Many studies have found that absenteeism undermines the effective delivery of healthcare. However, most studies focus on high-income countries. Low-income countries have been largely ignored in the literature.

This study explores absenteeism in primary health centres (PHCs) in Enugu State, Nigeria. Ten PHCs were purposively selected from six local governments in Enugu State. In-depth interviews and focus group discussions were conducted with frontline health workers, managers, service users and health facility committee chairpersons.

Absenteeism was found to be highly prevalent among health workers, and represents an even bigger burden within PHCs when lateness is also considered. But absenteeism is not always deliberate. Economic pressures, ill-health, challenges regarding transportation and other structural inefficiencies, and managerial/organisational dynamics contribute to the absence of health workers. The impact of absenteeism is felt by both service users and co-workers.

Although measures exist that aim to reduce absenteeism in PHCs, our findings show that these can be easily circumvented and are ineffective due to implementation and structural issues.  The ACE approach to anti-corruption, in turn, offers a promising solution to the broader problem of absenteeism in Enugu.