October 8, 2019

In some regions of sub-Saharan Africa, it’s fairly common for health care providers to be unexpectedly absent from clinical practice, which can negatively impact patient care.

Dr. Katherine Tumlinson

Dr. Katherine Tumlinson

A new study from Katherine Tumlinson, PhD, assistant professor of maternal and child health at the UNC Gillings School of Global Public Health, shows that engaging Kenyan health care providers on their experiences and perspectives is key to addressing provider absenteeism. Tumlinson is the lead author of “Understanding healthcare provider absenteeism in Kenya: a qualitative analysis,” which was published online September 11 in BMC Health Services Research.

Tumlinson says it’s important to understand health system challenges from the perspective of health care providers themselves, because they are the ones on the front lines of service delivery.

“When such perspectives are overlooked, it is a disservice to those who we entrust with the public’s health,” she says. “We often forget that providers have needs, just like patients, and understanding their perspectives is important in helping them to do their jobs well.”

While maternal mortality and under-five mortality around the world have steadily decreased since 1990, death rates remain high in many low-income settings within sub-Saharan Africa. One factor contributing to the poor quality of health care delivery in these regions is provider absenteeism.

To learn more, Tumlinson and her team examined absenteeism among health care providers in Kenya. Though many studies have documented the prevalence of provider absence, this is the first to investigate the factors that may contribute to the behavior.

“Our recent and very preliminary data suggest that between 25 and 50 percent of public sector health care providers in western Kenya are absent at any given time,” says Tumlinson. “A number of factors contribute to high levels of absenteeism, including infrequent supervision, lack of professional consequences, limited accountability and low wages.”

From July 2015 and June 2016, researchers conducted in-depth, semi-structured interviews with 20 providers in health care facilities in Central and Western Kenya. Half of providers reported that absenteeism – most commonly arriving late or leaving early – occurs in both private and public health facilities and is facilitated by institutional issues such as lack of supervision or professional consequences, limited accountability and low wages, as well as additional employment at other health facilities.

“We are still investigating the cumulative impact of absenteeism in Kenya, but preliminary data suggest that patients become discouraged and reduce their care seeking behaviors when they are unable to find providers at their health care facility,” Tumlinson says.

In 2020, she will pilot a community-based monitoring of public sector facilities in collaboration with Kenya’s Kisumu County Health Director in an effort to reduce absenteeism and other clinic issues. Tumlinson says she is encouraged by similar efforts in Uganda that have been successful.

“It’s difficult to stop these harmful behaviors if we don’t fully understand why providers do them,” she says. “Solving this health system challenge will require creativity.”

Contact the Gillings School of Global Public Health communications team at sphcomm@unc.edu.

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