This progress report documents the design, implementation and rollout of a pilot intervention to reduce health worker absenteeism in primary healthcare facilities in Enugu State, Nigeria.

The problem  

Health worker absenteeism is a major constraint on the effectiveness, equity and credibility of PHC systems in Nigeria. In Enugu State, it contributes to irregular service availability, increased workload for available staff, reduced patient confidence, and weakened accountability between health workers, managers and communities.

Approach

The intervention is informed by the SOAS-ACE Power–Capabilities–Interests (PCI) framework, which highlights how attendance outcomes are shaped by power relations, capabilities and incentives among local actors.

This shifts the focus from punitive enforcement to absenteeism as a governance challenge, shaped by:

  • Structural constraints (e.g. transport costs, delayed remuneration)
  • Weak attendance monitoring systems
  • Informal norms and community expectations

The resulting intervention combines:

  • Material support
  • Peer accountability
  • Community oversight

The project was delivered through four phases:

  • Rapid mapping and baseline data collection across selected PHCs
  • Participatory co-creation workshops to identify causes and design interventions
  • Pilot implementation to test feasibility and operational realities
  • Rollout across selected local government areas (LGAs)

What this report shows

This report provides a detailed account of project activities and learning to date. It shows that:

  • Absenteeism is driven by a combination of structural, administrative and social factors
  • Interventions need to align with existing governance realities
  • Integrated approaches can be feasibly implemented within PHC systems
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Citation
Onwujekwe, O., Ozo, O., Eze, O., Agu, I., Ogbozor, P., Odii, A., C, C. N., Ndukaihe, I., Obi, C., Ojiakor, M., Onu, P., Ude, K., Mbachu, C., Roy, P., Balabanova, D. 2026. 'Addressing health worker absenteeism in Nigeria: design, implementation and rollout of interventions in Enugu State'. SOAS Anti-Corruption Evidence (ACE) SOAS University of London. https://ace.soas.ac.uk/publication/addressing-health-worker-absenteeism-in-nigeria-design-implementation-and-rollout-of-interventions-in-enugu-state/