Have you ever considered absenteeism of health workers as corruption? Do you think of absenteeism as an issue that has marred health service delivery in Nigeria? Would you choose to blame just health workers for their absence at work? These are some questions that have been in the research space of the SOAS-ACE/HPRG project on health sector corruption in Nigeria.
Since November 2017, a team of researchers from Health Policy Research Group, University of Nigeria, Nsukka, London School of Hygiene and Tropical Medicine and School of Oriental and African Studies, London have been on an Anti-corruption Evidence research project. The study is of applied significance to the health sector of Nigeria, particularly Primary Healthcare [PHC], as it seeks to scale up efficiency of health workers in a bid to boost health service delivery. This is one of such contributions to the achievement of 2030 Universal Health Coverage.
Generally, corruption in Nigeria has been a much debated issue and it forms a cardinal goal of the present government. Amidst efforts targeting to curb corruption in Nigeria, the country records so poorly in corruption perception indexes computed by Transparency International in recent years. David Cameron once described the country as “fantastically corrupt”, which sums several popular opinions about the country on corruption – opinions we advise should be considered and further challenged.
On health sector corruption, ACE team had earlier done a systematic profiling of corrupt practices in the health sector across countries in Anglophone West Africa. The team further held a Nominal Group Technique workshop with frontline health workers from different parts of Nigeria and an elaborate brainstorming session with healthcare policy makers, all in Abuja from 24th – 25th April, 2018. These processes arrived at a consensus that absenteeism of health workers, particularly at the PHC level is of much corruption concern to the health sector and the country at large. Besides absenteeism being a top corruption concern in the health sector, stakeholders admitted it the most feasible to address horizontally using frontline health workers, community based interventions and local government officials. Inasmuch the research approach of the team does not favour vertical interventions from top governmental authorities owing to political complexities, our study would still recommend that these stakeholders at the apex begin to consider seriously, the strengthening of health system in Nigeria, of which curbing absenteeism is crucial.
Sequel to the identification of absenteeism as a topmost corruption issue in the health sector, the ACE team swung into action in collecting data and synthesizing information on the subject. So far, the team has visited about 15 PHCs spread across several Local Government Areas in Enugu State. Interactions on the issue have been held with about 180 service users, 60 frontline health workers, 12 local government health administration officers, and 18 community health facility committee chairpersons. Conversations have strongly pointed at the harms absenteeism occasions for PHCs, as well as the dynamics around it. The consequences have manifested in death of patients, poor access to PHCs and negative perceptions toward the public health sector in Nigeria.
Going a step further, we found couple of factors responsible for absenteeism of health workers. No doubt that if absenteeism must be curbed, these factors must be addressed, of which include: infrastructure deficit, community apathy, weak enforcement of rules, political protection of health workers, poor pay, transport difficulties, lack of supervision, poor involvement of facility committees, overwork and underwork of healthcare staff, tribal sentiments, to mention but few. Adding to our interventive plans for this study, will be a Discreet Choice Experiment, which will enable us compare proposed horizontal solutions and identify the best of them. In our subsequent blogs, we will detail our findings from the field, step-by-step. Do watch this space.
Thank you for the read.
Compiled by the ACE Team