Design, implementation and testing of a feasible intervention to address absenteeism of frontline health workers in Nigeria
| ISRCTN | ISRCTN35927664 |
|---|---|
| DOI | https://doi.org/10.1186/ISRCTN35927664 |
| Sponsor | SOAS University of London |
| Funder | UK aid from the UK Government [Contract P07073] |
- Submission date
- 11/09/2026
- Registration date
- 20/09/2026
- Last edited
- 18/09/2026
- Recruitment status
- No longer recruiting
- Overall study status
- Ongoing
- Condition category
- Other
Plain English summary of protocol
Background and study aims
Health worker absenteeism is a challenge in primary healthcare facilities in Nigeria. When health workers are absent from work, patients may have difficulty getting the care they need. This study tests a package of interventions designed with health workers, health policy makers, community members and other stakeholders to reduce absenteeism among frontline health workers. It also aims to understand how the approaches work, what helps or hinders their implementation, and whether they can be sustained and used more widely.
Who can participate?
The study involves frontline health workers and Officers-in-Charge in participating primary healthcare facilities, members of the Community Monitoring and Support Committees (CMSCs), health service users and other community members. Both women and men can participate.
What does the study involve?
The study includes facilities receiving the programme and comparison facilities that do not receive it during the study period.
The programme has three components: transport support, peer support among health workers, and community monitoring and support. Transport support helps eligible health workers with travel costs. Peer-support groups help health workers and facility heads support one another and address attendance problems. CMSCs monitor health worker attendance and support facilities in addressing barriers to attendance.
Researchers assess attendance using facility attendance records and visits to the facilities. Questionnaires, interviews and group discussions are also used to understand participants' experiences and changes in service delivery.
What are the possible benefits and risks of participating?
The study will help improve health worker attendance, accountability and the availability of primary healthcare services. However, participants may not benefit directly.
There are no medical treatments involved. Some participants may feel uncomfortable discussing absenteeism or accountability. Participants' information is kept confidential, and individual health workers are not identified in study reports.
Where is the study run from?
The study is conducted in primary healthcare facilities in Enugu State, Nigeria, and is led by the University of Nigeria, working with the London School of Hygiene & Tropical Medicine (LSHTM) and SOAS University of London.
When is the study starting and how long is it expected to run for?
The study will commence from 1 November 2024 to June 2027 in Nigeria. The intervention was implemented in two states. In Enugu state, from August 2025 to January 2026, followed by the endline evaluation in March 2026 in Enugu state and subsequent analysis and dissemination. In Kano state, intervention commenced from December 2026 to May 2026. Endline evaluation was conducted in June 2026, analysis and dissemination follows. Development of knowledge products continues.
Who is funding the study?
The study is funded by UK aid from the UK Government [Contract P07073].
Who is the main contact?
Prof. Obinna Onwujekwe
Email: obinna.onwujekwe@unn.edu.ng
Contact information
Principal investigator, Scientific
Health Policy Research Group, University of Nigeria, Enugu Campu
Enugu
401105
Nigeria
 ORCID ID |
0000-0002-1214-4285 |
|---|---|
| Phone | +234 8037007771 |
| obinna.onwujekwe@unn.edu.ng |
Public
Enugu State University of Science and Technology, Agbani, Enugu, Nigeria
Enugu
402004
Nigeria
| ORCID ID |
0000-0003-1343-1822 |
|---|---|
| Phone | +234 8039325131 |
| pamela.ogbozor@esut.edu.ng |
Study information
| Primary study design | Interventional |
|---|---|
| Allocation | Non-randomized controlled trial |
| Masking | Open (masking not used) |
| Control | Uncontrolled |
| Assignment | Parallel |
| Purpose | Health services research, Prevention |
| Participant information sheet | 50274 ACE 2_Participant Information sheet.pdf |
| Scientific title | Design, implementation and testing of a multi-component intervention to reduce absenteeism among frontline health workers in primary healthcare facilities in Nigeria: a pre- and post-intervention study |
| Study acronym | Anti-corruption Evidence 2 (ACE 2) |
| Study objectives | |
| Ethics approval(s) |
Approved 19/01/2024, University of Nigeria Teaching Hospital (UNTH) (Ituku-Ozalla, Enugu, 01129, Nigeria; +234 42252022; info@unth.edu.ng), ref: UNTH/HREC/2024/01/829 |
| Health condition(s) or problem(s) studied | Reducing absenteeism among health workers |
| Intervention | This is a quasi-experimental, mixed-methods study involving intervention and control primary healthcare (PHC) facilities in Enugu State, Nigeria. The intervention facilities receive a co-created multi-component intervention comprising: (1) supplementary monthly transport allowances for eligible health workers; (2) peer support networks; and (3) community monitoring and support. The supplementary transport allowance is paid monthly at the beginning of each month to eligible health workers to reduce transport-related barriers to attending work. The peer support network is conducted monthly and operates at three levels: intra-facility peer support among health workers within each PHC, inter-facility peer support across participating PHCs, and a forum for facility heads/Officers-in-Charge (OICs) to promote shared learning, problem-solving and accountability. The community monitoring and support component involves members of the Community Monitoring and Support Committee (CMSC) visiting PHCs at least three times per week to monitor health worker attendance and support facilities in addressing identified barriers to attendance. The control PHC facilities continue routine primary healthcare service delivery and do not receive the multi-component intervention during the six-month intervention period. Quantitative data are collected from the control facilities at baseline and endline using the same assessment approach as in the intervention facilities. The study uses a non-randomized design. Four PHC facilities were purposively selected for the intervention arm across four Local Government Areas (LGAs) in Enugu State, and one comparison PHC facility was selected from each corresponding LGA to form the control arm. Health workers participate according to the study arm of their respective PHC facility and are not individually assigned to the intervention or control arms. The intervention runs for six months. Quantitative and qualitative data are collected at baseline and endline, while process evaluation is conducted monthly throughout the intervention period to assess implementation, fidelity, acceptability, feasibility and adaptations. Quantitative data are used to assess changes in absenteeism and related outcomes, while qualitative data are used to understand the mechanisms of change, implementation processes and sustainability of the intervention. Changes in absenteeism are assessed using before-and-after and intervention-versus-control comparisons. |
| Intervention type | Behavioural |
| Primary outcome measure(s) |
|
| Key secondary outcome measure(s) |
1. Consistency and reliability of healthcare service provision measured using facility records and the facility/provider survey at endline (March 2026) |
| Completion date | 30/06/2027 |
Eligibility
| Participant type(s) | |
|---|---|
| Age group | Mixed |
| Lower age limit | 18 Years |
| Upper age limit | 120 Years |
| Sex | All |
| Target sample size at registration | 356 |
| Total final enrolment | 314 |
| Key inclusion criteria | The participants must be frontline health workers in selected primary health centers. |
| Key exclusion criteria | 1. Frontline health workers in selected primary health centers that refused to participate in the study 2. Other workers in the PHC who do not provide clinical services like administrative staff, cleaners, securities etc. |
| Date of first enrolment | 01/07/2025 |
| Date of final enrolment | 01/06/2026 |
Locations
Countries of recruitment
- Nigeria
Study participating centres
Results and Publications
| Individual participant data (IPD) Intention to share | No |
|---|
Study outputs
| Output type | Details | Date created | Date added | Peer reviewed? | Patient-facing? |
|---|---|---|---|---|---|
| Participant information sheet | 18/09/2026 | No | Yes |
Additional files
- 50274 ACE 2_Participant Information sheet.pdf
- Participant information sheet
Editorial Notes
18/09/2026: Trial's existence confirmed by University of Nigeria Teaching Hospital (UNTH).
