Private money-making indulgence and inefficiency of primary healthcare in Nigeria: a qualitative study of health workers\u2019 absenteeism

Prince Agwu,Aloysius Odii,Pamela Ogbozor,Charles Orjiakor,Obinna Onwujekwe

doi:10.1007/s00038-020-01405-3

Abstract

ObjectivesGenerating additional personal income is common with primary healthcare (PHC) workforce in Nigeria, which could be because of the inconsistencies marring their monthly salaries. Therefore, this study investigates the drivers of private economic activities of PHC providers in the public sector, and the links to absenteeism, as well as inefficiency of PHC facilities in Nigeria.MethodsA qualitative study design was used to collect data from 30 key-informants using in-depth interviews. They were selected from 5 PHC facilities across three local government areas in Enugu state, south-eastern Nigeria. Data were analysed thematically, and guided by phenomenology.ResultsFindings showed that majority of the health workers were involved in different private money-making activities. A main driver was inconsistencies in salaries, which makes it difficult for them to routinely meet their personal and household needs. As a result, PHC facilities were found less functional.ConclusionsAbsenteeism of PHC providers can be addressed if efforts are made to close justifiable gaps that cause health workers to struggle informally. Such lesson can be instructive to low- and middle-income countries in strengthening their health systems.

Highlights

Nigeria has a widespread of health facilities (Kress et al 2016), and a high-density health workforce which is poorly funded by the government (Akwataghibe et al 2013; WHOThis article is part of the special issue ‘‘Market-driven forces and Public Health’’.2019)
Objectives Generating additional personal income is common with primary healthcare (PHC) workforce in Nigeria, which could be because of the inconsistencies marring their monthly salaries
Findings showed that majority of the health workers were involved in different private money-making activities

Summary

Introduction

Nigeria has a widespread of health facilities (Kress et al 2016), and a high-density health workforce which is poorly funded by the government (Akwataghibe et al 2013; WHOThis article is part of the special issue ‘‘Market-driven forces and Public Health’’.2019). As a result of poor funding for the health sector, the welfare concerns of human resources for healthcare have been severely challenged, leading to steady migration of health workforce away from Nigeria, and health workers seeking additional means of income earning (Adeloye et al 2017). Given this context, health workers are bound to miss work during official work periods leading up to a kind of absenteeism we refer to in this study as survival absenteeism. Such cases contribute significantly to ineffectiveness and inefficiency of the public healthcare system, especially at the PHC level

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Conclusion