Article Text

Download PDFPDF

‘I have no love for such people, because they leave us to suffer’: a qualitative study of health workers’ responses and institutional adaptations to absenteeism in rural Uganda
  1. Raymond Tweheyo1,2,
  2. Catherine Reed3,
  3. Stephen Campbell2,
  4. Linda Davies4,
  5. Gavin Daker-White2
  1. 1Department of Public Health, Lira University, Lira, Uganda
  2. 2Centre for Primary Care, Division of Population Health, The University of Manchester, Manchester, UK
  3. 3Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
  4. 4Centre for Health Economics, Division of Population Health, The University of Manchester, Manchester, UK
  1. Correspondence to Dr Raymond Tweheyo; ratweheyo{at}


Background Achieving positive treatment outcomes and patient safety are critical goals of the healthcare system. However, this is greatly undermined by near universal health workforce absenteeism, especially in public health facilities of rural Uganda. We investigated the coping adaptations and related consequences of health workforce absenteeism in public and private not-for-profit (PNFP) health facilities of rural Uganda.

Methods An empirical qualitative study involving case study methodology for sampling and principles of grounded theory for data collection and analysis. Focus groups and in-depth interviews were used to interview a total of 95 healthcare workers (11 supervisors and 84 frontline workers). The NVivo V.10 QSR software package was used for data management.

Results There was tolerance of absenteeism in both the public and PNFP sectors, more so for clinicians and managers. Coping strategies varied according to the type of health facility. A majority of the PNFP participants reported emotion-focused reactions. These included unplanned work overload, stress, resulting anger directed towards coworkers and patients, shortening of consultation times and retaliatory absence. On the other hand, various cadres of public health facility participants reported ineffective problem-solving adaptations. These included altering weekly schedules, differing patient appointments, impeding absence monitoring registers, offering unnecessary patient referrals and rampant unsupervised informal task shifting from clinicians to nurses.

Conclusion High levels of absenteeism attributed to clinicians and health service managers result in work overload and stress for frontline health workers, and unsupervised informal task shifting of clinical workload to nurses, who are the less clinically skilled. In resource-limited settings, the underlying causes of absenteeism and low staff morale require attention, because when left unattended, the coping responses to absenteeism can be seen to compromise the well-being of the workforce, the quality of healthcare and patients’ access to care.

  • absenteeism
  • coping
  • health workforce governance
  • quality of care
  • public health sector
  • PNFP health sector (PNFP)
  • 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, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

View Full Text

Statistics from


  • Handling editor Seye Abimbola

  • Twitter Follow Raymond Tweheyo @RTweheyo

  • Contributors RT conceptualised the study, conducted data collection, analysis and drafted all versions of the manuscript. versions. GD-W, LD, SC and CR refined the study protocol, the data collection methods, participated in the analysis and read all versions of this manuscript.

  • Funding This study is part of a PhD which was funded by The University of Manchester President’s Doctoral Scholar Award. Additional research funding was obtained from the African Population and Health Research Council, Kenya (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 for publication Not required.

  • Ethics approval The University of Manchester Review Committee (Ethics/13212), Makerere University School of Public Health Higher Degrees and Ethics Review Committee (HDREC13/06/2014) and the Uganda National Council for Science and Technology (SS3522).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data are available upon reasonable request.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.