Financing advances on salaries of health workers in Chad: an example of a feasible strategy to sustain the Bamako Initiative

Brain drain: Do economic conditions "push" doctors out of developing countries?

Health worker migration is an issue of first order concern in global health policy circles and continues to be the subject of much policy debate. In this paper, we contribute to the discussion by studying the impact of economic conditions on the migration of physicians from developing countries. To our knowledge, this is one of the first papers to do so. A major contribution of this paper is the introduction of a new panel dataset on migration to the US and the UK from 31 sub-Saharan Africa countries. The data spans the period 1975-2004. Using this data, we estimate the impact of changes in economic conditions on physician migration. In our preferred specification that allows for country-specific time trends, we find that a temporary one percentage point decline in GDP per capita increases physician migration in the next period by approximately. 3 percent. In our IV models a one percentage point decline in GDP per capita increases physician migration in the next period by between 3.4 and 3.6 percent. Overall, our results suggest a significant effect of developing country economic conditions on physician migration.

Improving access to essential drugs for rural communities in Nigeria: the Bamako initiative re-visited

One of the major indices of the performance of the primary healthcare delivery remains improved access to essential drugs. The Bamako Initiative (BI) was introduced by WHO/UNICEF in the late 1980's to improve access to essential drugs for the most vulnerable in the society and thus improve the health outcomes. However, almost 20 years post-inception, the outcomes and/or impact of the BI on the health indices of many implementing African countries remains varied, with not so significant improvement in health status being registered in a majority of countries. A review of literature suggests that the poor outcomes may be attributable to issues more fundamental than just the absence of adequate funding. Although the current Nigeria Drug Policy (NDP) clearly enunciates and provides policy direction for the core objective of the Bamako Initiative (BI), which is "EQUITABLE ACCESS TO ESSENTIAL DRUGS at the community level", it appears the implementation guidelines may not have drawn on the NDP policy guidelines to provide an adequate framework/tools to ensure efficient realization of the core objectives of the BI. This paper appraises the implementation of the BI in Nigeria within the context of the NDP. It reviews the current status of the BI in the country and attempts to proffer solutions for improvement and/or functionality. The paper seeks:1. To provoke thoughts and direct attention to an aspect of Public Health Pharmacy, which had been hitherto neglected by Pharmacists and Programme Planners.2. To get pharmacists more involved in ensuring the efficiency and safety of drug supply at the community level.3. To engender more research by pharmacists and stakeholders for improved outcomes in this service area.

The impact of hospital management reforms on absenteeism in Costa Rica

The reduction of high levels of absenteeism among health care workers was one the objectives of the reforms undertaken to improve public hospital performance during the 1990s in Costa Rica. This paper attempts to assess the impact of changes in reimbursement methods and organizational reform on absence rates among health care personnel in Costa Rican public hospitals for the period 1995-2001. Our results show the reforms to have had a negative impact on absenteeism, which increased throughout the considered period. Results further indicate that the policy of not substituting absentee workers, which was introduced through the reforms, did not work as expected in a permissive environment in which peer pressure mechanisms were lacking. In addition, the explicit incentives for workers included in the reforms were retained and used at facility level. There is a pressing need in the future for control and disciplinary mechanisms for health care personnel and for the introduction of absence rates as an explicit goal to be monitored and evaluated.