IntraHealth announces the publication of Holding Health Workers Accountable: Governance Approaches to Reducing Absenteeism—a CapacityPlus technical brief that examines the costs of unexcused absenteeism in the health sector, describes underlying governance issues, and recommends strategies for addressing this problem.

When health workers are absent—or unfairly burdened with the workloads of their absent colleagues—access to care is compromised. Community members, who may travel long distances to seek care, begin to mistrust the heath system, lose productive time from their livelihoods and family responsibilities, and ultimately may experience adverse health outcomes from receiving inadequate or no care.

“In a sector focused on service delivery, health workers are at the nexus,” says lead author, Rachel Deussom. “You can have many elements of a good health system in place, but if health workers aren’t there to put all those things to use,” she notes, “the system will fail.”

The brief cites studies from a variety of countries including Uganda, India, and Venezuela, that revealed high absenteeism rates (including both excused and unexcused absences) with rates ranging as high as 25% to 40%. Many health workers are trying hard to do their part, and some absences can be attributed to the broader health system failing to adequately provide health workers with what they need to succeed at their jobs. Factors that contribute to absenteeism can include: difficult or dangerous conditions in or around the health facility, unclear job and attendance expectations, a lack of supervision, and prolonged delays in getting paid. Without understanding the extent and underlying causes of absenteeism, it is difficult for managers, communities, and even professional councils to hold absent health workers accountable.

The technical brief recommends several strategies to address the issue, including setting clear performance and attendance standards, improving accountability mechanisms, strengthening payroll systems and information systems that monitor absenteeism, and developing more effective incentive packages.

IntraHealth is producing tools to help decision-makers understand and address absenteeism and its underlying causes, including the Rapid Retention Survey Toolkit and a forthcoming productivity diagnostic and improvement toolkit.

Authors of this technical brief include IntraHealth staff members Rachel Deussom, Wanda Jaskiewicz, Sarah Dwyer, and Kate Tulenko. The brief is available as an interactive version and a printer-friendly document.

Led by IntraHealth International, CapacityPlus is the USAID-funded global project that uniquely focuses on the health workforce needed to achieve the Millennium Development Goals.