Healthcare Provider Absenteeism and Health Service Delivery in Kenya

Background: Healthcare provider absenteeism constitutes a persistent challenge in Kenya's health system, with potentially significant consequences for service delivery and population health outcomes. Despite its prevalence, quantitative evidence on absenteeism's measurable effects on health service utilisation remains limited. Methodology: Using facility-level data from the 2018 Kenya Health Service Delivery Indicators (KHSDI) survey collected from a sample of 3,094 health facilities across all 47 counties, this study employs multiple linear regression analysis to evaluate how healthcare provider absence rates affect three health service utilisation indicators: outpatient visits, inpatient bed-days, and facility deliveries. 2,684 facilities had data on the key indicators. Robust standard errors are applied to address heteroscedasticity. Results: The mean absence rate across facilities is 71.4%, indicating a severe and widespread staffing challenge. Absenteeism exerts a significant negative effect on outpatient visits (coefficient: -311.853, p<0.01) but does not significantly affect inpatient bed-days. An unexpected positive association is observed between absenteeism and facility deliveries, warranting cautious interpretation. Public ownership, medical staffing, facility size, equipment availability, and extended operating hours are positively associated with service delivery, while geographic isolation constrains outpatient utilisation. Conclusion: Healthcare provider absenteeism meaningfully constrains health service delivery in Kenya, particularly outpatient care. Interventions targeting workforce presence, alongside improvements in facility infrastructure and geographic access, represent high-return strategies for health system strengthening under Kenya's devolved county governance structure.