Holding Health Workers Accountable: Governance Approaches to Reducing Absenteeism

May 2012

Rachel Deussom, Wanda Jaskiewicz, Sarah Dwyer, and Kate Tulenko, IntraHealth International

Somewhere in the world…
A nurse rushes to leave the health center with the sun still high in the sky. She does not want to travel in the dark. Despite promises of secure housing next to the facility, the building has yet to be constructed. She has been renting a spare room in a larger town some distance away. The road is unpaved and poorly maintained, making travel difficult, especially in the rainy season, and the nurse often arrives to her shift late. Recently the doctor has been making inappropriate comments at work; the nurse has felt increasingly uncomfortable. At least in the afternoons, she does not have to deal with the doctor’s comments because he is seeing patients at his private clinic. However, the nurse then has no one to defer to when an emergency arises. When the nurse manages to visit her family and young children in the city, she will stay a day more than was authorized, which seems to be common practice. She will also likely miss another day from work this week as rumors are circulating that the health worker paycheck deposits, delayed six months, have finally reached the bank, a two-hour ride away.

Earlier in the day, a mother carries a feverish child on her back and walks 15 kilometers to the health center, only to find it empty. She returns the next day to find the waiting room overwhelmed with patients. The mother waits all day, but when the time comes for the child to be seen, the doctor has already left. An overworked nurse rushes through the appointment, speaking harshly. Unsatisfied, the mother returns home and tells her neighbors about the negative experience. The next time one of her children falls ill, instead of visiting the clinic, she buys medicine from the drug peddler in town.

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