Unpaid family responsibilities and absenteeism among health workers in primary healthcare centres in Enugu state, Nigeria: Does location of health facility matter?

Chukwudi Nwokolo, Obinna Onwujekwe, Divine Ndubuisi Obodoechi, Martin McKee, Blake Angell, Prince Agwu, Charles Orjiakor, Aloysius Odii, Eleanor Hutchinson, Dina Balabanova

Research output: Working paper/PreprintPreprint


Introduction: The high rate of absenteeism among health workers (especially those in primary healthcare) has become an issue of significant concern in Nigeria. It was estimated that 34% of staff are absent at any time, with substantial consequences for their ability to deliver safe and effective care. The available literature points to a diverse range of factors associated with absenteeism but one that has received less attention than others is the role of unpaid family responsibilities, which might be expected to vary with location of the facility. We examined the influence of unpaid family responsibilities on absenteeism among health workers and its interaction with urban and rural location.

Method: The study was undertaken in Enugu state, southeast Nigeria using a cross sectional survey, which included 412 health workers that work in primary healthcare (PHC) facilities. Data were collected using an interviewer-administered questionnaire. The study used the revised Steers and Rhodes (1990) model of absenteeism, with binary logistic regression to examine the associations between absenteeism and unpaid family responsibilities capturing the interaction of location and unpaid family role.

Results: Unpaid family responsibilities exhibit a positive but insignificant relationship with absenteeism. The same positive and insignificant relationship was found with rural location. However, when adjusted for location, unpaid family responsibilities significantly (p = 0.01) increased the probability of a health worker engaging in absenteeism by (26%). Also, health workers who live in the accommodation provided by facilities are significantly less likely to be absent. More so, health workers who perceive their workload to be manageable are significantly less likely to engage in absenteeism than those who perceive it to be occasionally too much but manageable and not manageable.

Conclusion: There are few strategies that have been successful in addressing absenteeism especially in acknowledging causes that lie outside the health system. Unpaid family responsibilities and location of health facility independently increases absenteeism but their effects were not significant, however when the two are interacted, there is a significant positive effect which was traced to the positive association between rural location and absenteeism. These findings point to the potential to reduce absenteeism by finding new ways to support staff, such as offering flexibility to allow them to take care of family responsibilities and by better provision of health worker accommodation in rural areas by host communities.
Original languageEnglish
PublisherResearch Square
Publication statusPublished - 29 Aug 2022


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