5/5 Key takeaway: tackling absenteeism isn’t only about monitoring attendance. It requires fair scheduling, supportive supervision, and recognition of emotional labour, all critical for resilient health systems everywhere.
Read the full paper here www.frontiersin.org/journals/psy...
4/5 Informal power structures, favoritism, and gendered expectations shape who can be absent without consequence, and who absorbs the costs. These dynamics are not unique to Nigeria.
3/5 Absenteeism doesn’t just disrupt services. It redistributes emotional labour. Workers report exhaustion, frustration, isolation, and moral distress, especially where accountability is weak or uneven.
2/5 Using qualitative research in Nigerian PHC facilities we found that unscheduled colleague absenteeism dramatically increases workload, emotional strain, and burnout for remaining staff.
🧵1/5 Health worker absenteeism is usually framed as a governance failure. But what about its hidden costs for those who still show up? Our new study with @dinabalabanova.bsky.social and Nigerian colleagues shifts the lens to the frontline workers left behind.
Join us for this excellent event - highly relevant to many countries experiencing crises and governance disruptions.
We look forward to constructive dialogue @martinmckee.bsky.social
11/ The bottom line: Fix governance → strengthen accountability → reduce corruption → improve PHC performance. Without this chain, PHC reforms will not deliver.
You can read the whole paper here: www.tandfonline.com/toc/khsr20/5/4
10/ As Nigeria moves to implement the Supreme Court ruling granting local government areas fiscal autonomy, these findings are timely—and essential. Strengthening subnational governance is the foundation for effective PHC.
9/ We argue that investments like the government's Basic health care Provision fund must be accompanied by reforms in governance, accountability, HR systems, and financing mechanisms. Otherwise, resources risk being wasted.
8/ The result? A system where corruption is not an individual failing but a structural outcome of weak subnational governance. Reforms that ignore this reality, however well‑intentioned, will fall short.
7/ Fourth, erratic PHC financing.
With little statutory financing from subnational authorities, many facilities survive on user fees and “private practice” by those in charge This de facto privatization creates perverse incentives and deepens inequities.
6/ Third, dysfunctional human resource management.
Chronic absenteeism, unchecked use of informal “volunteers,” and non‑tenured facility managers turning facilities into personal enterprises, all thrive in the absence of oversight.
5/ Second, weak rules and enforcement.
Regulations exist on paper but are rarely communicated, operationalised, or enforced. Many facilities have no functional SOPs, enabling impunity, absenteeism, and arbitrary decision‑making.
4/ First, low political interest in PHC. Local authorities often deprioritize PHC because it brings few political rewards. Budgets are unpredictable, planning is weak, and investments favor visible infrastructure over basic services.
3/ We interviewed senior PHC managers and identified four major governance deficiencies driving corruption and weak service delivery at the frontline. These problems are systemic, predictable, and fixable.
2/ Led by Prince Agwu, with Charles Orjiakor, Aloysius Odii , Pamela Ogbozor, @eleanorhutch.bsky.social Obinna Onwujekwe & @dinabalabanova.bsky.social & funded by UK FCDO, MRC, and @wellcometrust.bsky.social
🧵1/ Our new study in Health Systems & Reform describes how poor accountability and corruption in Nigeria’s primary healthcare (PHC) are rooted in subnational governance failures, and not just actions by those working on the frontline. This matters hugely for current reforms.
🧵 1/ Our new study in BMJ Global Health looks at the role of social capital in tackling - or fuelling - in healthcare systems. With @dinabalabanova.bsky.social and Nigerian colleagues. In Nigeria, we show how personal networks often determine who gets care. Here’s what we found.
This is not an academic exercise. Addressing corruption helps save lives, improve access to essential care and protecting those vulnerable to illicit practices.
We continue this work with #TheLancetGlobalHealthCommissiononAnti-CorruptioninHealth | lnkd.in/ebwCQ9YP
& #AccountabilityinAction Malawi
✅ Creating practical tools, for health care managers, for anti-corruption and law enforcement agencies seeking to address corruption in health. These shed light on processes to address different types of corruption and guide decisions,
Key to this work was breaking the silos between different institutions: health systems management and governance structures and the State Anti-Corruption Strategy Committee and ICPC. The civil society organisation representing users are a key partner in this process.
✅ Consistent stakeholder engagement through policy dialogues, media, community initiatives.
They have set up a process of engagement, to co-create pragmatic and politically viable solutions. This involves diverse groups of stakeholders at all levels of the health system and society.
✅ State-of the art research.
In the past 6 years, the group conducted innovative and rigorous research and published extensively in high-quality journals, thus reaching technical audience. This informs effective policies.
✅ Creating an institutional base.
The group has become a focal point for research on health sector corruption and anti-corruption, in Africa and worldwide. They are often approached to share expertise and inform international anti-corruption efforts.
@ninavdm.bsky.social
I am incredibly privileged to have led the #AccountabilityinAction project with Obinna Onwujekwe and the wonderful team in Health Policy Research Group, Uni Nigeria. How does the group acts on health sector corruption? A thread
@martinmckee.bsky.social @eleanorhutch.bsky.social @lancetgh.bsky.social
1/ How does the COVID Inquiry's Module 2 report align with what we said in @independentsage.bsky.social at the time? A 🧵on Transparency, Early & Decisive Action, Scientific Advice, Integration of Social & Economic Harms, Communication and Behavioural Science, Governance, Data and Preparedness
We often forget how far we have come: Today almost 3/4 of EU electricity generation is from non-fossil energy sources.
It is not long ago that fossil fuels dominated the EU's electricity mix.
This year their share is approaching 1/4 of EU electricity generation.
Source is @ember-energy.org
Our new paper (by @petravarkonyi.bsky.social) shows a link b/n perceived corruption and health outcomes in central & eastern Europe. Expanded coverage isn’t enough—informal payments persist. Real change needs anti-corruption/ACTA tinyurl.com/2ky3rbkc
@martinmckee.bsky.social @obshealth.bsky.social
Crises like pandemics, cholera outbreaks & climate disasters don’t just strain health systems — they amplify corruption risks.
New #GIACE blog by Claudia Baez Camargo & @dinabalabanova.bsky.social explores how overlapping emergencies in Malawi opened space for corruption.
🔗 bit.ly/BaselGIACEBlog