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108 Fighting the Diseases of Poverty
Svensson, 2003). In Honduras 2.4 per cent of staff were “ghost”
workers and 5 per cent of staff had unilaterally moved to other locations
(World Bank, 2001f).
Poor recordkeeping capacity and failures to require acceptable
reports in Mozambique (Lindelow, Ward and Zorzi, 2004) undermined
health care delivery and regular availability of inputs. In
Nigeria, existing management information systems were deemed
ineffective due to complicated and obscure reporting requirements,
incomplete record keeping and low capacity (World Bank, forthcoming).
Drug management in Costa Rica, a well run middle income
country, exhibits particular weaknesses in logistics and distribution
attributed to flawed information systems and inadequate monitoring
(Cohen, 2002). Each of these represent deficient aspects of
recordkeeping that compromise efforts at management.
Poor management also appears to signal corruption in some
instances. In Bolivia multivariate analysis showed a significant association
between longer waiting time and corruption indicators
(Gatti, Gray-Molina and Klugman, 2003), and in the Philippines perceptions
of corruption in public health services discouraged use of
public facilities, particularly in poor communities (Azfar and Gurgur,
2001). Corruption no doubt is associated with bad management, the
question remains as to whether and how management flaws lead to
corruption.
This brief review does not do justice to the complexity of the
issue, and more attention to the problem of incentives and management
are warranted. Although a chronic weakness of health
systems, management is critical to performance and improved effectiveness.
Ensuring the availability of funds, hiring and deploying
staff, maintaining basic record systems, and tracking facility performance
are the basic ingredients for improving management and
overall health care delivery.
Policy options for promoting better governance
Improving governance poses an important challenge to govern-