Blog Post 3
When Presence Becomes Optional: Absenteeism as an Integrity Failure
In many parts of Nigeria, the hospital is open
but care is not available.
The signboard is there.
The building is there.
The ward is there.
But the health worker is not there.
Absenteeism has become so normal that communities now plan around it:
- “Go early, maybe you’ll meet them.”
- “Try tomorrow, he might come.”
- “If you don’t know someone inside, don’t waste your time.”
This is not just a staffing problem.
This is a trust problem.
And at its root, it is an integrity problem.
A Patient’s Lived Experience: “We Came, But Nobody Came”
A pregnant woman in labour was rushed to a facility at midnight. Her husband carried a torchlight. The relatives were hopeful, because at least they made it to a health facility.
They knocked.
No response.
They knocked again.
A security man came out slowly and said:
“The nurse has not come. The doctor is not around.”
The woman cried out in pain.
Her husband begged.
The security man shrugged:
“Try the private clinic.”
But the private clinic was far.
And money was short.
They tried to manage the labour themselves, waiting and praying.
By morning, the situation had worsened.
They left the facility with a heartbreak they will never forget.
That day, the community learned a lesson:
A facility without reliable staff is not a health facility.
It is a building.
Absenteeism is Not “Normal”. It is Harm
When health workers are absent:
- emergencies become deaths
- simple illnesses become complications
- pregnant women lose babies
- children worsen from treatable diseases
- people lose faith and stop seeking care
Absenteeism destroys the credibility of the system.
It tells patients:
“Your life depends on chance.”
Why Absenteeism Happens.
But Why It Must Not Continue
Absenteeism has many drivers:
- poor remuneration and delayed salaries
- burnout and unsafe work environments
- weak supervision
- political interference
- lack of consequences
- poor facility leadership
- dual practice without regulation
But even when these factors exist, a hard truth remains:
Patients cannot be punished for system weaknesses.
A patient does not choose when to fall ill.
A woman does not schedule labour.
A child does not plan fever.
Healthcare is a duty of care.
And duty requires presence.
What Must Change
Practical Actions
1) Attendance Accountability Systems
- Duty rosters must be real, not decorative.
- Supervisors must verify presence, not assume it.
2) Strengthen Facility Leadership
- Every facility must have clear leadership responsibility.
- Leadership must respond when staff abandon duty.
3) Protect and Motivate Health Workers
- Ensure timely salaries and fair workload distribution.
- Provide minimum working tools and safe conditions.
4) Regulate Dual Practice and Moonlighting
- If allowed, it must be structured and transparent.
- Public duty must never become optional.
5) Community Feedback and Citizen Oversight
- Communities should have a voice in monitoring service availability.
- Facilities must display complaint/reporting channels publicly.
The Integrity Call
Absenteeism is a silent killer.
It does not make headlines like epidemics, but it kills trust daily.
A health system cannot earn trust when presence is optional.
And Nigeria cannot achieve better health outcomes when care depends on luck.
Trust Renewal demands that:
Presence becomes a standard.
Accountability becomes real.
And patients stop paying the price for institutional weakness.
Insha’Allah, we will build a system where every Nigerian can walk into a facility and find care, not excuses.
Dr. Abdullahi Jibril Mohammed
Health Systems Specialist and Healthcare Integrity Champion
Author, Trust Renewal: The Integrity Call for Better Health for All
