Designing feasible anti-corruption strategies in the Nigerian health system

A latent class analysis of a discrete choice experiment

Bibliographic Data

ID11916465
AuthorsBlake Angell (0000-0002-7188-7740, The George Institute for Global Health, corresponding author), Obinna Onwujekwe (0000-0002-1214-4285, University of Nigeria), Pallavi Roy (0000-0001-8359-0883, SOAS University of London), Chukwudi Nwokolo (0000-0003-3434-0866, University of Nigeria), Martin Mckee (0000-0002-0121-9683, Faculty of Public Health), Kate L Mandeville (0000-0002-5525-1574, London School of Hygiene & Tropical Medicine), Kate Mandeville, Divine Ndubuisi Obodoechi (0000-0001-7873-1856, University of Nigeria), Divine Obodoechi, Prince Agwu (0000-0001-9224-7622, University of Dundee), Aloysius Odii (0000-0002-2222-0835, University of Nigeria), Charles T Orjiakor (0000-0001-5379-8915, University of Nigeria), Charles Orjiakor, Eleanor Hutchinson (0000-0002-9718-2407, Faculty of Public Health), Dina Balabanova (0000-0001-7163-3428, Faculty of Public Health)
Year2023
Volume166
Pages106208-106208
Publication date2023-02-24
Open AccessYes
TypeARTICLE
VenueWorld Development (JOURNAL)
Journal identifiersISSN: 0305-750X • E-ISSN: 1873-5991
PublisherElsevier BV (PUBLISHER)
DOI10.1016/j.worlddev.2023.106208
OpenAlexW4321767339
LanguageEN
Citations received1
References cited26

Health worker absenteeism is a major form of corruption in the Nigerian health system, reducing the impact of healthcare investment and disproportionately affecting vulnerable communities. Top-down governance and accountability measures to improve attendance have had limited effect, potentially because they have not addressed underlying incentives driving health worker behaviour. To inform feasible interventions to reduce absenteeism, we sought to investigate how potential interventions targeting key drivers of absenteeism could influence behaviour through a discrete choice experiment with 412 primary health care workers in Enugu State, Nigeria. The experiment included six attributes drawing on a literature review, qualitative research and stakeholder consultation: facility relationship with the community, method of supervision, attendance-related rewards or punishments, flexible working policy, posting location and financial incentives. Respondent choices were analysed with mixed multinomial logistic and latent class models and used to simulate job uptake under different policies. We found all attributes significantly influenced choices: workers strongly preferred jobs that facilitated supportive community relationships (β = 0.37), had a financial incentive worth 10 % of a worker’s salary (β = 0.39), rewarded attendance with credit towards promotion (β = 0.25) or placement in training (β = 0.14), and offered flexible work conditions (β = 0.14). Using latent class analysis, we identified two sub-groups of workers who differed in their willingness to accept a job and preferences over specific attributes, suggesting some may be more susceptible to feasible interventions to improve attendance. We argue that focusing on the needs of these groups may offer a path to incrementally, but sustainably, reduce absenteeism across the system. Our findings build on frameworks developed in anti-corruption research in other sectors only recently been applied to the health sector. The work represents some of the only empirical evidence to inform anti-corruption strategies in Nigeria and internationally, with findings relevant to other low- and middle-income countries seeking to combat absenteeism among primary health care workers

Absenteeism · Attendance · Business · Economic growth · Economics · Incentive · Psychological intervention · Public economics · Corruption and Economic Development · Global Maternal and Child Health · Healthcare Systems and Reforms · Medicine · Nursing · Psychology · Social Psychology

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