Conceptualizing the impacts of dual practice on the retention of public sector specialists - evidence from South Africa

Human Resources for Health

Lucy Gilson¹  John Ashmore² 

[1] Department of Global Health and Development, London School of Hygiene and Tropical Medicine, Keppel Street, London, England;Health Economics Unit, School of Public Health and Family Medicine, Falmouth Annex, Medical Campus, University of Cape Town, Observatory, Cape Town, South Africa

关键词: Health worker distribution;    Loyalty;    Migration;    Retention;    Public private mix;    Multiple job holding;   

Others  :  1133712
DOI  :  10.1186/1478-4491-13-3

 received in 2014-08-19, accepted in 2014-12-29,  发布年份 2015

【 摘 要 】

Background

‘Dual practice’, or multiple job holding, generally involves public sector-based health workers taking additional work in the private sector. This form of the practice is purported to help retain public health care workers in low and middle-income countries’ public sectors through additional wage incentives. There has been little conceptual or empirical development of the relationship between dual practice and retention.

Methods

This article helps begin to fill this gap, drawing on empirical evidence from a qualitative study focusing on South African specialists. Fifty-one repeat, in-depth interviews were carried out with 28 doctors (predominantly specialists) with more than one job, in one public and one private urban hospital.

Results

Findings suggest dual practice can impact both positively and negatively on specialists’ intention to stay in the public sector. This is through multiple conceptual channels including those previously identified in the literature such as dual practice acting as a ‘stepping stone’ to private practice by reducing migration costs. Dual practice can also lead specialists to re-evaluate how they compare public and private jobs, and to overworking which can expedite decisions on whether to stay in the public sector or leave. Numerous respondents undertook dual practice without official permission.

Conclusions

The idea that dual practice helps retain public specialists in South Africa may be overstated. Yet banning the practice may be ineffective, given many undertake it without permission in any case. Regulation should be better enforced to ensure dual practice is not abused. The conceptual framework developed in this article could form a basis for further qualitative and quantitative inquiry.

【 授权许可】

   
2015 Ashmore and Gilson; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Berman P, Cuizon D: Multiple public-private job holding of healthcare providers in developing countries: an exploration of theory and evidence. London: DFID Issues Paper; 2004.
• [2]Ferrinho P, Lerberghe WV, Fronteira I, Hipólito F, Biscaia A: Dual practice in the health sector: review of the evidence. Hum Resour Heal. 2004, 2:14. BioMed Central Full Text
• [3]Roenen C, Ferrinho P, Van Dormael M, Conceição MC, Van Lerberghe W: How African doctors make ends meet: an exploration. Trop Med Int Health. 1997, 2:127-35.
• [4]Garcia-Prado A, Gonzalez P: Policy and regulatory responses to dual practice in the health sector. Health Policy. 2007, 84:142-52.
• [5]Gruen R, Anwar R, Begum T, Killingsworth J, Normand C: Dual job holding practitioners in Bangladesh: an exploration. Soc Sci Med. 2002, 54:267-79.
• [6]Gupta N, Dal PM: Assessment of human resources for health using cross-national comparison of facility surveys in six countries. Hum Resour Heal. 2009, 7:268.
• [7]Jumpa M, Jan S, Mills A: Dual practice of public sector health care providers in Peru. Health Economics and Financing Programme (HEFP) working paper 06/03. London: London School of Hygiene and Tropical Medicine; 2003.
• [8]Jumpa M, Jan S, Mills A: The role of regulation in influencing income-generating activities among public sector doctors in Peru. Hum Resour Heal 2007, 5:2. BioMed Central Full Text
• [9]Kiwanuka S, Rutebemberwa E, Nalwadda C, Okui O, Sengooba F, Kinengyere A, et al.: Interventions to manage dual practice. Cochrane Database Syst Rev. 2011, 7:25.
• [10]Socha K, Bech M: Physician dual practice: a review of literature. Health Policy 2010. In Press, Corrected Proof
• [11]Ferrinho P, Van Lerberghe W, Julien M, Fresta E, Gomes A, Dias F, et al.: Research report. How and why public sector doctors engage in private practice in Portuguese-speaking African countries. Health Policy Plan 1998, 13:332-8.
• [12]Macq J, Ferrinho P, De Brouwere V, Van Lerberghe W: Managing health services in developing countries: between ethics of the civil servant and the need for moonlighting. Hum Resour Heal. 2001, 5:17-24.
• [13]Muula A, Maskeo F: How are health professionals earning their living in Malawi? BMC Health Serv Res. 2006, 6:3. BioMed Central Full Text
• [14]Bir A, Eggleston K: Physician dual practice: access enhancement or demand inducement?. Boston: Tufts University, Department of Economics, Working Paper; 2003:3.
• [15]Chikanda A: Skilled health professionals’ migration and its impact on health delivery in Zimbabwe. Oxford: Centre on Migration, Policy and Society, University of Oxford, Working paper 04–04; 2004.
• [16]National Department of Health of South Africa: Human resources for health strategy for the health sector: 2012/13–2016/17. Pretoria: Department of Health; 2011.
• [17]McIntyre D, Thiede M, Nkosi M, Mutyambizi V, Castillo-Riquelme M, Gilson L, et al.: SHIELD work package 1 report: a critical analysis of the current South African Health System. Cape Town: University of Cape Town and University of the Witwatersrand; 2007.
• [18]Econex: NHI Note 7: updated GP and specialist numbers for South Africa. Stellenbosch: Econex; 2010.
• [19]McIntyre D, Goudge J, Harris B, Nxumalo N, Nkosi M: Prerequisites for national health insurance in South Africa: results of a national household survey. SAMJ. 2009, 99:725-9.
• [20]Ataguba J, Akazili J, McIntyre D: Socioeconomic-related health inequality in South Africa: evidence from General Household Surveys. Int J Equity Health. 2011, 10:48. BioMed Central Full Text
• [21]Statistics South Africa: Statistical release. Pretoria: Stats SA; 2013.
• [22]Colborn R, Kane-Berman J, Hermann A, Van Niekerk J: Limited private practice at academic hospitals - an ‘in-house’ group practice. SAMJ. 1996, 86:257-60.
• [23]Hoffenberg R: Personal view: the future of medical education in South Africa. Br Med J. 1997, 315:612-3.
• [24]Public Service Commission: Remunerative work outside the public service: an investigation undertaken in the Gauteng Provincial Health Sector. Pretoria: Public Service Commission of South Africa; 2004.
• [25]Wadee H, Khan F: Human resources for health. South African Health Review 2007: The role of the private sector within the South African health system. Durban: Health Systems Trust; 2007.
• [26]Ashmore J: ‘Going private’: A qualitative comparison of medical specialists’ job satisfaction in the public and private sectors of South Africa. Hum Resour Heal. 2013, 11:1. BioMed Central Full Text
• [27]Wilson F: Organizational behavior: a critical introduction. New York: Oxford University Press; 1999.
• [28]Mbindyo P, Blaauw D, Gilson L, English M: Developing a tool to measure health worker motivation in district hospitals in Kenya. Hum Resour Heal. 2009, 7:40. BioMed Central Full Text
• [29]Mathauer I, Imhoff I: Health worker motivation in Africa: the role of non-financial incentives and human resource management tools. Hum Resour Heal. 2006, 4:24. BioMed Central Full Text
• [30]Franco L, Bennett S, Kanfer R: Health sector reform and public sector health worker motivation: a conceptual framework. Soc Sci Med. 2002, 54:1255-66.
• [31]Tzeng H: The influence of nurses’ working motivation and job satisfaction on intention to quit an empirical investigation in Taiwan. Int J Nurs Stud. 2002, 39:867-78.
• [32]Lambert E, Hogan N, Barton S: The impact of job satisfaction on turnover intent: a test of a structural measurement model using a national sample of workers. Soc Sci J. 2001, 38:233-50.
• [33]Locke E: The nature and causes of job satisfaction. In The handbook of industrial and organizational psychology. Edited by Dunnette M, Hough L. Palo Alto, CA: Consulting Psychologists Press; 1976:1319-28.
• [34]Spector P: Job satisfaction: application, assessment, causes and consequences. Thousand Oaks, CA: Sage; 1997.
• [35]Bluedorn A: A unified model of turnover from organizations. Hum Relations. 1982, 35:135-53.
• [36]Tett R, Meyer J: Job satisfaction, organizational commitment, turnover intention, and turnover: path analyses based on meta-analytic findings. Pers Psychol. 1993, 46:259-93.
• [37]Porter L, Steers R, Mowday R: Organizational commitment, job satisfaction, and turnover among psychiatric technicians. J Appl Psychol. 1974, 59:603-9.
• [38]Mobley W: Intermediate linkages in the relationship between job satisfaction and employee turnover. J Appl Psychol. 1977, 62:237-40.
• [39]Humphrey C, Russell J: Motivation and values of hospital consultants in South-East England who work in the National Health Service and do private practice. Soc Sci Med. 2004, 59:1241-50.
• [40]McClintock W, Taylor N: Analysis of interviews with people holding multiple jobs in the health sector: multiple job holding in New Zealand. Christchurch: Working paper number 6, Taylor Baines & Associates; 2004.
• [41]Glesne C: Becoming qualitative researchers. 2nd edition. New York, NY: Longman; 1999.
• [42]Lincoln Y, Guba E: Naturalistic inquiry. Newbury Park, CA: Sage Publications; 1985.
• [43]Rensburg D Van (Ed): Health and health care in South Africa. Pretoria: Van Schaik Publishers; 2004.
• [44]Erasmus E, Blaauw D, Gilson L: Private wards in public hospitals in South Africa: The policy context and models of operation. Johannesburg: Center for Health Policy, Wits and Department of Public Health and Family Medicine, University of Cape Town; 2009.
• [45]Bian Y, Sun Q, Jan S, Yu J, Meng Q: Dual practice by public health providers in Shandong and Sichuan Provinces, in China. HEFP working paper 07/03. London: London School of Hygiene and Tropical Medicine; 2003.