Unmasking the open secret of posting and transfer practices in the health sector

Abstract

This article focuses on processes of granting posts and transfers to health care workers and administrators that can be described as ‘mission inconsistent (MI)’, meaning that they are not conducted in a way that maximizes health outcomes or that respects the norms of health care worker professionalism. We synthesize relevant literature from several different disciplinary perspectives to describe what is known about the problem of MI posting and transfer in the health sector, to critically engage and interrogate these literatures, and to briefly discuss efforts that have been made to maximize mission consistency. The article concludes by suggesting principles for future research that would foster a more complete understanding of posting and transfer practices.

Corruption and population health outcomes: an analysis of data from 133 countries using structural equation modeling

“…Corruption in healthcare can occur at any point in the system, including payments, procurement, the pharmaceutical and medical supply chains, and health service delivery; and it may take many forms, including embezzlement, theft, bribes and kickbacks, and failure to deliver services (Novignon 2015; Schaaf and Freedman 2015;Scott et al 2011;Transparency International 2006). Kirigia and Diarra-Nama (2008), discussing corruption in the health sector, highlight management failures in three areas: financial resources, medical supplies, and health worker/patient interactions (i.e., human resources).…”

“…A large body of literature attests to the negative consequences of corruption in the health sector (Jain 2001;Muldoon et al 2011;Novignon 2015;Schaaf and Freedman 2015;Scott et al 2011;Stipčić et al 2015). For instance, Gupta et al (2002), drawing on data from 89 countries over more than a decade (1985)(1986)(1987)(1988)(1989)(1990)(1991)(1992)(1993)(1994)(1995)(1996)(1997), found a significant link between corruption and child and infant mortality, low birth weight, lower likelihood of an attended birth, and lower rates of immunization.…”

A symbiosis of civil service and politics in transfers: The case of Pakistan's management cadres

“…Politicization of transfers negatively impacts three major goals of the civil service: meritocracy, political neutrality, and service provision (Banik 2001;Lewis 2010;Schaaf and Freedman 2015). Merit-based appointments in the bureaucracy are essential for economic and political development as they allow qualified civil servants to be assigned to appropriate policy-making and implementation positions (Kearney 1986;Evans and Rauch 1999;Cameron 2010;Iyer and Mani 2012).…”

“…Kristiansen and Ramli (2006) and Blunt et al (2012) found similar behaviour in Indonesia, where the bureaucrats jostled for positions located in urban centres or on development projects with opportunities to gain illicit wealth. Officials in Nepal, Ethiopia, and Ghana were also found to avoid postings in remote rural areas by lobbying with the authorities for transfers to large population centres (Aitken 1994;Andersen 2004;Serneels et al 2007;Schaaf and Freedman 2015).…”

“…At the provincial and district levels, management positions can be occupied by both federal and provincial management cadres. The performance of these officers is assessed based on confidential reports written by their supervising officers and are not shared with the employees (Schaaf and Freedman 2015). These reports generally focus on follow- development budget could be utilized to carry out capital investments in infrastructure and service delivery improvement in 2010 (the last year included in this study).…”