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Mbarara, Uganda | URN | Health worker absenteeism in Mbarara District has fallen from 11 percent to three percent in the past year, while referrals of expectant mothers to Mbarara Regional Referral Hospital have also dropped by half, district officials say.
The improvement follows intensified supervision of health facilities and measures to ensure that medical workers are present and providing services when they are scheduled to work. Mbarara District Health Officer Dr Peter Sebutinde said the district has reduced absenteeism over the past 12 months through unannounced supervision and disciplinary action against health workers who absent themselves from duty without permission.
He said the district stopped relying only on attendance registers and instead began physically verifying whether health workers were at their duty stations.
“There was a high rate of absenteeism. We swung into action with the accounting officer, and we suspended many; we reprimanded many. We are not looking at the books, duty attendance registers. No, you go and ask for the presence of the officer,” Sebutinde said.
He said district officials make unannounced visits to health facilities and require staff present to account for colleagues who are absent. The district also introduced daily accountability on the work done by individual staff members to assess their output.
Mbarara Chief Administrative Officer John Patrick Nuwagaba said the district has also streamlined services according to the level of each health facility. He said Health Centre IIs are expected to provide basic care, Health Centre IIIs obstetric care, while Health Centre IVs should handle emergency obstetric services.
Nuwagaba said the system had previously been undermined by absenteeism and poor conditions at some lower-level facilities, forcing expectant mothers to seek care at the regional referral hospital. He said some mothers referred themselves because doctors were unavailable, linen was dirty, and the general conditions at some facilities discouraged them from seeking care there.
The district has since prioritised ensuring that medical officers required for emergency obstetric care are available when needed. Dr Sebutinde said the improvements have been achieved despite the district operating at only about 40 percent of its approved staffing level.
He said the district has strengthened communication with communities through WhatsApp groups, community health extension workers and Village Health Teams. Through these channels, residents have been able to report challenges including staff absenteeism, drug shortages and other gaps at health facilities.
Dr Deus Twesigye, Acting Senior Executive Consultant at Mbarara Regional Referral Hospital, said the facility previously recorded a sharp increase in referrals of expectant mothers over weekends when health workers were often unavailable at lower-level facilities.
He said the hospital raised the issue with district leaders, resulting in improved attendance and availability of health workers at the lower facilities. According to Twesigye, maternal referrals to the regional referral hospital have consequently fallen from more than 30 percent to about 15 percent in the last 12 months.The district health authorities say the changes are intended to ensure that patients receive the right care at the appropriate level and reduce unnecessary pressure on Mbarara Regional Referral Hospital.
