‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
BMJ Global Health
Abstract
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. Ninetyfive
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.
Description
Keywords
Nobody, Work, Qualitative study, Health workforce absenteeism, Rural Uganda
Citation
Tweheyo R, Daker-White G, Reed C, et al. ‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda. BMJ Glob Health 2017;2:e000455. doi:10.1136/ bmjgh-2017-000455