health worker absenteeism in selected health facilities in enugu state do internal CORD-Papers-2022-06-02 (Version 1)

Title: Health Worker Absenteeism in Selected Health Facilities in Enugu State: Do Internal and External Supervision Matter?
Abstract: Background: Absenteeism is widespread in Nigerian health facilities and is a major barrier to achievement of effective Universal Health Coverage. We have examined the role of internal (by managerial staff within facilities) and external (by managers at a higher level) supervision arrangements on health worker absenteeism. Specifically we sought to determine whether these forms of supervision have any role to play in reducing health worker absenteeism in health facilities in Enugu State Nigeria. Methods: We conducted interviews with 412 health workers in urban and rural areas of Enugu State in South-Eastern Nigeria. We used binary logistic regression to estimate the role of different types of supervision on health worker absenteeism in selected health facilities in Enugu State. Results: Internal supervision arrangements significantly reduce health worker absenteeism (odds ratio = 0.516 p = 0.03). In contrast existing external supervision arrangements were associated with a small but significant increase in absenteeism (OR = 1.02 0.043). Those reporting a better financial situation were more likely to report being absent (OR = 1.36 p < 0.01) but there was no association with age and marital status of respondents. Our findings also pointed to the potential for alternative forms of supervision provided in a supportive rather than punitive way for example by community groups monitoring the activities of health workers but trying to understand what support these workers may need within or beyond the work environment. Conclusion: The existing system of external supervision of absenteeism in health facilities in Nigeria is not working but alternatives that take a more holistic approach to the lived experiences of health workers might offer an alternative.
Published: 2021-10-11
Journal: Front Public Health
DOI: 10.3389/fpubh.2021.752932
DOI_URL: http://doi.org/10.3389/fpubh.2021.752932
Author Name: Obodoechi Divine Ndubuisi
Author link: https://covid19-data.nist.gov/pid/rest/local/author/obodoechi_divine_ndubuisi
Author Name: Onwujekwe Obinna
Author link: https://covid19-data.nist.gov/pid/rest/local/author/onwujekwe_obinna
Author Name: McKee Martin
Author link: https://covid19-data.nist.gov/pid/rest/local/author/mckee_martin
Author Name: Angell Blake
Author link: https://covid19-data.nist.gov/pid/rest/local/author/angell_blake
Author Name: Agwu Prince
Author link: https://covid19-data.nist.gov/pid/rest/local/author/agwu_prince
Author Name: Orjiakor Charles
Author link: https://covid19-data.nist.gov/pid/rest/local/author/orjiakor_charles
Author Name: Nwokolo Chukwudi
Author link: https://covid19-data.nist.gov/pid/rest/local/author/nwokolo_chukwudi
Author Name: Odii Aloysius
Author link: https://covid19-data.nist.gov/pid/rest/local/author/odii_aloysius
Author Name: Hutchinson Eleanor
Author link: https://covid19-data.nist.gov/pid/rest/local/author/hutchinson_eleanor
Author Name: Balabanova Dina
Author link: https://covid19-data.nist.gov/pid/rest/local/author/balabanova_dina
sha: 38a1acd63b493bd6d941c97bcf3c1295cbade148
license: cc-by
license_url: https://creativecommons.org/licenses/by/4.0/
source_x: Medline; PMC
source_x_url: https://www.medline.com/https://www.ncbi.nlm.nih.gov/pubmed/
pubmed_id: 34708020
pubmed_id_url: https://www.ncbi.nlm.nih.gov/pubmed/34708020
pmcid: PMC8542720
pmcid_url: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8542720
url: https://www.ncbi.nlm.nih.gov/pubmed/34708020/ https://doi.org/10.3389/fpubh.2021.752932
has_full_text: TRUE
Keywords Extracted from Text Content: Onwujekwe women patients non-government organizations respondents handsanitizers CHEWs PPE Ndubuisi Obodoechi 1,032,297 CN Agwu OO COVID-19 UNICEF BA, DO DO Covid-19 PA Met ESPHDA matrix Crigler OICs PHCs senior/higher −12.1 Orjiakor Nwokolo Obodoechi Onwujekwe Agwu ACKNOWLEDGMENTS I Odii
Extracted Text Content in Record: First 5000 Characters:Background: Absenteeism is widespread in Nigerian health facilities and is a major barrier to achievement of effective Universal Health Coverage. We have examined the role of internal (by managerial staff within facilities) and external (by managers at a higher level) supervision arrangements on health worker absenteeism. Specifically, we sought to determine whether these forms of supervision have any role to play in reducing health worker absenteeism in health facilities in Enugu State Nigeria. Methods: We conducted interviews with 412 health workers in urban and rural areas of Enugu State, in South-Eastern Nigeria. We used binary logistic regression to estimate the role of different types of supervision on health worker absenteeism in selected health facilities in Enugu State. Internal supervision arrangements significantly reduce health worker absenteeism (odds ratio = 0.516, p = 0.03). In contrast, existing external supervision arrangements were associated with a small but significant increase in absenteeism (OR = 1.02, 0.043). Those reporting a better financial situation were more likely to report being absent (OR = 1.36, p < 0.01) but there was no association with age and marital status of respondents. Our findings also pointed to the potential for alternative forms of supervision, provided in a supportive rather than punitive way, for example by community groups monitoring the activities of health workers but trying to understand what support these workers may need, within or beyond the work environment. Conclusion: The existing system of external supervision of absenteeism in health facilities in Nigeria is not working but alternatives that take a more holistic approach to the lived experiences of health workers might offer an alternative. Absenteeism is a major problem in health systems worldwide. For example, it has been linked to the annual loss of 2 weeks of work in Organization for Economic Co-operation and Development (OECD) countries (1) . However, the problem seems even greater in low-and middle-income countries, with severe consequences for already weak health systems (2) (3) (4) (5) . This is especially so in the public primary healthcare facilities on which the poor often depend. Thus, absenteeism is a major barrier to achievement of Universal Health Coverage (UHC). Health worker absenteeism is attracting growing concern amongst service users and policy makers, concerned about the consequences for health outcomes and productivity (6, 7) . This is especially so in Nigeria, where it is recognized by key stakeholders as the most important manifestation of corruption in the health system because of its widespread nature and its ability to impact service delivery and other health outcomes (8) . A Nigerian study of 242 health workers found that 110 had at least one spell of absence in a year (9) , while qualitative research finds it to be pervasive (5, 10, 11) . Other research has pointed to lack of, or weak policies, including on supervision, the topic of this paper, as a major contributor (10) . The Covid-19 pandemic has extremely strained health workers involvement in providing health care all over the world. However, in Nigeria it didn't contributed much to absenteeism of health workers as most of them were very present at work delivering various health care to patients while protecting themselves. This is expected because by their profession, it is an obligation for them to be present at their places of work even if their health is at risk. During this study, most of them were present and work various shifts to meet up with various health care demands. Nevertheless, various PPE were provided to keep health workers safe at all times during the pandemic. Within facilities, absenteeism has profound consequences for everyone involved. Those health workers who are present face extra work; they may have to perform tasks above their level of competence; facilities may depend on volunteers to provide services, and ultimately, patients are offered low-quality care, if they receive any at all (5, 11) . As more health workers can be absent from work without facing severe consequences, those who are diligent in their work become increasingly frustrated and may, with time, engage in absenteeism (12) . Health workers expressed basically that most of them are affected by negative pressures from unavoidable causes such as ill health, long distances to health facilities, family responsibilities, leadership style of their superiors, political connections among others (13). Financial pressures necessitating workers to keep a second job is also a major reason for absenteeism among health workers. The phenomenon of dual practice of health workers is a key driver to absenteeism, hence holding two or more jobs concurrently as a means to meet family demands and also make up for low salaries (14) . For all these reasons, there is a pressing need to understand factors that could reduce absenteeism by health worker.
Keywords Extracted from PMC Text: senior/higher women PPE hand-sanitizers Onwujekwe COVID-19 non-government organizations ESPHDA OO OICs " Ndubuisi Obodoechi respondents low- PHCs CN Crigler DO BA, DO matrix patients UNICEF −12.1 Agwu Met PA Covid-19 CHEWs 1,032,297
Extracted PMC Text Content in Record: First 5000 Characters:Absenteeism is a major problem in health systems worldwide. For example, it has been linked to the annual loss of 2 weeks of work in Organization for Economic Co-operation and Development (OECD) countries (1). However, the problem seems even greater in low- and middle-income countries, with severe consequences for already weak health systems (2–5). This is especially so in the public primary healthcare facilities on which the poor often depend. Thus, absenteeism is a major barrier to achievement of Universal Health Coverage (UHC). Health worker absenteeism is attracting growing concern amongst service users and policy makers, concerned about the consequences for health outcomes and productivity (6, 7). This is especially so in Nigeria, where it is recognized by key stakeholders as the most important manifestation of corruption in the health system because of its widespread nature and its ability to impact service delivery and other health outcomes (8). A Nigerian study of 242 health workers found that 110 had at least one spell of absence in a year (9), while qualitative research finds it to be pervasive (5, 10, 11). Other research has pointed to lack of, or weak policies, including on supervision, the topic of this paper, as a major contributor (10). The Covid-19 pandemic has extremely strained health workers involvement in providing health care all over the world. However, in Nigeria it didn't contributed much to absenteeism of health workers as most of them were very present at work delivering various health care to patients while protecting themselves. This is expected because by their profession, it is an obligation for them to be present at their places of work even if their health is at risk. During this study, most of them were present and work various shifts to meet up with various health care demands. Nevertheless, various PPE were provided to keep health workers safe at all times during the pandemic. Within facilities, absenteeism has profound consequences for everyone involved. Those health workers who are present face extra work; they may have to perform tasks above their level of competence; facilities may depend on volunteers to provide services, and ultimately, patients are offered low-quality care, if they receive any at all (5, 11). As more health workers can be absent from work without facing severe consequences, those who are diligent in their work become increasingly frustrated and may, with time, engage in absenteeism (12). Health workers expressed basically that most of them are affected by negative pressures from unavoidable causes such as ill health, long distances to health facilities, family responsibilities, leadership style of their superiors, political connections among others (13). Financial pressures necessitating workers to keep a second job is also a major reason for absenteeism among health workers. The phenomenon of dual practice of health workers is a key driver to absenteeism, hence holding two or more jobs concurrently as a means to meet family demands and also make up for low salaries (14). For all these reasons, there is a pressing need to understand factors that could reduce absenteeism by health worker. Among these factors, much attention has focused on the quality and nature of supervision, which influences the productivity and quality of care in PHCs more generally (12, 15, 16). However, what literature exists focuses on comparisons between supportive and abusive supervision (17, 18). In the current study we examine the association with absenteeism with supervision of health workers by internal health facility managers and by external supervisors, who often come unannounced. We consider these two dimensions to explore the proximity and perceptions toward the supervisor (internal vs. external) and how they contribute toward reducing absenteeism. Supervisors support Community Health Extension Workers (CHEWs) by explaining their roles, ensuring they have the supplies needed to perform their duties effectively, and addressing any community and personal problems they encounter (19). While there is a consensus in the literature on health worker absenteeism that improved supervision is needed, evidence on its impact has been inconsistent. One study found that external supervision had mixed influences as some workers (62%) perceived it to be helpful in, amongst other things, improving supplies, identifying expired drugs, and providing on-the job training, yet other workers (24%) found external supervisors to be uninterested in the problems of the facility, making only infrequent visits (20). Hence, poor supervision may be as ineffective as none (21). Crigler et al. (19) reported how supervision had evolved from punitive and critical of those being supervised to being facilitative or supportive. However, they also differentiated facility-based supervision and that by district level supervisors. Mukasa et al. (22) in researching experiences of health workers in Uganda repo
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