Understanding healthcare provider absenteeism in Kenya: a qualitative analysis

Katherine Tumlinson,Margaret W Gichane,Katherine Lemasters,Siân L Curtis

doi:10.1186/s12913-019-4435-0

Katherine Tumlinson, Margaret W Gichane + Show 2 more

Open Access

https://doi.org/10.1186/s12913-019-4435-0

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Abstract

BackgroundHealthcare worker absenteeism is common in resource limited settings and contributes to poor quality of care in maternal and child health service delivery. There is a dearth of qualitative information on the scope, contributing factors, and impact of absenteeism in Kenyan healthcare facilities.MethodsIn-depth semi-structured interviews were conducted between July 2015 and June 2016 with 20 healthcare providers in public and private healthcare facilities in Central and Western Kenya. Interviews were audio-recorded, transcribed, coded, and analyzed using an iterative thematic approach.ResultsHalf of providers reported that absenteeism occurs in both private and public health facilities. Absenteeism was most commonly characterized by providers arriving late or leaving early during scheduled work hours. The practice was attributed to institutional issues including: infrequent supervision, lack of professional consequences, limited accountability, and low wages. In some cases, healthcare workers were frequently absent because they held multiple positions at different health facilities. Provider absences result in increased patient wait times and may deter patients from seeking healthcare in the future.ConclusionThere is a significant need for policies and programs to reduce provider absenteeism in Kenya. Intervention approaches must be cognizant of the contributors to absenteeism which occur at the institutional level.

Highlights

Healthcare worker absenteeism is common in resource limited settings and contributes to poor quality of care in maternal and child health service delivery
Scope of absenteeism Half of the twenty participants report that provider absenteeism occurs frequently in health facilities in Kenya
Excessively late arrival times, and early departures from work are not acceptable practices within Kenya’s formal employment sector and the partial-day absences occur despite the clear expectation that all staff should be present from 7:30 am or 8:00 am until 5 pm

Summary

Introduction

Healthcare worker absenteeism is common in resource limited settings and contributes to poor quality of care in maternal and child health service delivery. Maternal and child health (MCH) is embedded in multiple Millennium and Sustainable Development Goals, is the focus of the United Nations Secretary-General’s Global Strategy for Women’s Health, and is on the national political agendas of many developing countries [1,2,3]. Maternal and child mortality remain high in many lowincome settings within sub-Sarahan Africa. Failure to close the gap between current and optimal MCH outcomes within select countries is partially attributable to the poor quality of healthcare available in many resource constrained areas; in such settings, poor quality of care may prevent adequate delivery of critical services such as family planning or perinatal healthcare [5]. The first step towards high quality care is provider attendance [6]. Providers may be absent from work for a variety of legitimate reasons, several prior studies have investigated or highlighted the rate, frequency, or prevalence of providers engaging in unscheduled absence from the workplace [6,7,8,9,10,11,12,13]

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