Background

Igabi Local Government Area (LGA), located in Kaduna State’s Central Senatorial Zone, is one of the ten focal 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 Center (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 the PHC managers to take charge of staff discipline in their respective PHC facilities. However, lateness and absenteeism continued to persist, requiring the LGA PHC mentor to prioritize lateness and absenteeism reduction during mentoring sessions with the PHC Managers.

Strategies Adopted

To curb these issues, the LGA PHC mentor led the PHC managers in instituting the following absenteeism reduction strategies at their facilities:

1. Introduction of attendance registers: This is mandatory for all staff to fill daily, upon resumption for duty and at closing. The PHC officers-in-charge have the directive to rule off at 8.00 am.
2. Ensuring all intervention PHC facilities have an updated staff list, fully disaggregated by skill mix.
3. Introduction of duty rosters, which should account for all facility staff, clearly stipulating when they will be on and off duty.

Furthermore, the managers began one-on-one engagements with the habitual latecomers and absentees for performance improvement. Deploying the 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 has gradually declined or been 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.

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 for permission if there is a very important thing that will not allow them to come to work. This is unlike before when any one 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

Walahi (Arabic word, loosely translated as ‘honestly’) I was surprised that day when one of my staff was sick, she couldn’t reach me on phone so she entered Keke Napep (tricycle) and came to the PHC despite the sickness. This was just to seek for permission to stay at home for the day. We are happy with each other now.

Zaliha Ilu, Officer-in-Charge, PHC Rigachukun

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 know there are consequences for not filling it.

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

About the Kaduna PHC Management Strengthening Project (KPMSP)

KPMSP is being implemented in 107 Ward Priority Primary Healthcare Centers (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) have received training on Data Management, Planning and Community Relations, Inventory and Supply Chain Management, Human Resources Management, and Financial Management.

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

By HSDF’s Health Systems Strengthening team. Specific contributors were: Aliyu Tukur and Abolade Oyelere