abstract: 'Public-sector healthcare providers are on the frontline of family

  planning service delivery in low- and middle-income countries like

  Kenya, yet research suggests public-sector providers are frequently

  absent. The current prevalence of absenteeism in Western Kenya, as well

  as the impact on family planning clients, is unknown. The objective of

  this paper is to quantify the prevalence of public-sector healthcare

  provider absenteeism in this region of Kenya, to describe the potential

  impact on family planning uptake and to source locally-grounded

  solutions to provider absenteeism. We used multiple data collection

  methods including unannounced visits to a random sample of 60

  public-sector healthcare facilities in Western Kenya, focus group

  discussions with current and former family planning users, key informant

  interviews with senior staff from healthcare facilities and both

  governmental and non-governmental organizations, and journey mapping

  activities with current family planning providers and clients. We found

  healthcare providers were absent in nearly 60\% of unannounced visits

  and, among those present, 19\% were not working at the time of the

  visit. In 20\% of unannounced visits, the facility had no providers

  present. Provider absenteeism took many forms including providers

  arriving late to work, taking an extended lunch break, not returning

  from lunch, or being absent for the entire day. While 56\% of provider

  absences resulted from sanctioned activities such as planned vacation,

  sick leave, or off-site work responsibilities, nearly half of the

  absences were unsanctioned, meaning providers were reportedly running

  personal errands, intending to arrive later, or no one at the facility

  could explain the absence. Key informants and focus group participants

  reported high provider absence is a substantial barrier to contraceptive

  use, but solutions for resolving this problem remain elusive.

  Identification and rigorous evaluation of interventions designed to

  redress provider absenteeism are needed.'
affiliation: 'Tumlinson, K (Corresponding Author), Univ N Carolina, Gillings Sch Global
  Publ Hlth, Dept Maternal \& Child Hlth, Chapel Hill, NC 27515 USA.

  Tumlinson, K (Corresponding Author), Univ N Carolina, Carolina Populat Ctr, Chapel
  Hill, NC 27515 USA.

  Tumlinson, Katherine; Williams, Caitlin R., Univ N Carolina, Gillings Sch Global
  Publ Hlth, Dept Maternal \& Child Hlth, Chapel Hill, NC 27515 USA.

  Tumlinson, Katherine, Univ N Carolina, Carolina Populat Ctr, Chapel Hill, NC 27515
  USA.

  Britton, Laura E., Columbia Univ, Sch Nursing, New York, NY USA.

  Williams, Caitlin R., Inst Clin Effectiveness \& Hlth Policy, Dept Mother \& Child
  Hlth, Buenos Aires, DF, Argentina.

  Wambua, Debborah Muthoki, Innovat Poverty Act Kenya IPA K, Nairobi, Kenya.

  Onyango, Dickens Otieno, Kisumu Cty Dept Hlth, Kisumu, Kenya.

  Onyango, Dickens Otieno, Inst Trop Med, Antwerp, Belgium.'
author: Tumlinson, Katherine and Britton, Laura E. and Williams, Caitlin R. and Wambua,
  Debborah Muthoki and Onyango, Dickens Otieno
author-email: ktumlin@email.unc.edu
author_list:
- family: Tumlinson
  given: Katherine
- family: Britton
  given: Laura E.
- family: Williams
  given: Caitlin R.
- family: Wambua
  given: Debborah Muthoki
- family: Onyango
  given: Dickens Otieno
da: '2023-09-28'
doi: 10.1093/heapol/czac022
earlyaccessdate: MAR 2022
eissn: 1460-2237
files: []
issn: 0268-1080
journal: HEALTH POLICY AND PLANNING
keywords: 'Absenteeism; low- and middle-income countries; universal health

  coverage; Kenya; family planning; quality of care; maternal health'
keywords-plus: HEALTH-WORKERS; OUTCOMES; IMPACT
language: English
month: MAY 12
number: '5'
number-of-cited-references: '28'
orcid-numbers: 'Tumlinson, Katherine/0000-0001-8314-8219

  Williams, Caitlin Rain/0000-0002-4925-869X'
pages: 575-586
papis_id: 7d1d3cc0e56f66c57f76fd474abbea74
ref: Tumlinson2022absenteeismfamily
researcherid-numbers: 'Tumlinson, Katherine/E-6975-2013

  '
times-cited: '3'
title: 'Absenteeism Among Family Planning Providers: A Mixed-Methods Study in Western
  Kenya'
type: article
unique-id: WOS:000769088500001
usage-count-last-180-days: '0'
usage-count-since-2013: '2'
volume: '37'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2022'