Absenteeism amongst Health Workers – Developing a Typology to Support Empiric Work in Low-income Countries and Characterizing Reported Causes

Word Count: Abstract 205 Main Text 4064 Additional file: A summary of studies included in the review. Abstract The contribution of inadequate health worker numbers and emigration have been highlighted in the international literature but relatively little attention has been paid to absenteeism as a factor that undermines health care delivery in low income countries. We therefore aimed to review literature on absenteeism to inform needed work on this topic. Specifically we aimed to develop a typology of definitions that might be useful to classify different forms of absenteeism and identify factors associated with absenteeism. Sixty nine studies were reviewed, only four were from sub-Saharan Africa where the human resources for health crisis is most acute. Forms of absenteeism studied and methods used vary widely, No previous attempt to develop an overarching approach to classifying forms of absenteeism was identified. A typology based on three key characteristics is proposed as to fill this gap and considers absenteeism as defined by three key attributes: planned / unplanned, sanctioned / unsanctioned and voluntary / involuntary. Factors reported to influence rates of absenteeism may be broadly classified into three thematic categories; work place and content, personal and organizational and cultural factors. Literature presents an inconsistent picture of the effects of specific factors within these themes perhaps related to true contextual differences or inconsistent definitions of absence.