Figure 4

Causal loop diagram illustrating factors influencing dual practice during the 1990’s to the present. Dual practice opportunities grow exponentially, as it becomes more attractive to government providers working in an underfunded and over-burdened public system. A formal, written government policy does not exist. Local facility-level coping mechanisms emerge to mitigate negative consequences of dual practice on the health system. Periodic threats for increasing restrictions re-activate the feedback loop presented in Figure 3.