Private money-making indulgence and inefficiency of primary healthcare in Nigeria: a qualitative study of health workers’ absenteeism.

Generating additional personal income is common with the primary healthcare (PHC) workforce in Nigeria, which could be because of the inconsistencies marring their monthly salaries. Therefore, this study investigates the drivers of private economic activities of PHC providers in the public sector, and the links to absenteeism, as well as inefficiency of PHC facilities in Nigeria. A qualitative study design was used to collect data from 30 key informants using in-depth interviews. They were selected from 5 PHC facilities across three local government areas in Enugu state, south-eastern Nigeria. Data were analyzed thematically and guided by phenomenology. Findings showed that the majority of the health workers were involved in different private money-making activities. A main driver was inconsistencies in salaries, which makes it difficult for them to routinely meet their personal and household needs. As a result, PHC facilities were found less functional. Absenteeism of PHC providers can be addressed if efforts are made to close justifiable gaps that cause health workers to struggle informally. Such lessons can be instructive to low- and middle-income countries in strengthening their health systems.