Is There a Doctor in the House? Medical Worker Absence in India

The availability of medical providers, a crucial element in quality of care, depends not only on budgeting for and filling posts but also on ensuring that providers are not frequently absent. We present data from a nationally representative all-India survey (conducted in 2003) of over 1400 public health centers across 19 major states, in which survey enumerators physically verify the attendance of providers during unannounced visits, and find that nearly 40% of doctors and medical service providers are absent from work on a typical day. Doctor absence rates ranged from 30% in Madhya Pradesh to over 67% in Bihar. High absence of medical workers is unlikely to be explained by official duties outside the clinic since even pharmacists and lab technicians who are expected to be at the clinic during working hours had absence rates of 30%. While some doctors had a higher underlying absence rate than others, the absence problem is quite widely distributed and not concentrated among a few doctors. Doctors posted at remote facilities and at facilities with poor infrastructure and equipment were absent at significantly higher rates, as were those with longer commutes. Doctors were more likely to be absent than junior staff, but all levels of staff were significantly less absent in facilities where the doctor in charge was more likely to be present.