The impact of health worker absenteeism on patient health care seeking behavior, testing and treatment: A longitudinal analysis in Uganda.

Han Zhang,Günther Fink,Jessica Cohen

doi:10.1371/journal.pone.0256437

Abstract

IntroductionAbsenteeism of frontline health workers in public sector facilities is widespread in low-income countries. There is little quantitative evidence on how health worker absenteeism influences patient treatment seeking behavior, though low public sector utilization and heavy reliance on the informal sector are well documented in low-income settings.MethodsUsing a unique panel dataset covering health facilities and households over a 10-month period in Uganda, we investigate the extent to which health worker absenteeism (defined as zero health workers present at a health facility) impacts patient care seeking behavior, testing, and treatment.ResultsWe find high rates of health worker absenteeism at public sector health facilities, with most of the absenteeism occurring at lower level public health clinics. On average, no health worker was present in 42% of all days monitored in lowest level public health clinics, whereas this number was less than 5% in high level public hospitals and private facilities. In our preferred empirical model with household fixed effects, we find that health worker absenteeism reduces the odds that a patient seeks care in the public sector (OR = 0.65, 95% CI = 0.44–0.95) and receives malaria testing (OR = 0.73, 95% CI = 0.53–0.99) and increases the odds of paying out-of-pocket for treatment (OR = 1.41, 95% CI = 1.10–1.80). The estimated differences in care-seeking are larger for children under-five than for the overall study population.ConclusionsThe impact of health worker absenteeism on the quality of care received as well as the financial burden faced by households in sub-Saharan Africa is substantial.

Highlights

Absenteeism of frontline health workers in public sector facilities is widespread in lowincome countries
We find high rates of health worker absenteeism at public sector health facilities, with most of the absenteeism occurring at lower level public health clinics
No health worker was present in 42% of all days monitored in lowest level public health clinics, whereas this number was less than 5% in high level public hospitals and private facilities

Summary

Methods

Using a unique panel dataset covering health facilities and households over a 10-month period in Uganda, we investigate the extent to which health worker absenteeism (defined as zero health workers present at a health facility) impacts patient care seeking behavior, testing, and treatment. While underfive mortality has declined substantially in Uganda since 1980, the under-five mortality burden remains high, at 46 deaths per 1000 live births in 2018 [38]. Most of these child deaths are attributable to malaria, anemia, malnutrition, and diarrheal disease [39]. Malaria is a common cause of illness in the study districts, with 16.9% malaria prevalence among children under-five and with higher prevalence rates at the time of the study [42, 43]. Other common childhood illnesses in this region include anemia, malnutrition, diarrhea, and respiratory infections [39]

Results

Discussion

Conclusion