Coping Strategies

This study examined the coping mechanisms of health workers in the public health sector of Nasarawa and Ondo states in Nigeria to supplement their salaries and benefits; it also estimated the proportionate value of the revenues from those coping mechanisms in relation to the health workers’ official incomes. [from abstract]

This paper reports the findings of the Zambian study pertaining to human resources for health, including issues with high staff vacancies, high rates of absenteeism and tardiness, impact on patients and the coping mechanisms health workers are employing to augment their incomes. [adapted from summary]

The objectives of the research are to come to a better understanding of why health workers adopt behaviours that impact negatively on patients and to look for solutions in policy and practice to improve staff motivation and morale. [from author]

This study details the perceived benefits, problems, and risks of abuse of per diems and allowances in developing countries. Drawing on 41 interviews with government and nongovernmental officials in Malawi and Uganda the report highlights how practices to maximize per diems have become a defining characteristic of many public institutions and influence how employees carry out their work. As per diems have become de facto top ups of salaries, more fundamental reform of health worker incentives and payment is also needed. [from abstract]

District health systems in Africa depend largely on public funding. In many countries, not only are these funds insufficient, but they are also released in an untimely fashion, thereby creating serious cash flow problems for district health managers. This paper examines how the untimely release of public sector health funds in Ghana affects district health activities and the way district managers cope with the situation. [from abstract]

Insufficient attention has been paid to understanding what determines the performance of health workers and how they make labor market choices. This paper reports on findings from focus group discussions with both health workers and users of health services in Ethiopia. We describe performance problems identified by both health users and health workers participating in the focus group discussions including absenteeism and shirking, pilfering drugs and materials, informal health care provision and illicit charging, and corruption.

The two main objectives of this study were to examine aspects of the acculturation of overseas-born and Australian-trained health professionals in the Australian health discourse and identify key coping strategies used by them when in working in the rural context. [from abstract]

This article presents the results of a 2002 social audit of the health sector of three Baltic States. Comparisons were made of perceptions, attitudes and experience regarding unofficial payments in the health services of Estonia, Latvia and Lithuania. The findings can serve as a baseline for interventions and to compare each country’s approach to health service reform in relation to unofficial payments. [adapted from abstract]

Coping strategies have, in some countries, become so prevalent that it has been widely assumed that the very notion of civil services ethos has completely – and possibly irreversibly – disappeared. This paper describes the importance and the nature of pilfering of drugs by health staff in Mozambique and Cape Verde, as perceived by health professionals from these countries. Their opinions provide pointers as to how to tackle these problems. [from abstract]

This resulted in a collection of papers with very different viewpoints and formats, reflecting the different professional and geographical backgrounds of the participants. First a set of papers describes the performance of health personnel in a number of countries and attempts to improve it. A second part looks more closely at the various coping strategies health care workers, medical and paramedical, clinical and managerial, actually apply to deal with difficult working and living conditions.

This report presents results from the Egypt Health Care Providers Surveys, the objectives of which were to: provide a comprehensive picture of all sources of health care services; provide policy relevant data on critical issues for health sector reform; and create a database on health care providers for use by the Ministry of Health and Population in developing policy reform proposals. Five separate surveys were conducted on health care institutions, private clinics, pharmacies, dayas (traditional birth attendants), and other practitioners. The sample of 10,048 providers was developed from a complete enumeration of all health care providers in sampling areas and data from the 1986 national census.

The migration of health professionals from southern Africa to developed nations is negatively affecting the delivery of health care services in the source countries. Oftentimes however, it is the reasons for the out-migration that have been described in the literature. The work and domestic situations of those health professionals continuing to serve in their posts have not been adequately studied. The present study utilized a qualitative data collection and analysis method. This was achieved through focus group discussions and in-depth interviews with health professionals and administrators to determine the challenges they face and the coping systems they resort to and the perceptions towards those coping methods. [author’s description]

The broad objective of this paper is to contribute to the retention of health workers in Malawi by providing an enhanced understanding of health workers’ coping strategies, together with the identification of possible strategies that could impact on their retention. [from author]

Health sector workers respond to inadequate salaries and working conditions by developing various individual coping strategies; some, but not all, of which are of a predatory nature. The paper reviews what is known about these practices and their potential consequences (competition for time, brain drain and conflicts of interest).

This paper reports on income generation practices among civil servants in the health sector, with a particular emphasis on dual practice. It first approaches the subject of public-private overlap. Thereafter it focuses on coping strategies in general and then on dual practice in particular. In this paper dual practice is approached from six different perspectives: what is meant by dual practice; typology of dual practices; prevalence; impact on personal income, the health care system and health status; reasons; and possible interventions. [adapted from author]

The Chinese government has found it impossible to maintain uniform pay levels, particularly in the face of a radical devolution of its own financial management. Health workers have increasingly resorted to informal methods of earning an income. The government considers this to be unprofessional behavior and has used a combination of moral pressure and loss of professional privileges to discourage it.