Full text PDF - International Policy Network

Corruption in public health 107
problem in Turkey as they move to reform the health system (World
Bank, 2003c), and was at the heart of ineffective service delivery in
the Dominican Republic (La Forgia et al., 2004). Disincentives to
good performance often are due to rigid civil service rules that limit
promotion and pay differentials that could be used to reward
superior performance. At the same time low productivity or outright
abuses can go unnoticed (Lewis, LaForgia and Sulvetta. 1992).
Low wages also lead workers to seek additional employment
outside government. In Kogi State, Nigeria, 42 per cent of the staff
had not been paid their salaries for more than 6 months in the past
year (Das Gupta, Gauri and Khemani, 2003), converting staff into
virtual volunteers and eroding the credibility of the health system.
In addition to the Nigeria state, reports from Ethiopia, Mozambique
and Uganda (Lindelow, Serneels and Lemma, 2003; Lindelow, Ward
and Zorzi, 2003; Azfar and Gurgur, 2001) indicated that the need to
have additional sources of income effectively compromised
providers’ ability to carry out their public duties on the scale
intended. In qualitative surveys health workers said they missed
work or cut short their hours to devote time to other economic
activities. Another study in Nigeria showed that the greater the lag
in paying salaries the more likely health workers were to engage in
pharmaceutical sales and seek other employment in the private
sector (Khemani, 2004). Family survival therefore plays a role in
absenteeism and low productivity.
Evidence from a number of countries suggests that vague and
poorly understood policies, uneven recordkeeping and minimal use
of such information contribute to poor management. An assessment
in Nigeria found a low level of knowledge among Federal Ministry
of Health (FMOH) staff regarding standard procedures and regulations,
and current budget allocations. Moreover, current budgets
and expenditures did not correspond (World Bank, forthcoming). In
Uganda staff records were inadequate. At the facility level only 56
per cent of the staff are to be found in district records, but at the
district level there were an additional 109 staff (out of a total of 465)
who do not show up on facility rosters (Lindelow, Reinikka and