Managing health services in developing countries: between the ethics of the civil servant and the need for moonlighting

Abstract

We report on income generation and work mix among 100 civil servants who manage public health services in developing countries. Corrected for purchasing power parity, the government pays the respondents a median salary of 3,800 US$PPP per annum. This salary puts these managers among the better-off in their countries. However, it definitely remains below what they could expect from alternative occupations as medical doctors in their own countries. An impressive 87% of the respondents complement their salaries with at least one of the following: working for NGOs or development agencies, private practice, or other income-generating activities. All in all moonlighting adds an extra 50 to 80% to their public sector salaries. There are three possible consequences: competition for time, outflow of resources from the public sector, and conflicts of interest. The problem of moonlighting needs to be addressed openly so as to protect public sector values while meeting both professional needs and user demands for quality.