Health service delivery in nine African countries
FIGURE 2.1 Absence rate of care providers in nine African countries, by country and health facility ownership Niger Mozambique Togo Sierra Leone Uganda Madagascar Tanzania Kenya Nigeria 0
20
40
60
Absent (% of care providers) Private or NGO
Public
Source: SDI (Service Delivery Indicators) health surveys. Note: This figure shows the total rate of absence during a second, unannounced visit. The denominator is up to 10 randomly selected health care providers listed on the roster at each facility. Dashed lines are overall average. Country surveys were conducted in the following years: Kenya (2018), Madagascar (2016), Mozambique (2014), Niger (2015), Nigeria (2013), Sierra Leone (2018), Tanzania (2016), Togo (2013), and Uganda (2013). NGO = nongovernmental organization.
Niger and Togo, more health care providers are absent in public facilities than in private ones. Health care providers may be absent from the facility for a variety of reasons. Figure 2.2 shows the reasons for absence in public facilities, including training or a meeting (21 percent), official mission (11 percent of absences), sick or maternity leave (11 percent), and other authorized absence (28 percent). Across all public facilities, only 4 percent of providers are absent without authorization, with the highest rates among doctors and clinical officers (5 percent) and nurses (4 percent) and the lowest rates among other health workers (3 percent).9 Overall, more than 90 percent of absences in public facilities are authorized. However, this is a likely overestimate because facility administrators may be hesitant to report unauthorized absences, and there is no method for confirming the reasons for absence. Notwithstanding important contextual differences, these data indicate some general trends across countries. The total absence rate is high, exceeding 20 percent in almost all countries. Unauthorized absences are a much smaller fraction, but they are more prevalent in public than in private facilities in all nine countries. The higher rate of absence in public facilities may stem from differences in incentive structures, differences in management and supervision, or differences in demands that take public health care providers outside of the facility. Some absences may be out of the control of facility administrators, 25
