Private money-making indulgence and inefficiency of primary healthcare in Nigeria: a qualitative study of health workers

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ORIGINAL ARTICLE

Private money-making indulgence and inefficiency of primary healthcare in Nigeria: a qualitative study of health workers’ absenteeism Prince Agwu1,2



Pamela Ogbozor2,6 • Aloysius Odii2,4 • Charles Orjiakor2,3 • Obinna Onwujekwe2,5

Received: 2 February 2020 / Revised: 27 May 2020 / Accepted: 7 June 2020 / Published online: 25 August 2020  The Author(s) 2020

Abstract Objectives Generating additional personal income is common with primary healthcare (PHC) workforce in Nigeria, which could be because of the inconsistencies marring their monthly salaries. Therefore, this study investigates the drivers of private economic activities of PHC providers in the public sector, and the links to absenteeism, as well as inefficiency of PHC facilities in Nigeria. Methods A qualitative study design was used to collect data from 30 key-informants using in-depth interviews. They were selected from 5 PHC facilities across three local government areas in Enugu state, south-eastern Nigeria. Data were analysed thematically, and guided by phenomenology. Results Findings showed that majority of the health workers were involved in different private money-making activities. A main driver was inconsistencies in salaries, which makes it difficult for them to routinely meet their personal and household needs. As a result, PHC facilities were found less functional. Conclusions Absenteeism of PHC providers can be addressed if efforts are made to close justifiable gaps that cause health workers to struggle informally. Such lesson can be instructive to low- and middle-income countries in strengthening their health systems. Keywords Absenteeism  Primary healthcare  Informal jobs  Corruption  Market forces  Money-making activities

Introduction Nigeria has a widespread of health facilities (Kress et al. 2016), and a high-density health workforce which is poorly funded by the government (Akwataghibe et al. 2013; WHO This article is part of the special issue ‘‘Market-driven forces and Public Health’’. & Prince Agwu [email protected] 1

Department of Social Work, University of Nigeria, Nsukka, Nsukka, Nigeria

2

Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Nsukka, Nigeria

3

Department of Psychology, University of Nigeria, Nsukka, Nsukka, Nigeria

4

Department of Sociology and Anthropology, University of Nigeria, Nsukka, Nsukka, Nigeria

2019). It has been found that the country regularly falls below the African Union’s (AU) 15% benchmark health funding commitment per annual budget. Since the 2001 Abuja Declaration, Nigeria has never exceeded 6% total government health expenditure per annual expenditure of government (Onyeji 2017). As a result of poor funding for the health sector, the welfare concerns of human resources for healthcare have been severely challenged, leading to 5

Department of Health Administration and Management, University of Nigeria, Enugu Campus, Nsukka, Nigeria

6

Department of Psychology, Enugu State University of Science