Using Automated Attendance Tracking Tools to Manage Absenteeism of Health Workers Dr. Vincent Oketcho and Imara Roychowdhury

Background Health worker absenteeism is a key barrier to providing quality health care leading to reduced health worker productivity, disruption of health care delivery and poor access to health care services In Uganda, health worker absenteeism rate was estimated at 52% (World Bank 2013) and only 73% of posts are filled in public health sector Access to key services is still low (e.g. health facility deliveries stood at 58.1% in 2017, Antenatal Care four visits stood at 37% in 2017 (MOH AHSPR). Belize

Methodology/Approach IntraHealth worked with Ministry of Health (MOH) to design an automated system for tracking and reporting absenteeism data of health workers in real time (2x/day). The system captures data for each health worker per shift worked using biometric scanners. Data is then transferred to a local computer where it is analyzed and uploaded into the iHRIS servers at the MOH to generate reports on attendance to duty for management action. Belize

How does the Automated Attendance Tracking System work? 1. Health Workers scan their finger at the beginning and end of their shift 2. Data is sent from the biometric scanner to a local computer 3. Computer conducts analysis using biometric scanner software 4. Take health facility level action 5. Attendance data is sent to MOH servers 6. Data is matched using individual ID numbers in iHRIS 7. Generate reports against online duty roster in iHRIS 8. Take higher-level action Facility-Level Activities Ministry-Level Activities To change the photo in the background, right click and select “Change Picture” and select a new image. Other pre-cropped banners are available on ResourceSpace under Themes/IntraHealth Materials/Cropped Banners: https://resourcespace.intrahealth.org/?c=576

Absenteeism Analysis Summary Report % of time present at health facility is increasing over time % of time off-duty should stay between 24-27% Reported absenteeism without approval is decreasing in participating districts To change the photo in the background, right click and select “Change Picture” and select a new image. Other pre-cropped banners are available on ResourceSpace under Themes/IntraHealth Materials/Cropped Banners: https://resourcespace.intrahealth.org/?c=576

Results Belize

Absenteeism Rate – Districts 2017 (With or Without approval) Belize

Absenteeism trend by cadre (2015-2017) Belize

Absenteeism rate by health facility level (%) 2016 2017 Percentage reduction RRH 57.3 37.1 20.2 GENERAL HOSPITAL 46.1 42.7 3.4 HCIV 51.5 44.1 7.4 HCIII 44.2 43.8 0.4 HCII 39.5 38.7 0.8 Belize

Absenteeism rate (Public/PNFP Health Facilities)  Absenteeism category   2016 2017 Diff. Overall absenteeism rate Public  46.9 42.8 4.0 PFNP 41.4 41.3 0.05 Absenteeism rate without approval 14.2 12.3 1.9 11.4 9.8 1.7 Authorized Absenteeism Rate 32.7 30.6 2.1 30 31.6 -1.6 Belize

Absenteeism rate –Rural vs Urban Districts RURAL /URBAN Overall absenteeism rate Absenteeism rate without approval (%) RURAL DISTRICTS 42.9 12.8 URBAN DISTRICTS 41.9 10.2 Belize

Major causes of absence from the health facility Leave (all forms: study, sick, maternity, etc.) Official assignments Trainings/Workshops Work climate factors (e.g weak leadership & management (governance), delayed pay, lack of equipment, tools and supplies, lack of accommodation) Personal leave e.g. family responsibilities, burials, pregnancy Belize

Discussion The automated attendance monitoring tool has improved tracking and timely generation of credible evidence on absenteeism of health workers Created awareness and urgency for action at all levels including political leadership e.g. paying salaries based on number of days worked Increased availability of skilled health providers in health facilities Belize

Lessons Learned Management action is critical to the success of absenteeism reduction strategies Most of the causes of health worker absence from the health facility are within management control (e.g. leave, off duty, workshops) and can significantly reduce absenteeism if effectively addressed Use of technology based tools reduces manipulation and fraud in collection and reporting absenteeism data, and increases management confidence to take action. Belize

Conclusion/ Recommendations Scale up automated tracking tools (biometric machines) to lower facilities to ease data collection, analysis and reporting on absenteeism Implement management incentives to improve reporting rates, analysis and utilization of absenteeism data at all levels e.g. through strengthening supervision, rewards and sanctions Link absenteeism tracking tool with other Health Management Information Systems (DHIS2), and Human Resource Management Systems (IPPS) to monitor improvement in service outputs, and link pay to performance for sustainability. Continue to improve tools and processes for attendance tracking & analysis including use of smartphones, dashboards Future research needs to be conducted to measure impact of absenteeism reduction on health worker productivity and service Belize

Contact: Dr.Vincent Oketcho voketcho@intrahealth.org STRENGTHENING HUMAN RESOURCES FOR HEALTH