Background

Igabi Local Government Area (LGA), located in Kaduna State’s Central Senatorial Zone, is one of the ten focal Local Government Areas (LGAs) of the Kaduna PHC Management Strengthening Project (KPMSP). In February 2021, a baseline assessment of the nine intervention PHC facilities in Igabi was conducted by a representative of the Health Strategy and Delivery Foundation (HSDF), who serves as the LGA Primary Healthcare Centre (PHC) mentor. This assessment revealed high levels of lateness and unapproved staff absenteeism across all the PHCs.

As part of the intervention, PHC managers received in-class training on how to address lateness and absenteeism.  In addition, the Executive Secretary of the Kaduna State Primary Healthcare Board, Dr. Hamza Abubakar mandated PHC managers to take charge of staff discipline in their respective PHC facilities. However, lateness and absenteeism continued to persist, requiring the LGA PHC mentors to prioritize lateness and absenteeism reduction during mentoring sessions with the PHC Managers.

Strategies adopted by the LGA PHC mentor to curb instances of absenteeism at the PHC facilities include:

1. Introduction of attendance registers: Attendance registers were mandatory for all staff to fill, upon resumption for duty and at closing.  PHC officers-in-charge were directed to rule off at 8.00 am.
2. Updated staff list: All intervention PHC facilities had an updated staff list, fully disaggregated by skill mix.
3. Introduction of duty rosters: This accounted for all facility staff, showing those who were on and off duty per time.

Furthermore, the managers began one-on-one engagements with the habitual latecomers and absentees for performance improvement. Deploying a carrot and stick approach, they recommended rewards for well-performing staff, while names of erring staff were sent to the Local Government Health Authority (LGHA) headquarters, where necessary. With this effort, absenteeism in focus PHCs in Igabi LGA gradually declined or was eliminated between February and June 2021.

Reduction in lateness and absenteeism benefits the health facility in terms of more equitable workload distribution and helps the patient by reducing waiting time. All these would result in the efficient use of human resources in the facilities to improve service delivery and utilization.

Here’s feedback from some of the PHC Managers

“Since the commencement of KPMSP, my staff have become very serious with their work. They always call and seek permission if there is a very important thing that will not allow them to come to work. This is unlike before when anyone can just decide to stay at home, sometimes for days and when they finally come, they will just be giving excuses.”

Hauwa Dawai, Officer-in-Charge, PHC Mando

“Before now, I sometimes come to work late but now I always make sure I arrive at the PHC early so that I can show leadership by example.”

Bako Danjuma, Officer-in-Charge, PHC Zangon Aya

“Before KPMSP, no one cared about the time book. There were times when it would not be filled for several months. Now, we use it every day and all our staff knows there are consequences for not filling it.“

Hassana Kudan, Officer-in-Charge, PHC Miyetti, Rigasa

Conclusion

The capacity to control PHC facility absenteeism has given the PHC OICs more confidence to lead their subordinates in other areas like delegation, peer-to-peer learning and performance feedback. All these are hoped to, in the long run translate to improvement in PHC service delivery and increase in uptake of PHC services.

About the Kaduna PHC Management Strengthening Project (KPMSP)

KPMSP is being implemented in 107 Ward Priority Primary Healthcare Centres (PHCs) across 10 Local Government Areas in Kaduna State. The project aims to improve the management capacity of PHC Managers by developing and deploying a systems framework within which the managers would operate (job description, competency framework, management curriculum); and providing them with both in-class and on-the-job capacity building.

During the intervention, PHC Managers (Officers-in-Charge and their deputies) received training in Data management, Planning & Community Relations, Inventory & Supply Chain Management, Human Resources Management, and Financial Management.

LGA Zonal-level supervisors and Ward Development Committee (WDC) members have also been orientated on PHC management. This is to improve the capacity to provide supervisory and oversight functions on how the focus PHC facilities are managed.

 By HSDF’s KPMSP team. Specific Contributors were Aliyu Tukur and Abolade Oyelere