Official Bank Sites Related Information Multimedia March 23, 2006—In this second article on the issue of absenteeism among teachers and medical workers, we explore some of the possible solutions and issues in a World Bank-Harvard University research study. If you are in a developing country, and your staff is failing on regular basis to show up for work, you might think the only obvious answer is to offer more money as an incentive. But this isn’t the solution you’ll find in a study by World Bank and Harvard University researchers looking into the issue of high absenteeism among teachers and health workers in six developing countries. The study found it was often the higher-paid teachers and doctors who failed to show up for work. And as Halsey Rogers, Senior Economist with the Bank’s Development Research Group, 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 did find the better the work environment in the school or health facility, the lower the absence rate. “We found a clear association between better infrastructure and lower absence,” Rogers says. “The most logical explanation in countries where there’s little monitoring of workers is that what’s 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 with the Bank’s South Asia Human Development Sector, 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. He says 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 found teachers or medical workers who failed to turn up to work were rarely disciplined. Rogers says the study suggests there could be value in giving local institutions, like school associations, the power to hire and fire teachers. “It’s not enough just to go in and set up parent teacher associations (PTAs). However in the Indian schools where PTAs are more active we do find a little bit lower absence, and our sense is if you gave these PTAs more power to determine teacher hiring and firing, probably you would see better results.” 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,” he says. “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. “But, ultimately beyond the doctors and teachers, there are millions of parents and millions of patients. They are actually the real clients of the governments and if that voice is what the governments ultimately respond to, then we will see changes.” |
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