{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T14:07:03Z","timestamp":1787753223479,"version":"build-2784847793"},"reference-count":30,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T00:00:00Z","timestamp":1699574400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Planning &amp; Management"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Universal Health Coverage (UHC) can only be achieved if people receive good quality care from health workers, yet in Nigeria, as in many other low\u2010 and middle\u2010income countries (LMICs), many health workers are absent from work. Absenteeism is a well\u2010known phenomenon but is often considered as the self\u2010serving behaviour of individuals, independent from the characteristics of health systems structures and processes and the broader contexts that enable it. We undertook a qualitative inquiry among 40 key informants, comprising health facility heads and workers, community leaders and state\u2010level health policymakers in Nigeria. We employed a phenomenology approach to examine their lived experiences and grouped findings into thematic clusters. Absenteeism by health workers was found to be a response to structural problems at two levels \u2013midstream (facility\u2010level) and upstream (government level) \u2013 rather than being a result of moral failure of individuals. The problems at midstream level pointed to an inconsistent and unfair application of rules and regulations in facilities and ineffective management, while the upstream drivers relate mainly to political interference and suboptimal health system leadership. Reducing absenteeism requires two\u2010pronged interventions that tackle defects in the upstream and midstream rather than just focusing on sanctioning deviant staff (downstream).<\/jats:p>","DOI":"10.1002\/hpm.3736","type":"journal-article","created":{"date-parts":[[2023,11,10]],"date-time":"2023-11-10T14:20:32Z","timestamp":1699626032000},"page":"417-431","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Targeting systems not individuals: Institutional and structural drivers of absenteeism among primary healthcare workers in Nigeria"],"prefix":"10.1002","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9224-7622","authenticated-orcid":false,"given":"Prince","family":"Agwu","sequence":"first","affiliation":[{"name":"Department of Pharmacology and Therapeutics Health Policy Research Group College of Medicine University of Nigeria  Enugu Nigeria"},{"name":"Department of Social Work University of Nigeria  Nsukka Nigeria"},{"name":"School of Humanities, Social Sciences, and Law University of Dundee  Dundee UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Obinna","family":"Onwujekwe","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics Health Policy Research Group College of Medicine University of Nigeria  Enugu Nigeria"},{"name":"Department of Health Administration and Management University of Nigeria  Enugu Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Uche","family":"Obi","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics Health Policy Research Group College of Medicine University of Nigeria  Enugu Nigeria"},{"name":"Department of Community Medicine University of Nigeria  Nsukka Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"McKee","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aloysius","family":"Odii","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics Health Policy Research Group College of Medicine University of Nigeria  Enugu Nigeria"},{"name":"Department of Sociology &amp; Anthropology University of Nigeria  Nsukka Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles","family":"Orjiakor","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapeutics Health Policy Research Group College of Medicine University of Nigeria  Enugu Nigeria"},{"name":"Department of Psychology University of Nigeria  Nsukka Nigeria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eleanor","family":"Hutchinson","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dina","family":"Balabanova","sequence":"additional","affiliation":[{"name":"London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,11,10]]},"reference":[{"key":"e_1_2_10_2_1","unstructured":"DadwalV.Why Fighting Corruption Is Key to Improving Healthcare;2014. accessed 24 March 2021.https:\/\/www.weforum.org\/agenda\/2014\/10\/fighting\u2010corruption\u2010improving\u2010healthcare\/"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102020\u2010003092"},{"key":"e_1_2_10_4_1","first-page":"151","volume-title":"Is good governance good for development","author":"Khan M","year":"2012"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czz070"},{"key":"e_1_2_10_6_1","unstructured":"Transparency International.Corruption Perceptions Index;2020. accessed 20 March 2021.https:\/\/www.transparency.org\/en\/countries\/nigeria"},{"key":"e_1_2_10_7_1","unstructured":"Socioeconomic Rights and Accountability Project [SERAP].Police Judiciary Among Top Five Most Corrupt Institutions in Nigeria;2019. accessed 30 September 2022.https:\/\/saharareporters.com\/2019\/03\/27\/police\u2010judiciary\u2010among\u2010top\u2010five\u2010most\u2010corrupt\u2010institutions\u2010nigeria"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2019.128"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00038\u2010020\u201001405\u20103"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/1478\u20104491\u201011\u201034"},{"key":"e_1_2_10_11_1","unstructured":"BalabanovaD HutchinsonE MayhewS et\u00a0al.Health Workers Are Vital to Defeat COVID\u201019: But Only if They Are at Work;2020. accessed 30 September 2022.https:\/\/healthsystemsglobal.org\/news\/health\u2010workers\u2010are\u2010vital\u2010to\u2010defeat\u2010covid\u201019\u2010but\u2010only\u2010if\u2010they\u2010are\u2010at\u2010work\/"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh-2017-000455"},{"key":"e_1_2_10_13_1","article-title":"Measuring the impact of public health policys","volume":"7","author":"Brownson RC","year":"2010","journal-title":"Prev Chronic Dis"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001073"},{"key":"e_1_2_10_15_1","first-page":"13","article-title":"\u201cI can\u2019t kill myself\u201d: local narratives and meanings that foster absenteeism in Nigerian primary health centres","author":"Orjiakor CT","year":"2023","journal-title":"J Glob Health"},{"key":"e_1_2_10_16_1","unstructured":"Federal Ministry of Health.Nigeria Health Facility Registry;2019. accessed 28 August 2021.https:\/\/hfr.health.gov.ng\/facilities\/hospitals\u2010search?_token=UmD0tZTjW0Gu30ieC19mXu8Z2mJcgryJREVqPwhD&state_id=114&lga_id=&ward_id=0&facility_level_id=0&ownership_id=1&operational_status_id=1&registration_status_id=0&license_status_id=0&geo_codes=0&service_type=0&service_category_id=0&facility_name=&entries_per_page=20"},{"key":"e_1_2_10_17_1","unstructured":"OnwujekweO OdiiA AgwuP et\u00a0al.Exploring Health\u2010Sector Absenteeism and Feasible Solutions: Evidence from the Primary Healthcare Level in Enugu South East Nigeria;2019.https:\/\/researchonline.lshtm.ac.uk\/id\/eprint\/4659908\/"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/23288604.2023.2199515"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.46743\/2160\u20103715\/2015.2281"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40037\u2010019\u20100509\u20102"},{"key":"e_1_2_10_21_1","volume-title":"Qualitative Methods in Social Work Research","author":"Padgett DK","year":"2008"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjgh\u20102017\u2010000455"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.15171\/ijhpm.2019.128"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1002\/job.2560"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1002\/job.2675"},{"key":"e_1_2_10_26_1","doi-asserted-by":"publisher","DOI":"10.56801\/seejph.vi.204"},{"key":"e_1_2_10_27_1","article-title":"The gendered drivers of absenteeism in the Nigerian health system","author":"Ogbozor P","year":"2022","journal-title":"Health Pol Plann"},{"key":"e_1_2_10_28_1","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.12189"},{"key":"e_1_2_10_29_1","first-page":"2","article-title":"Community\u2010based strategies to improve primary health care (PHC) services in developing countries","volume":"6","author":"Olalubi OA","year":"2020","journal-title":"Case stud Nigeria"},{"key":"e_1_2_10_30_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czu069"},{"key":"e_1_2_10_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0140\u20106736(06)68634\u20100"}],"container-title":["The International Journal of Health Planning and Management"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hpm.3736","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,2]],"date-time":"2024-03-02T11:20:36Z","timestamp":1709378436000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hpm.3736"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,10]]},"references-count":30,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1002\/hpm.3736"],"URL":"https:\/\/doi.org\/10.1002\/hpm.3736","archive":["Portico"],"relation":{},"ISSN":["0749-6753","1099-1751"],"issn-type":[{"value":"0749-6753","type":"print"},{"value":"1099-1751","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,10]]},"assertion":[{"value":"2022-12-20","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-10-31","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-10","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}