Interventions to manage dual practice among health workers


Many health professionals have two or more jobs. This is referred to as dual practice. In many low- and middle-income countries, low pay and difficult working conditions lead many health workers in the public health sector to add to their income by taking on private patients who pay for the services that they receive. In addition to this extra income, work in the private sector may also offer advantages such as higher status, more control over working hours and better professional opportunities. By allowing public sector health workers to supplement their income, it may be easier for the public sector to keep their skilled health workers. This type of dual practice may also lead health workers to spend less time in their public sector job, and may also encourage some health workers to be inefficient and corrupt. For instance, they may take time off without permission to go and work in their private positions; they may lower the quality of their services in the public sector in order to drive patients to their private practice; or they may take resources such as transport and drugs from their public sector workplace to use in their private sector jobs. In some countries, governments have imposed a ban on dual practice, or have attempted to regulate how many hours their health workers are allowed to conduct a private practice or how much they are allowed to earn from this practice by imposing mandatory licenses and private sector price ceilings. In other countries, health workers are given special incentives such as higher salaries and promotions if they agree to only work in the public sector, while other countries have allowed limited private practice (health workers seeing private patients) within public facilities.


Kiwanuka, S.; Rutebemberwa, E.; Nalwadda, C.; Okui, O.; Ssengooba, F.; Kinengyere, A.A.; Pariyo, G.W. Interventions to manage dual practice among health workers. Cochrane Database of Systematic Reviews (2011) : [DOI: 10.1002/14651858.CD008405.pub2]

Interventions to manage dual practice among health workers

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