Who is absent and why? Factors affecting doctor absenteeism in Bangladesh

Bibliographic Data

ID19592014
AuthorsMir Raihanul Islam (0000-0003-2125-2218, corresponding author), Blake Angell (0000-0002-7188-7740, UNSW Sydney, corresponding author), Nahitun Naher (0000-0002-7593-8613, BRAC University, corresponding author), Bushra Zarin Islam (0000-0002-9988-7558, University of Massachusetts Amherst, corresponding author), Mushtaq Husain Khan (0000-0002-0813-2548), Martin Mckee (0000-0002-0121-9683, London School of Hygiene & Tropical Medicine, corresponding author), Eleanor Hutchinson (0000-0002-9718-2407, London School of Hygiene & Tropical Medicine, corresponding author), Dina Balabanova (0000-0001-7163-3428, London School of Hygiene & Tropical Medicine, corresponding author), Sayed M Ahmed (0000-0001-5032-7181, BRAC University, corresponding author)
EditorsVeena Sriram (0000-0002-7465-5881)
Year2024
Volume4
Issue4
Pagese0003040
Publication date2024-04-04
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenuePLOS Global Public Health (JOURNAL)
Journal identifiersISSN: 2767-3375 • E-ISSN: 2767-3375
PublisherPublic Library of Science (PLoS) (PUBLISHER)
DOI10.1371/journal.pgph.0003040
PMID38574057
OpenAlexW4393951758
LanguageEN
References cited21

Absenteeism by doctors in public healthcare facilities in rural Bangladesh is a form of chronic rule-breaking and is recognised as a critical problem by the government. We explored the factors underlying this phenomenon from doctors’ perspectives. We conducted a facility-based cross-sectional survey in four government hospitals in Dhaka, Bangladesh. Junior doctors with experience in rural postings were interviewed to collect data on socio-demographic characteristics, work and living experience at the rural facilities, and associations with professional and social networks. Multiple logistic regression was used to determine the factors associated with rural retention. Of 308 respondents, 74% reported having served each term of their rural postings without interruptions. The main reasons for absenteeism reported by those who interrupted rural postings were formal training opportunities (65%), family commitments (41%), and a miscellaneous group of others (17%). Almost half of the respondents reported unmanageable workloads. Most (96%) faced challenges in their last rural posting, such as physically unsafe environments (70%), verbally abusive behaviour by patients/caregivers (67%) and absenteeism by colleagues that impacted them (48%). Respondents who did not serve their entire rural posting were less likely to report an unmanageable workload than respondents who did (AOR 0.39, 95% CI 0.22–0.70). Respondents with connections to influential people in the local community had a 2.4 times higher chance of serving in rural facilities without interruption than others (AOR 2.40, 95% CI 1.26–4.57). Our findings demonstrate that absenteeism is not universal and depends upon doctors’ socio-political networks. Policy interventions rarely target unsupportive or threatening behaviour by caregivers and community members, a pivotal disincentive to doctors’ willingness to work in underserved rural areas. Policy responses must promote opportunities for doctors with weak networks who are willing to attend work with appropriate support

Absenteeism · Cross-sectional study · Environmental health · Logistic regression · Public health · Rural area · Socioeconomics · Sociology · Workload · Global Health Workforce Issues · Global Maternal and Child Health · Healthcare Policy and Management · Medicine · Nursing · Psychology · Social Psychology