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

2. 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

3. 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

4. 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
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5. 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
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6. Results
Belize

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

8. Absenteeism trend by cadre (2015-2017)
Belize

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

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