ArticleBMJ global health2017
'Nobody is after you; it is your initiative to start work': a qualitative study of health workforce absenteeism in rural Uganda.
Article in BMJ global health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 28 papers.
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Who cites it
28 citing papers in PubMed.
- Sustainability capacity and health worker normalisation of a successful non-communicable disease (NCD) health systems intervention within primary care settings in Uganda: a quantitative approach to a qualitative question.BMC health services research · 2023Trial
- Exploring the facilitators and barriers to achieving universal health coverage in Uganda: a qualitative study of the free healthcare policy.Health research policy and systems · 2025Article
- Absenteeism of Healthcare Workers in Primary Healthcare in Sub-Saharan Africa: A Scoping Review.The International journal of health planning and management · 2025Article
- Childhood Cancer Awareness Program in Bungoma County, Kenya.Journal of cancer education : the official journal of the American Association for Cancer Education · 2025Article
- Beyond facility-based births: Is Uganda delivering effective maternal and newborn care? An analysis of the 2022 demographic health survey and 2023 harmonized health facility assessment survey.PLOS global public health · 2025Article
- Review
- Public service motivation, public sector preference and employment of Kenyan medical doctor interns: a cross-sectional and prospective study.Human resources for health · 2024Article
- Deconcentrating regulation in low- and middle-income country health systems: a proposed ambidextrous solution to problems with professional regulation for doctors and nurses in Kenya and Uganda.Human resources for health · 2024Article
- Factors associated with perceived work-life balance among health workers in Gulu District, Northern Uganda: a health facility-based cross-sectional study.BMC public health · 2024Article
- Antimicrobial stewardship in private pharmacies in Wakiso district, Uganda: a qualitative study.Journal of pharmaceutical policy and practice · 2023Article
- "I can't kill myself": Local narratives and meanings that foster absenteeism in Nigerian primary health centres.Journal of global health · 2023Article
- Patient and health worker perspectives on quality of HIV care and treatment services in Haiti.BMC health services research · 2023Article
- The gendered drivers of absenteeism in the Nigerian health system.Health policy and planning · 2022Article
- Leveraging mHealth usage logs to inform health worker performance in a Resource-Limited setting: Case example of mUzima use for a chronic disease program in Western Kenya.PLOS digital health · 2022Article
- How are health workers paid and does it matter? Conceptualising the potential implications of digitising health worker payments.BMJ global health · 2022Article
- Corruption in the health sector: A problem in need of a systems-thinking approach.Frontiers in public health · 2022Review
- Provision of cervical cancer prevention services in Northern Uganda: a survey of health workers from rural health centres.BMC health services research · 2021Article
- Infant malnutrition treatment in Kenya: Health worker and breastfeeding peer supporter experiences.Maternal & child nutrition · 2021Article
- Towards an Explanation of the Social Value of Health Systems: An Interpretive Synthesis.International journal of health policy and management · 2021Article
- Retention of healthcare workers 1 year after recruitment and deployment in rural settings: an experience post-Ebola in five health districts in Guinea.Human resources for health · 2021Article
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Authors and funding
6 authors.
Funding
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Abstract
backgroundPublished 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.
methodsWe 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.
resultsHealthcare 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.
conclusionHealth workforce managers and policy makers need to improve governance efficiencies and to seek learning opportunities across different health providers.
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