Absenteeism among health workers is the highest in India, according to World Bank’s Global Monitoring Report-2008 (GMR). Referring to a survey carried out in 2002 -03, the report says that the rate of absenteeism among primary healthcare workers in India is 40%. This has a strong impact on the Millennium Development Goals (MDGs) like reducing child and maternal mortality and sanitation MDGs. The GMR attempts to highlight how healthcare quality is critical to reaching the MDGs. “The quality of healthcare services matters because it reflects the extent to which investments to national healthcare systems are able to raise both human capital and individual welfare,” says the report.
Trained doctors can make a dramatic difference in improving healthcare, but absenteeism is both chronic and pervasive in many developing countries. While India and Indonesia top the list, countries like Bangladesh and Uganda follow with more than 35% absenteeism among primary healthcare workers. The absence rates in five developing countries averaged 35% in 2002-03. The report mentions that it is possible that these figures underestimates the severity of the problem because health care personnel can be present without actually providing medical care. When asked what can be the possible reasons behind such absenteeism, Dr Zia Qureshi, senior advisor with the office of the chief economist of the World Bank and the lead author of the GMR 2008 report said: “The government framework is weak. There are issues of governance which includes incentives, oversight and accountability. The government in developing countries need to expand their programs with effectiveness.” According to Qureshi, the incentives are weak in India and hence people respond to that by taking leaves and being absent from their work station. There is also lack of accountability among health workers due to which they move freely without attending to jobs. Agrees Shrawan Nigam, Senior consultant, Indian Council for Research on International Economic Relations (ICRIER), who feels that the problem is more severe in rural India. “There is a concept of passing on the responsibility to the panchayati raj, whereas the work is not happening at that level as well and there is a need for monitoring,” asserts Nigam. According to Nigam, absenteeism is high among teachers in India too. The report points out that though there is a need for more spending on education and health programs, that is not the sole answer. “The quality and equity of spending are equally important,” says Qureshi. Improved governance, stronger accountability mechanisms and sound expenditure management are essential to raise the quality of health and education. Although, the report predicts that on current trends the human development MDGs are unlikely to be met yet they can be achieved if stronger efforts are made both by the countries and their development partners. “Progress must be accelerated and made more inclusive. Private players along with public ones have a major role to play. It calls for a reform to make sure that resources are spend effectively and reaches poor and undeveloped areas,” suggests Qureshi.
Source: ECONOMIC TIMES -17MAY 2008