Interventions for managing the movement of health workers between public and private organizations in low- and middle-income countries

Abstract

Health workers migrate between the public and the private sector due to many factors including seeking better pay, job security, better working conditions and career opportunities (McCoy 2008; Nguyen 2008; Schrecker 2004). The public sector is the government-funded healthcare delivery system while the private sector can be either non-profit making, such as nongovernmental organizations (NGOs), or profit-making privately owned clinics and hospitals. The private sector has been expanding in many low- and middle-income countries and is now responsible for a large proportion of health care in many settings. However, governments in many low- and middle-income countries lack the capacity to enforce regulatory control of the private sector (Brugha 1998). The private sector also lacks the capacity to address public health challenges and is to a large extent inaccessible to the lowest socio-economic groups (Palmer 2003). A number of factors have been reported to affect the movement of health workers between the public and private sectors in low- and middle-income countries. In Namibia, for example, the presence of fringe benefits and conditions of service has been shown to pull and retain workers in the public sector while high salaries and "soft tissues" such as recognition and communication tend to pull and retain workers in the private sector(Lipinge 2006). In South Africa, high workload and low motivation in the public sector pushes health workers from the public to the private sector (Pillay 2009). In Mozambique, the many job opportunities created in NGOs and the reduced workload, closer supervision and better equipment offered by these organisations have been shown to pull workers to the private sector (Pfeiffer 2003; Pfeiffer 2008). In addition, public health reforms that reduce the workforce tend to push workers away from the public sector in low-income countries (Lethbridge 2004). It is critical therefore that financial and non-financial interventions be evaluated for their effect on movement of health workers between the public and private sectors.