an Eldis Resource
Getting teachers and doctors to report to work
The issue of absenteeism among teachers and medical workers
Authors:
F. H. Rogers
Publisher:
Development Education Programme, World Bank, 2006
The study finds that it is often the higher-paid teachers and doctors who fail to show up for work. As the author points out raising salaries alone probably shouldn’t be expected to reduce absenteeism for staff, who are usually neither well monitored nor rewarded for good performance.
But the study finds the better the work environment in the school or health facility, the lower the absence rate. It finds a clear association between better infrastructure and lower absence. The most logical explanation in countries where there is little monitoring of workers is that what is going to determine whether or not a person goes to work is how they feel about the place where they work. If the facilities are better – if they have for example functioning toilets and a roof – they are going to be more enthusiastic about going to work and working in those better conditions.
Nazmul Chaudhury, an Education Economist, says policies in education and health should be designed to take into account high absence rates. One approach to counter high absenteeism rates among doctors in remote regions could be to shift health budgets towards activities which don’t require as many doctors in those regions. These include immunization campaigns, pest control to limit infectious diseases and health education. The author notes that another idea, already being tried by some non-government organizations, is to provide periodic doctor visits rather than continually having doctors posted in remote areas or rotating the doctors out of those regions on a more regular basis.
The study finds that teachers or medical workers who failed to turn up to work were rarely disciplined. The study suggests there could be value in giving local institutions, like school associations, the power to hire and fire teachers. It is not sufficient just to go in and set up parent teacher associations (PTAs).
But in seeking possible solutions, Chaudhury raises the issue of whether there’s the political will to deal with the issue of high absenteeism.And he highlights another issue – the power of doctors and doctors’ unions in developing countries. The problem is that most public health systems are dominated by doctors, and backed by strong doctor unions. To have reform in this sector requires a lot of political mobilization and commitment, ultimately benchmarked by health outcomes.
Ultimately, what we keep on going back to is that maybe politicians view their strong clients right now to be the doctors’ unions and teachers’ unions, which are very vocal and can organize mass demonstrations in the street.
