How public health workers in Kenya cope with low pay

There is consensus that low government wages in developing countries result in a decline of public sector efficiency and productivity and create industrial unrest as well as incentives and opportunities for corruption and misuse of public resources.

Questions about the coping strategies of health workers to supplement their income are sensitive, and it is difficult to obtain truthful answers.

We need to distinguish between individual or group coping strategies and orchestrated activities, acknowledging, nevertheless, that they may be closely interrelated.

Some of these orchestrated activities are part of legitimate union action; others can still be classified as organised crime, especially where managers inflate tenders and pay in record time.

Underpaid staff develop a wide range of coping strategies to top up incomes: Teaching, consulting for development agencies, moonlighting in the private sector, per diems and allowances, or even dabbling in non-medical work. Such practices have a number of undesirable side effects such as distorting the incentive structure of public servants, encouraging specific forms of corruption and patronage, creating situations that engender conflict of interest, competition for time and brain drain.

Health system managers also face a working environment that does not live up to their expectations — financially or professionally. Some may abuse their positions by engaging in corruption or misappropriation such as inflating tenders. Others still manage to be seconded to non-governmental projects or organisations or to concentrate on activities that benefit from donor-funded per diems or allowances.

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Some researchers have resorted to colluding with funding agencies to establish NGOs or private companies to which they channel research grants to enable them pay themselves more than public institutions would allow. This could lead to unsafe or ineffective products entering the health system and medical knowledge being compromised.

By and large, governments have not been proactive in dealing with such problems mainly because of their reluctance to address the issue openly or go beyond rhetoric and ritual condemnations of unethical behaviour.

Controlling coping strategies of health sector personnel is a complex task. It requires a clear separation of personal coping strategies from organised crime and institutional or group coping strategies.