To address the absenteeism and the negligence of doctors, as was recently claimed in the media, experts of the World Bank and the UNFPA, in a recent forum (Sept. 28-29), suggested the adoption of a "demand side financing" (among other things) to provide resources to health service "users" (especially the poor). The expectation is that the clients would use their new-found purchasing power to reward or punish doctors and other service providers to bring them to the service facilities.

An interesting ideabut such a mechanism would work where clients have a choice of facilities; where they are relatively enlightened; where transportation and the overall infrastructure provides wider access; and, where a secondary market for the resource instruments (vouchers in this case) is unlikely to evolve because of better regulation and standards of living.

The real problem of healthcare delivery in Bangladesh is one of poorly designed and implemented "management system" that fails to adequately address the human resource, financial control, information, service, logistics, delivery and supervision systems. The DG's surprise visit is an example of a random supervisory visit, used rather infrequently in the arena of public services.

If this activity alone is ratcheted up and conducted more routinely at all levels, healthcare delivery should improve noticeably as the second day's visits suggest. Combining other elements of the management system, such surprised visits will help straighten the system even more. My suggestion is: Let's fix the supply side problems first before venturing into another expensive and untested experimentdemand side financing.

Perhaps the resources would be better spent if the DG were to be given a helicopter to conduct more random supervisory visits across the country. He could also bring along World Bank experts to check whether the high-absenteeism statistic suggested by the Bank is true or is a mere sampling error!