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‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda

BACKGROUND: 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 expl...

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Autores principales: Tweheyo, Raymond, Daker-White, Gavin, Reed, Catherine, Davies, Linda, Kiwanuka, Suzanne, Campbell, Stephen
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841506/
https://www.ncbi.nlm.nih.gov/pubmed/29527333
http://dx.doi.org/10.1136/bmjgh-2017-000455
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author Tweheyo, Raymond
Daker-White, Gavin
Reed, Catherine
Davies, Linda
Kiwanuka, Suzanne
Campbell, Stephen
author_facet Tweheyo, Raymond
Daker-White, Gavin
Reed, Catherine
Davies, Linda
Kiwanuka, Suzanne
Campbell, Stephen
author_sort Tweheyo, Raymond
collection PubMed
description BACKGROUND: 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. Ninety-five 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.
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spelling pubmed-58415062018-03-09 ‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda Tweheyo, Raymond Daker-White, Gavin Reed, Catherine Davies, Linda Kiwanuka, Suzanne Campbell, Stephen BMJ Glob Health Research BACKGROUND: 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. Ninety-five 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. BMJ Publishing Group 2017-12-29 /pmc/articles/PMC5841506/ /pubmed/29527333 http://dx.doi.org/10.1136/bmjgh-2017-000455 Text en © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. 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 and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
spellingShingle Research
Tweheyo, Raymond
Daker-White, Gavin
Reed, Catherine
Davies, Linda
Kiwanuka, Suzanne
Campbell, Stephen
‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda
title ‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda
title_full ‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda
title_fullStr ‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda
title_full_unstemmed ‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda
title_short ‘Nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural Uganda
title_sort ‘nobody is after you; it is your initiative to start work’: a qualitative study of health workforce absenteeism in rural uganda
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5841506/
https://www.ncbi.nlm.nih.gov/pubmed/29527333
http://dx.doi.org/10.1136/bmjgh-2017-000455
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