 per cent in Nicaragua,
38 per cent in Colombia (Giedion, Morales and Acosta, 2001) and
between 24–31 per cent across public and social security hospitals
in Argentina (Schargrodsky, Mera and Weinschelbaum, 2001). In
Peru estimates of hours absent from work ranged from 12 to 36
hours (Alc‡zar and Andrade, 2001) across the sampled hospitals.
Shaving off hours is more commonly reported than absent days in
all the Latin American country surveys. Late arrival and early departure
only represented 2–23 per cent of all absences in a four country
study (Uganda, Bangladesh, India and Indonesia) of medical personnel
based on surprise visits (Chaudhury, et al., 2004). The Colombia
case study above estimated that the cost of the lost time in the public
hospitals of Bogot‡ was equivalent to over US$1 million per year.