Who is absent and why? Factors affecting doctor absenteeism in Bangladesh

Mir Raihanul Islam; Blake Angell; Nahitun Naher; Bushra Zarin Islam; Mushtaq Husain Khan; Martin McKee; Eleanor Hutchinson; Dina Balabanova; Syed Masud Ahmed

doi:10.1371/journal.pgph.0003040

Who is absent and why? Factors affecting doctor absenteeism in Bangladesh

PLOS Glob Public Health. 2024 Apr 4;4(4):e0003040. doi: 10.1371/journal.pgph.0003040. eCollection 2024.

Authors

Mir Raihanul Islam¹, Blake Angell², Nahitun Naher³, Bushra Zarin Islam⁴, Mushtaq Husain Khan⁵, Martin McKee⁶, Eleanor Hutchinson⁷, Dina Balabanova⁷, Syed Masud Ahmed³

Affiliations

¹ Poverty, Gender and Inclusion Division, International Food Policy Research Institute, Dhaka, Bangladesh.
² The George Institute for Global Health, University of New South Wales Sydney, Sydney, Australia.
³ BRAC James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh.
⁴ School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America.
⁵ School of Oriental and African Studies (SOAS), University of London, London, England.
⁶ Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, United Kingdom.
⁷ Department of Global Health and Development, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom.

Abstract

Absenteeism by doctors in public healthcare facilities in rural Bangladesh is a form of chronic rule-breaking and is recognised as a critical problem by the government. We explored the factors underlying this phenomenon from doctors' perspectives. We conducted a facility-based cross-sectional survey in four government hospitals in Dhaka, Bangladesh. Junior doctors with experience in rural postings were interviewed to collect data on socio-demographic characteristics, work and living experience at the rural facilities, and associations with professional and social networks. Multiple logistic regression was used to determine the factors associated with rural retention. Of 308 respondents, 74% reported having served each term of their rural postings without interruptions. The main reasons for absenteeism reported by those who interrupted rural postings were formal training opportunities (65%), family commitments (41%), and a miscellaneous group of others (17%). Almost half of the respondents reported unmanageable workloads. Most (96%) faced challenges in their last rural posting, such as physically unsafe environments (70%), verbally abusive behaviour by patients/caregivers (67%) and absenteeism by colleagues that impacted them (48%). Respondents who did not serve their entire rural posting were less likely to report an unmanageable workload than respondents who did (AOR 0.39, 95% CI 0.22-0.70). Respondents with connections to influential people in the local community had a 2.4 times higher chance of serving in rural facilities without interruption than others (AOR 2.40, 95% CI 1.26-4.57). Our findings demonstrate that absenteeism is not universal and depends upon doctors' socio-political networks. Policy interventions rarely target unsupportive or threatening behaviour by caregivers and community members, a pivotal disincentive to doctors' willingness to work in underserved rural areas. Policy responses must promote opportunities for doctors with weak networks who are willing to attend work with appropriate support.

Copyright: © 2024 Islam et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

This publication is an output of the SOAS Anti-Corruption Evidence (ACE) research consortium funded by UK aid from the UK Government (Contract P07073 awarded to MHK). The views presented are those of the author(s) and do not necessarily reflect the UK government’s official policies or the views of SOAS-ACE or other partner organisations. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. For more information on SOAS-ACE, visit www.ace.soas.ac.uk.