Absenteeism of Healthcare Workers in Primary Healthcare in Sub-Saharan Africa: A Scoping Review

Introduction: Sub-Saharan Africa is facing a severe crisis in human resources for health. Primary healthcare is the most affected. This problem is aggravated by absenteeism, implying that healthcare workers are absent on duty during scheduled working hours. This scoping review maps existing literature on absenteeism among primary healthcare workers in Sub-Saharan Africa. Methods: This scoping review complies with the Population Concept Context guidelines of Arksey and O'Malley and the PRISMA 2020 checklist. A literature search (Medline, Embase, Scopus, Africa Index Medicus) was performed from inception until December 2023 in collaboration with a medical information specialist. Peer-reviewed English-published literature was considered. Two independent reviewers screened titles, abstracts, and full-texts. Results: Twenty-four studies were included from 7 of 46 Sub-Saharan countries (15%). Prevalence of absenteeism varied from 14% to 49%. Causes at individual and health-system levels were explored in 16 studies (67%) and included physician dual practices (75%), low wages (69%), and insufficient supervision (56%). Consequences at the healthcare worker and patient level were described in 14 studies (58%) and included hindered/delayed access to care (64%), high workload (29%), and increased treatment costs when patients are forced to attend private facilities (22%). Recommendations to address absenteeism were provided in 18 studies (75%) and included regular supervision (33%), performance-based rewards/punishments (33%), and augmented salaries (33%). Conclusion: Absenteeism is highly prevalent among primary healthcare workers in Sub-Sahara Africa. Its adverse impact on both healthcare workers and patients is profound. The complexity of different individual and health system causal factors shows that a multifactorial approach to address absenteeism is warranted.