Article Text
Abstract
Background Published evidence on the drivers of absenteeism among the health workforce is mainly limited to high-income countries. Uganda suffers the highest rate of health workforce absenteeism in Africa, attracting attention but lacking a definitive ameliorative strategy. This study aimed to explore the underlying reasons for absenteeism in the public and private ‘not-for-profit’ health sector in rural Uganda.
Methods We undertook an empirical qualitative study, located within the critical realist paradigm. We used case study methodology as a sampling strategy, and principles of grounded theory for data collection and analysis. Ninety-five healthcare workers were recruited through focus groups and in-depth interviews. The NVivo V.10 software package was used for data management.
Results Healthcare workers’ absenteeism was explained by complex interrelated influences that could be seen to be both external to, and within, an individual’s motivation. External influences dominated in the public sector, especially health system factors, such as delayed or omitted salaries, weak workforce leadership and low financial allocation for workers’ accommodation. On the other hand, low staffing—particularly in the private sector—created work overload and stress. Also, socially constructed influences existed, such as the gendered nature of child and elderly care responsibilities, social class expectations and reported feigned sickness. Individually motivated absenteeism arose from perceptions of an inadequate salary, entitlement to absence, financial pressures heightening a desire to seek supplemental income, and educational opportunities, often without study leave.
Conclusion Health workforce managers and policy makers need to improve governance efficiencies and to seek learning opportunities across different health providers.
- health workforce
- absenteeism
- public sector
- private sector
- Uganda
This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
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Footnotes
Handling editor Stephanie M Topp
Twitter Raymond Tweheyo @RTweheyo.
Contributors RT conceptualised the study, carried out data collection and analysis, and was responsible for the write-up and drafts of the manuscript. CR, LD, GD-W, SK and SC refined the study concept, protocol and data collection methods, and read all versions of this manuscript. CR, GD-W and SC additionally took part in the analysis.
Funding This study is part of a PhD project funded by The University of Manchester President’s Doctoral Scholar Award. Additional research funding was obtained from the African Population and Health Research Council, APHRC (African Dissertation Doctoral Fellowship), as well as a research bursary from the Department of Health Policy Planning and Management of Makerere University School of Public Health, Uganda.
Competing interests None declared.
Patient consent Research consent forms were signed by participants. This was not an intervention, and it did not involve patients.
Ethics approval Ethics approvals were obtained from The University of Manchester Review Committee (Ref: Ethics/13212), Makerere University School of Public Health Higher Degrees and Ethics Review Committee (Ref: HDREC13/06/2014), and the Uganda National Council for Science and Technology (Ref: SS3522). Further permissions were sought from District Health Officers, and Medical Superintendents at hospitals. All participants provided written informed consent.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No additional data are available.