What drives absenteeism among doctors in rural primary healthcare setting in Bangladesh? A qualitative exploration

Abstract

Abstract Absenteeism', among physicians, has been a long-standing issue in Bangladesh, but little is known about the intersection between political structures, health system policy and shortages that drives provider behaviour. Using an in-depth interview guideline 30 interviews were conducted with physicians working in rural and urban facilities through purposive sampling. Data were analysed in Atlas ti and synthesized following Gales framework method. Senior doctors were usually absent due to the lack of opportunities to specialise/dual/private practice in rural facilities. Absence of career progression (especially among junior physicians), inadequate and unsafe living and workplace arrangements, absence of transport facilities, lack of community understanding and ownership, non-cooperation from colleagues and absence of incentives or recognition de-motivated physicians to stay at their posts in rural facilities. Incidences of abuse (verbal/physical) by local community were common with female physicians particularly vulnerable. Disciplinary actions against absenteeism were unclear, and many respondents were unaware of these. Almost all of the doctors wished to move out of rural areas. Those who were successful, used their social and political networks and the payments of bribes to facilitate movement into urban settings. Doctors who did not have access to financial resources or to these networks failed to move out of rural areas and one left the profession.