Analysis of Absenteeism Among Health Workers in Public Primary Health Facilities, Mbale District, Uganda.

Abstract

Introduction: The study of health workers absenteeism in public primary health facilities in Mbale District draws findings from unannounced visits of 26 public primary health facilities. The Health facilities were visited thrice a week: Monday, Wednesday, and Friday at 9.00 AM in the morning and 3.00 PM in the afternoon each day.

The main objective of the study: was to analyze absenteeism among health workers in public health facilities. The specific objectives were to determine the prevalence of absenteeism among health workers in 2013, determine the factors associated with absenteeism and to estimate the financial losses incurred by Mbale District Local Government due to payment of salaries to absent health workers in public health facilities.

Methodology: A total of 154 health workers out of 404 (38.1%) were followed. In-depth interviews with senior district government Officials, health facility managers, and health workers were conducted to generate qualitative data that was used to substantiate and triangulate quantitative findings. Review of available literature and documents on absenteeism were conducted to substantiate the findings.

Results: The overall absenteeism rate was 46%. Wide variation was observed within the three days of the week and among professional cadres. Absenteeism rate was highest (61%) on Friday afternoon. Doctors had 100% absenteeism rate. Health workers at HCIVs were more likely to be absent from their health facilities compared to those in lower health facilities. The study established that gender was the only statistically significant factor. However, other factors associated to health workers absenteeism elicited during in-depth interviews include lack of accommodation at the health facilities leading to high transport fees incurred by health workers to and from the health facility, low salary coupled with irregular pay of the salaries. These factors were not any different from those hygiene and motivators described by Herzberg (1959). It was established that Mbale District Local Government loses a significant amount of funds worth USD 322,962(UGX 82,405,000) to payment of absent health workers. This money could pay the salary of Mbale Municipal health workers for a year.

Conclusion and recommendations: Absenteeism is more than a human resources issue. It costs Mbale District Local Government millions of money each year. Unless the government starts pro-actively addressing absenteeism, lots of money will be wasted. The Ministry of Health needs to consider implementing performance- based financing, increase the frequency of supportive supervision; internal and external, strengthen control measures like the use of attendance registers, and improve on the incentives and remuneration to health workers. In conclusion, health worker absenteeism in Mbale District is likely to exacerbate human resources for health insufficiencies and undermine demand for, quality of and efficiency of delivery of health services.