Which interventions improve the management of dual practice?

Abstract

Dual practice in the healthcare setting refers to the holding of more than one job, in unrelated health facilities, by a health professional. In many low-income countries, low pay and difficult working conditions lead many health professionals in the public sector to add to their income by taking on private patients who pay for the services that they receive. Dual practice has both negative and positive consequences and there are concerns that its negative impacts may exceed the positive ones. By allowing public sector workers to supplement their income, it may be easier for the public health sector to keep their skilled workers. However, dual practice may also lead health professionals to spend less time in their public sector job; take time off without permission to work in their private positions; lower the quality of their services in the public sector in order to drive patients to their private practice; or take resources from their public sector workplace to use in their private sector jobs. Various interventions have been implemented to manage dual practice e.g. banning dual practice, regulating the number of hours that public sector workers are allowed to do private practice, regulating how much public sector workers are allowed to earn from private practice, salary increases and promotions for workers who agree to only work in the public sector, and allowing limited private practice within public facilities.