Health Worker Absenteeism in Selected Health Facilities in Enugu State: Do Internal and External Supervision Matter?

Abstract

Background: Absenteeism is widespread in Nigerian health facilities and is a major barrier to achievement of effective Universal Health Coverage. We have examined the role of internal (by managerial staff within facilities) and external (by managers at a higher level) supervision arrangements on health worker absenteeism. Specifically, we sought to determine whether these forms of supervision have any role to play in reducing health worker absenteeism in health facilities in Enugu State Nigeria.Methods: We conducted interviews with 412 health workers in urban and rural areas of Enugu State, in South-Eastern Nigeria. We used binary logistic regression to estimate the role of different types of supervision on health worker absenteeism in selected health facilities in Enugu State.Results: Internal supervision arrangements significantly reduce health worker absenteeism (odds ratio = 0.516, p = 0.03). In contrast, existing external supervision arrangements were associated with a small but significant increase in absenteeism (OR = 1.02, 0.043). Those reporting a better financial situation were more likely to report being absent (OR = 1.36, p < 0.01) but there was no association with age and marital status of respondents. Our findings also pointed to the potential for alternative forms of supervision, provided in a supportive rather than punitive way, for example by community groups monitoring the activities of health workers but trying to understand what support these workers may need, within or beyond the work environment.Conclusion: The existing system of external supervision of absenteeism in health facilities in Nigeria is not working but alternatives that take a more holistic approach to the lived experiences of health workers might offer an alternative.

Absenteeism in primary health centres in Nigeria: leveraging power, politics and kinship

“…This study extends our knowledge of the nature of absenteeism in resource-constrained LMICs, in this case, Nigeria, by highlighting the influence of powerful political connections and networks. While there are studies on the diverse drivers of absenteeism, particularly issues of economy, domestic responsibilities, leadership capacity and infrastructure deficiencies,8 19 20 25 issues of political influence on healthcare provision have been underexplored. Respondents view often converge closely, suggesting a shared knowledge of how things work.…”

“…Enugu North LGA is an urban location, Oji River LGA is semi-urban, and Nsukka is rural. These areas were known to experience high rates of absenteeism in PHCs 8 19 25…”

‘Government don't know me and if I stop, they won't know’: A qualitative study on the lived experiences of volunteer health workers in the Nigerian health system and their implications for the sustainable development goals

“…In Igbo‐Etiti, the headquarters and one PHC were selected and in Nsukka, only one health facility was selected. It is important to note that sites were selected in part on the basis of reports of staff shortages and of absenteeism that we believed would increase the likelihood that volunteers would be used 24,25 . Sites were also selected to represent urban (typically busy) and rural (less busy) areas of the State.…”

“…It is important to note that sites were selected in part on the basis of reports of staff shortages and of absenteeism that we believed would increase the likelihood that volunteers would be used. 24,25 Sites were also selected to represent urban (typically busy) and rural (less busy) areas of the State. Selection of sites was contingent upon obtaining approval from the Officer-in-Charge (a health worker responsible for overseeing the administration of a PHC facility) and the Head, responsible for all the PHCs in a local government area.…”

How do moral hazard behaviors lead to the waste of medical insurance funds? An empirical study from China

“…Vona and Kassem state that the financial pressure of individuals or organizations is the key motivation for fraud ( 49 , 50 ). And the opportunity is created by ineffective control or governance systems, such as inadequate job division, weak internal control, and irregular audit ( 48 , 51 , 52 ). From the perspective of capability, Thompson proposed individual corruption and institutional corruption are two different phenomena in the field of healthcare ( 53 ).…”