The Universal Health Coverage (UHC) places a high premium on the availability of healthcare services for service users at any time and anywhere. In achieving this, primary healthcare facilities are vital. For reasons that they serve the grass-root population and are the most patronized health facilities by those who are poor. Unfortunately, these facilities face issues causing them to stay locked or are open with no presence of healthcare staff to attend to patients. This is described in health system studies as “absenteeism” of healthcare staff. In a systematic review by Onwujekwe and team, absenteeism of healthcare staff was found to be a corruption issue that undermines healthcare delivery in most developing countries which in turn has slowed the pace of these countries, including Nigeria towards achieving UHC by 2030. A workshop with Nigerian healthcare stakeholders organised by the team ranked absenteeism of health workers as the most prevalent corruption type facing the health sector, particularly the primary healthcare centers (PHCs), and as well, can be readily addressed using horizontal strategies. A confirmation of the perpetual absence of healthcare workers at health facilities can be found in the experience of the Borno State Governor in July 2019, who visited a facility at 1 am but found no doctor on duty.
In the south-eastern part of Nigeria, precisely Enugu state, the issue of absenteeism of PHCs health workers was discussed elaborately in a qualitative study led by Professor. Obinna Onwujekwe of the Faculty of Health Sciences, University of Nigeria. The findings acknowledged a non-24hour healthcare services at the PHCs, and that the blames for being absent from work should not be entirely placed on the health workers alone, as some of them adopt absenteeism as a survival strategy for themselves and their families. For instance, health workers who are poorly paid or not paid at all can begin farming or trading so they and their families could eat and take care of their basic needs. Some avoid the facilities at night periods because it is not safe, and some refuse to trade the closeness with their families for being regularly present at work.
It is against the backdrop that the study enlisted several causes of absenteeism, some of which would need combined efforts of the local government areas (known to be responsible for PHCs), community authorities, healthcare staff and patients to address, while others will need interventions to be coordinated by the State Primary Healthcare Development Agency (SPHCDA). Of these causes or drivers, those relating to housing difficulties, insecurity of facilities, absence of power supply and working equipment, inconsiderate postings of healthcare staff, family responsibilities, poor pay, transport difficulties, cultural obligations, overwork owing to dearth of staff, weak monitoring and supervision, and political protection of erring health workers from sanctions, were extensively talked about. The study equally listed several impacts of absenteeism which all narrowed down to the overworking of staff who are present, financial risk for patients who seek alternative healthcare services, and poor health conditions for patients including reported mortality cases. With the knowledge of these problems, the team hopes to build a coalition of partners that will help address these concerns. At the moment, the strategies to curb absenteeism as mentioned in the qualitative study are undergoing a Discrete Choice Experiment which would help in prioritization of these strategies given the preferences of the health workers that we expect to see at work all the time. In future blogs, we hope to discuss how this process will fare, including the efforts that will be made in implementing them. It is the desire of the study to achieve practical and measurable changes in the health sector of Nigeria with respect to the commitment of healthcare staff and improved healthcare services for patients at the grass-root level.
Written by the University of Nigeria ACE (Anti-corruption Evidence Consortium) TEAM.