Private money-making indulgence and inefficiency of primary healthcare in Nigeria: a qualitative study of health workers’ absenteeism

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Abstract

Objectives

Generating additional personal income is common with primary healthcare (PHC) workforce in Nigeria, which could be because of the inconsistencies marring their monthly salaries. Therefore, this study investigates the drivers of private economic activities of PHC providers in the public sector, and the links to absenteeism, as well as inefficiency of PHC facilities in Nigeria.

Methods

A qualitative study design was used to collect data from 30 key-informants using in-depth interviews. They were selected from 5 PHC facilities across three local government areas in Enugu state, south-eastern Nigeria. Data were analysed thematically, and guided by phenomenology.

Results

Findings showed that majority of the health workers were involved in different private money-making activities. A main driver was inconsistencies in salaries, which makes it difficult for them to routinely meet their personal and household needs. As a result, PHC facilities were found less functional.

Conclusions

Absenteeism of PHC providers can be addressed if efforts are made to close justifiable gaps that cause health workers to struggle informally. Such lesson can be instructive to low- and middle-income countries in strengthening their health systems.

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Most cited references 12

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Health workforce and governance: the crisis in Nigeria

Davies Adeloye, Rotimi Adedeji David, Adenike Ayobola Olaogun … (2017)

Background In Nigeria, several challenges have been reported within the health sector, especially in training, funding, employment, and deployment of the health workforce. We aimed to review recent health workforce crises in the Nigerian health sector to identify key underlying causes and provide recommendations toward preventing and/or managing potential future crises in Nigeria. Methods We conducted a scoping literature search of PubMed to identify studies on health workforce and health governance in Nigeria. A critical analysis, with extended commentary, on recent health workforce crises (2010–2016) and the health system in Nigeria was conducted. Results The Nigerian health system is relatively weak, and there is yet a coordinated response across the country. A number of health workforce crises have been reported in recent times due to several months’ salaries owed, poor welfare, lack of appropriate health facilities and emerging factions among health workers. Poor administration and response across different levels of government have played contributory roles to further internal crises among health workers, with different factions engaged in protracted supremacy challenge. These crises have consequently prevented optimal healthcare delivery to the Nigerian population. Conclusions An encompassing stakeholders’ forum in the Nigerian health sector remain essential. The national health system needs a solid administrative policy foundation that allows coordination of priorities and partnerships in the health workforce and among various stakeholders. It is hoped that this paper may prompt relevant reforms in health workforce and governance in Nigeria toward better health service delivery in the country.

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Absenteeism amongst health workers – developing a typology to support empiric work in low-income countries and characterizing reported associations

Alice Belita, Patrick Mbindyo, Mike English (2013)

The contribution of inadequate health worker numbers and emigration have been highlighted in the international literature, but relatively little attention has been paid to absenteeism as a factor that undermines health-care delivery in low income countries. We therefore aimed to review the literature on absenteeism from a health system manager’s perspective to inform needed work on this topic. Specifically, we aimed to develop a typology of definitions that might be useful to classify different forms of absenteeism and identify factors associated with absenteeism. Sixty-nine studies were reviewed, only four were from sub-Saharan Africa where the human resources for health crisis is most acute. Forms of absenteeism studied and methods used vary widely. No previous attempt to develop an overarching approach to classifying forms of absenteeism was identified. A typology based on key characteristics is proposed to fill this gap and considers absenteeism as defined by two key attributes, whether it is: planned/unplanned, and voluntary/involuntary. Factors reported to influence rates of absenteeism may be broadly classified into three thematic categories: workplace and content, personal and organizational and cultural factors. The literature presents an inconsistent picture of the effects of specific factors within these themes perhaps related to true contextual differences or inconsistent definitions of absenteeism.

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Corruption in Anglophone West Africa health systems: a systematic review of its different variants and the factors that sustain them

Obinna Onwujekwe, Prince Agwu, Charles Orjiakor … (2019)

Abstract West African countries are ranked especially low in global corruption perception indexes. The health sector is often singled out for particular concern given the role of corruption in hampering access to, and utilization of health services, representing a major barrier to progress to universal health coverage and to achieving the health-related Sustainable Development Goals. The first step in tackling corruption systematically is to understand its scale and nature. We present a systematic review of literature that explores corruption involving front-line healthcare providers, their managers and other stakeholders in health sectors in the five Anglophone West African (AWA) countries: Gambia, Ghana, Liberia, Nigeria and Sierra Leone, identifying motivators and drivers of corrupt practices and interventions that have been adopted or proposed. Boolean operators were adopted to optimize search outputs and identify relevant studies. Both grey and published literature were identified from Research Gate, Yahoo, Google Scholar, Google and PubMed, and reviewed and synthesized around key domains, with 61 publications meeting our inclusion criteria. The top five most prevalent/frequently reported corrupt practices were (1) absenteeism; (2) diversion of patients to private facilities; (3) inappropriate procurement; (4) informal payments; and (5) theft of drugs and supplies. Incentives for corrupt practices and other manifestations of corruption in the AWA health sector were also highlighted, while poor working conditions and low wages fuel malpractice. Primary research on anti-corruption strategies in health sectors in AWA remains scarce, with recommendations to curb corrupt practices often drawn from personal views and experience rather that of rigorous studies. We argue that a nuanced understanding of all types of corruption and their impacts is an important precondition to designing viable contextually appropriate anti-corruption strategies. It is a particular challenge to identify and tackle corruption in settings where formal rules are fluid or insufficiently enforced.

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Author and article information

Contributors

Prince Agwu:

ORCID: http://orcid.org/0000-0001-9224-7622

prince.agwu@unn.edu.ng

Journal

Journal ID (nlm-ta): Int J Public Health

Journal ID (iso-abbrev): Int J Public Health

Title: International Journal of Public Health

Publisher: Springer International Publishing (Cham )

ISSN (Print): 1661-8556

ISSN (Electronic): 1661-8564

Publication date (Electronic): 25 August 2020

Publication date PMC-release: 25 August 2020

Publication date (Print): 2020

Volume: 65

Issue: 7

Pages: 1019-1026

Affiliations

[1 ]GRID grid.10757.34, ISNI 0000 0001 2108 8257, Department of Social Work, , University of Nigeria, Nsukka, ; Nsukka, Nigeria

[2 ]GRID grid.10757.34, ISNI 0000 0001 2108 8257, Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, , University of Nigeria, ; Nsukka, Nigeria

[3 ]GRID grid.10757.34, ISNI 0000 0001 2108 8257, Department of Psychology, , University of Nigeria, Nsukka, ; Nsukka, Nigeria

[4 ]GRID grid.10757.34, ISNI 0000 0001 2108 8257, Department of Sociology and Anthropology, , University of Nigeria, Nsukka, ; Nsukka, Nigeria

[5 ]GRID grid.10757.34, ISNI 0000 0001 2108 8257, Department of Health Administration and Management, , University of Nigeria, ; Enugu Campus, Nsukka, Nigeria

[6 ]GRID grid.442535.1, ISNI 0000 0001 0709 4853, Department of Psychology, , Enugu State University of Science and Technology, ; Enugu, Nigeria

Author information

Prince Agwu http://orcid.org/0000-0001-9224-7622

Article

Publisher ID: 1405

DOI: 10.1007/s00038-020-01405-3

PMC ID: 7497334

PubMed ID: 32840632

SO-VID: 95e13ad7-fe53-476a-9cb8-bed3d00abd4d

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 2 February 2020

Date revision received : 27 May 2020

Date accepted : 7 June 2020

Funding

Funded by: UK Aid

Award ID: P0 7073

Award Recipient : Obinna Onwujekwe

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ScienceOpen disciplines: Public health

Keywords: absenteeism,primary healthcare,informal jobs,corruption,market forces,money-making activities

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ScienceOpen disciplines: Public health

Keywords: absenteeism, primary healthcare, informal jobs, corruption, market forces, money-making activities

Private money-making indulgence and inefficiency of primary healthcare in Nigeria: a qualitative study of health workers’ absenteeism

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Global Health Next Generation Network

Most cited references 12

Health workforce and governance: the crisis in Nigeria

Absenteeism amongst health workers – developing a typology to support empiric work in low-income countries and characterizing reported associations

Corruption in Anglophone West Africa health systems: a systematic review of its different variants and the factors that sustain them

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