“I can’t kill myself”

Local narratives and meanings that foster absenteeism in Nigerian primary health centres

Bibliographic Data

ID19550295
AuthorsCharles T Orjiakor (0000-0001-5379-8915, University of Nigeria), Obinna Onwujekwe (0000-0002-1214-4285, University of Nigeria), Martin Mckee (0000-0002-0121-9683, London School of Hygiene & Tropical Medicine), Eleanor Hutchison (London School of Hygiene & Tropical Medicine), Prince Agwu (0000-0001-9224-7622, London School of Hygiene & Tropical Medicine), Dina Balabanova (0000-0001-7163-3428, London School of Hygiene & Tropical Medicine)
Year2023
Volume13
Pages04129-04129
Publication date2023-10-20
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueJournal of Global Health (JOURNAL)
Journal identifiersISSN: 2047-2978 • E-ISSN: 2047-2986
PublisherInternational Society of Global Health (PUBLISHER • GB)
DOI10.7189/jogh.13.04129
PMID37861129
OpenAlexW4387798821
LanguageEN
Citations received1
References cited22

Background: Absenteeism in the health sector is increasingly seen as a form of harmful rule-breaking, with health workers receiving a salary although they are not present to provide care. It is a barrier to achieving universal health coverage yet remains widespread in primary health centres (PHCs) in Nigeria and many other low-resource settings. Traditional approaches to combatting absenteeism have relied on anti-corruption measures such as promoting accountability and transparency. However, more needs to be understood about the social and cultural realities, including perceptions and norms enabling or constraining the application of such measures in Nigeria and in similar contexts. Methods: We conducted 34 in-depth interviews (IDIs) with frontline health workers and their managers/supervisors and two focus group discussions (FDGs) with service users (n = 22) in Enugu State, South Eastern Nigeria. We discussed their experiences and views about absenteeism, allowing the respondents' framings to emerge. We adopted a mixed approach of narrative analysis and phenomenology to examine respondents' narratives - identifying the concepts and social constructs within the narratives that manifested through the language used. Results: Stakeholders acknowledged the problem of absenteeism but had differing perspectives on its dynamics. Health workers distinguished two forms of absenteeism: one as a mundane, everyday response to the poorly funded health system; and the other, brazen and often politically enabled absenteeism, where health workers whom powerful politicians protect are absent without facing consequences. There is a general feeling of powerlessness among both health service providers and service users confronted by politically backed absentees as the power dynamics in the health sector resonate with experiences in other spheres of life in Nigeria. Health workers rationalised mundane, technical absenteeism, adjusted to it and felt it should be accommodated in the health system. Service users are often unsure about who is absent and why, but when they notice absenteeism, they often ascribe it to wider system malpractices that characterise public services. Conclusion: Interventions to tackle absenteeism and other forms of health sector corruption should be sensitive to socio-cultural and political contexts that shape everyday lives in specific contexts. Challenging narratives/beliefs that normalise absenteeism should be part of reform plans

Absenteeism · Accountability · Attendance · Focus group · Health care · Narrative · Political science · Public health · Public relations · Sociology · Global Maternal and Child Health · Healthcare Operations and Scheduling Optimization · Healthcare Systems and Reforms · Medicine · Nursing · Psychology · Social Psychology

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