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public sector incentives

Why doctors leave their posts – problem-solving irregularities in the health sector with healthcare workers in Bangladesh

Mushtaq Khan's picture

It’s not often you get together the very people working on the frontline to sit down together and discuss why and how irregular practices occur in their sector – and what can be done about them. But that’s just what we did with a group of frontline health workers at a workshop in Bangladesh’s capital Dhaka in December 2017. We wanted to understand why corrupt and irregular practices occur in the health sector - what are the underlying incentives and processes? And what are some feasible and impactful ways to change these practices?

Many developing countries, including the three where our research consortium, the Anti-Corruption Evidence research consortium is working, Bangladesh, Nigeria and Tanzania, struggle to provide free or low-cost healthcare to all their citizens. Instead, citizens are often forced to buy services from the private sector at higher fees or worse, approach untrained or traditional healers. There is agreement in the literature that a large proportion of these inefficiencies occur due to corrupt practices (though there’s an active debate about whether using the c-word is helpful in this debate, which is why we talked about ‘irregularities’ during this workshop). Many of these practices are related to the way societies in developing countries are organized around patron-client relations, where tax resources are insufficient, and resources, jobs and promotions require lobbying powerful politicians.