Research

Pilfering for survival: how health workers use access to drugs as a coping strategy

Paulo Ferrinho^1,2,3 , Maria Carolina Omar¹ , Maria de Jesus Fernandes^1,2 , Pierre Blaise⁴ , Ana Margarida Bugalho^1,3 and Wim Van Lerberghe^1,5

¹  Associação para o Desenvolvimento e Cooperação Garcia de Orta, Lisbon, Portugal

²  Centro de Malária e Outras Doenças Tropicais, Universidade Nova de Lisboa, Lisbon, Portugal

³  Institute of Preventive Medecine, Faculty of Medicine, Universidade de Lisboa, Lisbon, Portugal

⁴  Institute of Tropical Medicine, Antwerp, Belgium

⁵  Department of Health Systems Policy and Operations, World Health Organization, Geneva, Switzerland

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Human Resources for Health 2004, 2:4doi:10.1186/1478-4491-2-4

Published:	28 April 2004

Abstract

Background

Coping strategies have, in some countries, become so prevalent that it has been widely assumed that the very notion of civil services ethos has completely – and possibly irreversibly – disappeared. This paper describes the importance and the nature of pilfering of drugs by health staff in Mozambique and Cape Verde, as perceived by health professionals from these countries. Their opinions provide pointers as to how to tackle these problems.

Methods

This study is based on a self-administered questionnaire addressed to a convenience sample of health workers in Mozambique and in Cape Verde.

Results

The study confirms that misuse of access to pharmaceuticals has become a key element in the coping strategies health personnel develop to deal with difficult living conditions. Different professional groups (mis)use their privileged access in different ways, but doctors diversify most. The study identifies the reasons given for misusing access to drugs, shows how the problem is perceived by the health workers, and discusses the implications for finding solutions to the problem.

Our findings reflect, from the health workers themselves, a conflict between their self image of what it means to be an honest civil servant who wants to do a decent job, and the brute facts of life that make them betray that image. The manifest unease that this provokes is an important observation as such.

Conclusion

Our findings suggest that, even in the difficult circumstances observed in many countries, behaviours that depart from traditional civil servant deontology have not been interiorised as a norm. This ambiguity indicates that interventions to mitigate the erosion of proper conduct would be welcome. The time to act is now, before small-scale individual coping grows into large-scale, well-organized crime.