Abstract
Background: Absenteeism is widespread in Nigerian health facilities and is a major barrier to achievement of effective Universal Health Coverage. We have examined the role of internal (by managerial staff within facilities) and external (by managers at a higher level) supervision arrangements on health worker absenteeism. Specifically, we sought to determine whether these forms of supervision have any role to play in reducing health worker absenteeism in health facilities in Enugu State Nigeria.Methods: We conducted interviews with 412 health workers in urban and rural areas of Enugu State, in South-Eastern Nigeria. We used binary logistic regression to estimate the role of different types of supervision on health worker absenteeism in selected health facilities in Enugu State.Results: Internal supervision arrangements significantly reduce health worker absenteeism (odds ratio = 0.516, p = 0.03). In contrast, existing external supervision arrangements were associated with a small but significant increase in absenteeism (OR = 1.02, 0.043). Those reporting a better financial situation were more likely to report being absent (OR = 1.36, p < 0.01) but there was no association with age and marital status of respondents. Our findings also pointed to the potential for alternative forms of supervision, provided in a supportive rather than punitive way, for example by community groups monitoring the activities of health workers but trying to understand what support these workers may need, within or beyond the work environment.Conclusion: The existing system of external supervision of absenteeism in health facilities in Nigeria is not working but alternatives that take a more holistic approach to the lived experiences of health workers might offer an alternative.
Highlights
Absenteeism is a major problem in health systems worldwide
In the current study we examine the association with absenteeism with supervision of health workers by internal health facility managers and by external supervisors, who often come unannounced
Absenteeism was broken down by number of days a health worker was absent from work within a 1 year and it was found that, while 92 of them never engaged in absenteeism, 225 of them were absent in 10 days or below (54.6%)
Summary
Absenteeism is a major problem in health systems worldwide. For example, it has been linked to the annual loss of 2 weeks of work in Organization for Economic Co-operation and Development (OECD) countries [1]. The problem seems even greater in low- and middle-income countries, with severe consequences for already weak health systems [2,3,4,5]. This is especially so in the public primary healthcare facilities on which the poor often depend. Absenteeism is widespread in Nigerian health facilities and is a major barrier to achievement of effective Universal Health Coverage.
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