Health abrupt and uncaring , this is usually the reason , although it could also be due to poor training or lack of training in customer care . These negative experiences usually have the effect of deterring service users from seeking services , especially if they have alternatives , such as being able to pay for private care . Some easily resort to self-medication , using medicines bought off the counter , including from unregulated drug shops and herbs .
The same factors that demoralize health workers also usually drive them into seeking ways to earn incomes in order to take care of themselves and their families . Some open up businesses , including drug shops or clinics , while others seek part-time employment in the private sector . One consequence of this is absenteeism , whereby health workers may not be reporting for duty as the terms of their employment require . Needless to say , such attitudes will impact negatively on service users who turn up for services and find that health facilities are closed when they should be open , or when they are open but with senior and skilled health workers missing because they are busy elsewhere .
Where health workers are able to operate their own clinics and drug shops , it opens the way for pilferage of medicines and supplies for sale in their own facilities . There are usually challenges with delivering medicines to health facilities in remote locations , which creates shortages of essential medicines , sometimes for long periods of time . After consultation with health workers , they are referred to drug shops to buy what they need . In some cases , for health workers to make ends meet , they charge service users for services or medicines , which by law should be available free of charge . Health workers do this by claiming that there are no medicines . Users are then told that the same medicines can be made available , but only if they are willing to pay for them .
Poor Supervision
There are countries where health workers are paid reasonably well , where salaries are paid on time , but where they still absent themselves from work , pilfer medicines and supplies , and mishandle service users , treating them with rudeness , without empathy . In such jurisdictions , this is usually the consequence of poor supervision or total lack of oversight from professional superiors both at the local and national levels . Why do professional superiours not supervise ? Sometimes they too are not held to account for not doing what they are supposed to do . In other cases , they lack the resources they need for supportive supervision . Some governments have tried addressing this problem by setting up local-level supervisory structures such as health unit management committees which are usually made up of local service users . While this strategy works in some cases , it does not work in many others . Health unit management committees usually eventually collapse . This happens when their members and health workers develop antagonistic relationships and fail to cooperate . Constant insubordination by health workers usually breeds fatigue among committee members who gradually let go until the committees are dysfunctional . Elsewhere , committees become ineffective because members develop cosy relationships with health workers and take to colluding with them and ignoring their misconduct instead of ensuring that they do what they were hired to do .
Poor supervision at the local level , including by health unit management committees , points to one unexpected factor in all this : failure by local authorities to measure up to the task of delivering services , even within the context of decentralization of decision-making power , resources and responsibility . There was a time way back in the 1980s when it was argued that centralized decision-making that excluded communities was the main cause of poor service delivery . This argument led to the decentralization and the creation of democratically elected local governments in which communities would play an active role in the decision-making process . It was believed that this would ensure that people in positions of authority account to those who had elected them .
Almost four decades down the road , it is clear that this was uncritically optimistic . Decentralisation did not necessarily ensure accountable leadership . On the contrary , in many instances , it led to elite capture of the newly created decision-making spaces as well as of the benefits of decentralization . One reason for this has been the weakness of the central state . Contrary to what was assumed by experts , decentralization requires strong oversight by the central government over local authorities in order to
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