Targeting systems not individuals: Institutional and structural drivers of absenteeism among primary healthcare workers in Nigeria.
absenteeism
anticorruption
corruption
health systems
primary healthcare
structural drivers
Journal
The International journal of health planning and management
ISSN: 1099-1751
Titre abrégé: Int J Health Plann Manage
Pays: England
ID NLM: 8605825
Informations de publication
Date de publication:
10 Nov 2023
10 Nov 2023
Historique:
revised:
29
10
2023
received:
20
12
2022
accepted:
31
10
2023
medline:
10
11
2023
pubmed:
10
11
2023
entrez:
10
11
2023
Statut:
aheadofprint
Résumé
Universal Health Coverage (UHC) can only be achieved if people receive good quality care from health workers, yet in Nigeria, as in many other low- and middle-income countries (LMICs), many health workers are absent from work. Absenteeism is a well-known phenomenon but is often considered as the self-serving behaviour of individuals, independent from the characteristics of health systems structures and processes and the broader contexts that enable it. We undertook a qualitative inquiry among 40 key informants, comprising health facility heads and workers, community leaders and state-level health policymakers in Nigeria. We employed a phenomenology approach to examine their lived experiences and grouped findings into thematic clusters. Absenteeism by health workers was found to be a response to structural problems at two levels -midstream (facility-level) and upstream (government level) - rather than being a result of moral failure of individuals. The problems at midstream level pointed to an inconsistent and unfair application of rules and regulations in facilities and ineffective management, while the upstream drivers relate mainly to political interference and suboptimal health system leadership. Reducing absenteeism requires two-pronged interventions that tackle defects in the upstream and midstream rather than just focusing on sanctioning deviant staff (downstream).
Types de publication
Journal Article
Langues
eng
Subventions
Organisme : UK Aid
Informations de copyright
© 2023 The Authors. The International Journal of Health Planning and Management published by John Wiley & Sons Ltd.
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