Abstract
Making progress towards universal health coverage (UHC) requires that health workers are adequate in numbers, prepared for their jobs and motivated to perform. In establishing the best ways to develop the health workforce, relatively little attention has been paid to the trends and implications of dual practice – concurrent employment in public and private sectors. We review recent research on dual practice for its potential to guide staffing policies in relation to UHC. Many studies describe the characteristics and correlates of dual practice and speculate about impacts, but there is very little evidence that is directly relevant to policy-makers. No studies have evaluated the impact of policies on the characteristics of dual practice or implications for UHC. We address this lack and call for case studies of policy interventions on dual practice in different contexts. Such research requires investment in better data collection and greater determination on the part of researchers, research funding bodies and national research councils to overcome the difficulties of researching sensitive topics of health systems functions.
Highlights
Over the last five years, universal health coverage (UHC) has become an agreed goal of global health policy and planning initiatives.[1,2] Target 3.8 of the Sustainable Development Goals (SDGs) is to achieve UHC, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.[3]
A consultation has concluded that progress towards UHC will require integrated, people-centred health services, a motivated health workforce and adequate financing from domestic and other sources
This reduces the provision of free-of-charge services. In such cases policy options could include top-down government regulation of dual practice, separation of private services and informing patients of their rights to access care without being charged. For those countries (e.g. Cabo Verde, China, South Africa and Thailand) with increasing demand for private services, increasing regulatory capacities and increased private sector provision, dual practice poses the risk of diverting patients and health professionals to the private sector.[22,24,25,27,31]
Summary
Over the last five years, universal health coverage (UHC) has become an agreed goal of global health policy and planning initiatives.[1,2] Target 3.8 of the Sustainable Development Goals (SDGs) is to achieve UHC, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all.[3]. Both the public and private sectors are needed to attain UHC.[11] Failure to understand why, how and to what extent health workers engage in dual practice may compromise attempts to regulate it and undermine progress.
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