Dual job holding by public sector health professionals in highly resource-constrained settings : problem or solution?

• Published in: Bulletin of the World Health Organization 2005-10, Vol.83 (10), p.771-776
• Main Authors: JAN, Stephen, YING BIAN, JUMPA, Manuel, QINGYUE MENG, NYAZEMA, Norman, PRAKONGSAI, Phusit, MILLS, Anne
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Career Mobility; Civil service; Compensation and benefits; Developing Countries; Finance; General aspects; Health aspects; Health manpower; Health Manpower - legislation & jurisprudence; Health Personnel; Health Policy; Health Policy & Services; Health Services Accessibility; Humans; Incentive plans; Laws, regulations and rules; LDCs; Low income groups; Medical personnel; Medical profession; Medical sciences; Medical sector; Medical service; Miscellaneous; Motivation; Patients; Physician incentive plans; Physician's practice patterns; Physicians; Private sector; Professional practice; Professionals; Public employees; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Public Sector; Quality assurance, Health care; Quality of Health Care; Quality of service; Regulation; Supplementary employment
• ISSN: 0042-9686; 1564-0604
• DOI: 10.1590/S0042-96862005001000014

This paper examines the policy options for the regulation of dual job holding by medical professionals in highly resource-constrained settings. Such activity is generally driven by a lack of resources in the public sector and low pay, and has been associated with the unauthorized use of public resources and corruption. It is also typically poorly regulated; regulations are either lacking, or when they exist, are vague or poorly implemented because of low regulatory capacity. This paper draws on the limited evidence available on this topic to assess a number of regulatory options in relation to the objectives of quality of care and access to services, as well as some of the policy constraints that can undermine implementation in resource-poor settings. The approach taken in highlighting these broader social objectives seeks to avoid the value judgements regarding dual working and some of its associated forms of behaviour that have tended to characterize previous analyses. Dual practice is viewed as a possible system solution to issues such as limited public sector resources (and incomes), low regulatory capacity and the interplay between market forces and human resources. This paper therefore offers some support for policies that allow for the official recognition of such activity and embrace a degree of professional self-regulation. In providing clearer policy guidance, future research in this area needs to adopt a more evaluative approach than that which has been used to date.