Absenteeism in primary health centres in Nigeria

Leveraging power, politics and kinship

Bibliographic Data

ID21880253
AuthorsAloysius Odii (0000-0002-2222-0835, University of Nigeria, corresponding author), Obinna Onwujekwe (0000-0002-1214-4285, University of Nigeria), Eleanor Hutchinson (0000-0002-9718-2407, London School of Hygiene & Tropical Medicine), Prince Agwu (0000-0001-9224-7622, University of Nigeria), Charles T Orjiakor (0000-0001-5379-8915, University of Nigeria), Pamela Ogbozor (0000-0003-1343-1822, Enugu State University of Science and Technology), Pallavi Roy (0000-0001-8359-0883, SOAS University of London), Martin Mckee (0000-0002-0121-9683, London School of Hygiene & Tropical Medicine), Dina Balabanova (0000-0001-7163-3428, London School of Hygiene & Tropical Medicine)
Year2022
Volume7
Issue12
Pagese010542
Publication date2022-12-01
Peer ReviewedYes
Open AccessYes
TypeARTICLE
VenueBMJ Global Health (JOURNAL)
Journal identifiersISSN: 2059-7908 • E-ISSN: 2059-7908
PublisherBMJ (PUBLISHER • GB)
DOI10.1136/bmjgh-2022-010542
PMID36593645
OpenAlexW4310809570
LanguageEN
Citations received7
References cited29

BACKGROUND: Primary health centres (PHCs) in Nigeria suffer critical shortages of health workers, aggravated by chronic absenteeism that has been attributed to insufficient resources to govern the system and adequately meet their welfare needs. However, the political drivers of this phenomenon are rarely considered. We have asked how political power and networks influence absenteeism in the Nigerian health sector, information that can inform the development of holistic solutions. METHODS: Data were obtained from in-depth interviews with three health administrators, 30 health workers and 6 health facility committee chairmen in 15 PHCs in Enugu State, Nigeria. Our analysis explored how political configurations and the resulting distribution of power influence absenteeism in Nigeria's health systems. RESULTS: We found that health workers leverage social networks with powerful and politically connected individuals to be absent from duty and escape sanctions. This reflects the dominant political settlement. Thus, the formal governance structures that are meant to regulate the operations of the health system are weak, thereby allowing powerful individuals to exert influence using informal means. As a result, health managers do not confront absentees who have a relationship with political actors for fear of repercussions, including retaliation through informal pressure. In addition, we found that while health system structures cannot effectively handle widespread absenteeism, networks of local actors, when interested and involved, could address absenteeism by enabling health managers to call politically connected staff to order. CONCLUSION: The formal governance mechanisms to reduce absenteeism are insufficient, and building alliances (often informal) with local elites interested in improving service delivery locally may help to reduce interference by other powerful actors

Absenteeism · Business · Corporate governance · Economic growth · Economics · Environmental health · Health facility · Health services · Political science · Politics · Population · Public relations · Global Maternal and Child Health · Healthcare Operations and Scheduling Optimization · Healthcare Systems and Reforms · Medicine · Psychology · Social Psychology · Finance