By Olubunmi Olorunpomi

On a quiet morning, Amira arrived at the local health clinic, clutching her feverish child tightly against her chest. Her heart pounded with worry as she approached the building, only to find the doors locked. She sat on the wooden bench outside, rocking her child gently, whispering prayers under her breath, and watching the minutes crawl by.

Finally, the doors creaked open. A health worker arrived at the clinic late and without a word of explanation. Amira experienced a mixture of relief and frustration as she finally gained access to care. Each minute of waiting had felt like an eternity, and she struggled afterward to overcome the sense of disappointment she experienced when she most needed healthcare assistance.

In emergencies where every second can mean life or death, the absence of a health worker increases the risk of tragedy. Each moment lost to absence can be the difference between a life saved and a life slipping away. This is the unseen cost of absenteeism in Nigeria’s healthcare system: a mother who fears she might lose her child while waiting, a father who spends his last money on transport only to return home without medicine, and the communities whose trust in the health system grows thinner with workers missing at their duty posts. The rate of absenteeism creates a painful divide between the care people seek and the care they receive.

Primary healthcare facilities in Sub-Saharan Africa are particularly affected by the critical shortage of healthcare workers. The persistent issue of absenteeism among healthcare workers exacerbates this challenge. Absenteeism is generally understood as a voluntary failure to report for duty, not officially excused, excluding situations such as illness, approved leave, or other unavoidable obligations that result in an involuntary absence from duty. (Belita, Mbindyo & English, 2013).

A World Bank working group study revealed that in ten Sub-Saharan African countries, including Kenya, Madagascar, Mozambique, Nigeria, Niger, Senegal, Sierra Leone, Tanzania, Togo, and Uganda, only about 70% of healthcare workers were present in clinics during scheduled working hours. This is especially concerning given that the region shoulders roughly 25% of the global disease burden yet has just 3% of the world’s healthcare workforce to respond to it. Absenteeism among such a limited pool of health workers deepens the crisis, restricting access to care and further straining already fragile systems (WHO, 2009).

The strain is often heaviest on the health workers who do show up. Day after day, they face an overwhelming tide of patients, which inevitably leads to fatigue, stress, and declining job satisfaction. Each time a colleague is absent, whether by choice or due to unavoidable circumstances, the pressure intensifies. Over time, this relentless burden can push even the most dedicated staff toward burnout, causing them to miss work themselves. Overwork quickly spirals into a vicious cycle, with low morale fueling voluntary absences, which in turn further undermine the system’s capacity.

Rural communities mainly rely on PHCs for essential services such as vaccinations, prenatal care, and treatment of childhood illnesses, but often find these centers understaffed. It is undeniable that absenteeism has undermined trust and jeopardized lives. For policymakers, the solution must go beyond mere staffing numbers. It must ensure presence, accountability, and reliability.

This is why the Kaduna State Primary Healthcare Board (SPHCB) and the Natview Foundation for Technology Innovation (NFTI) launched an important pilot project to integrate biometric attendance into the Human Resource for Health Management Information System (HRHMIS) across 23 primary healthcare centers (PHCs). The aim is not to police or punish healthcare workers, but to protect our communities by ensuring patients arrive to find a healthcare giver ready and waiting.

The introduction of biometric attendance aims to disrupt a cycle of manipulation and favoritism by making attendance visible and transparent. It protects the diligent caregiver and shines a light on patterns of absence while empowering health managers to respond swiftly, without fear or favor. Reliable staffing means fewer wasted trips for patients, especially in rural areas where transportation can be costly. Mothers arrive for antenatal appointments knowing someone will be there. Children scheduled for vaccinations receive them without delay. Trust returns to the health system both as a policy goal and a lived experience.

There are, of course, challenges. Skepticism among health workers is real. Some worry the technology is designed to monitor and penalize. While biometric attendance is not a panacea, it can serve as a significant turning point, particularly when combined with open communication, stakeholder engagement, and support for health workers. Kaduna’s pilot can draw lessons from Gombe State, where similar systems saw absenteeism decline. Why? The culture shifted, leading to consistent care that restored people’s trust in their PHCs. Homegrown solutions that work with communities, not around them, can succeed.

Biometric attendance enables Kaduna State to ensure that every second counts for patients and the wider community. When fully adopted, it will restore presence, strengthen commitment, and rebuild trust by making accountability visible. It is important to note that the system’s adoption culture cannot improve with heavy-handed enforcement. True adoption requires dialogue, trust, and a shared understanding of why the system matters.

The pilot in Kaduna’s 23 primary health centers provides an important opportunity to build this acceptance culture. The project’s Local Technical Assistants, trained to install and maintain the biometric devices, are already helping healthcare workers adjust by troubleshooting challenges and answering questions. These LTAs are essential to the technical rollout and the human side of technology adoption. With their presence in each facility, health workers are never left to navigate the system alone; instead, they receive continuous guidance, support, and reassurance at every stage.

Biometric attendance systems in healthcare go far beyond simply checking who is at work. Biometric attendance systems, unlike passwords or cards, offer a dependable identity verification method that remains unaffected by theft, forgery, or forgetfulness. This accuracy improves both workforce management and patient safety, ensuring that the right person is where they should be, doing the work they are trusted to do. It also brings convenience, as staff no longer need to carry tokens or remember logins; attendance becomes a seamless part of the daily routine, saving time and reducing barriers to accountability.

The financial benefits are equally compelling. Manual identification methods have led to high rates of duplicate records, costing health systems millions of dollars annually and putting patient safety at risk. Biometrics can eliminate these losses while also opening doors to greater inclusion, especially for people with literacy challenges or physical disabilities, who find the system easier and more dignified to use.

Adopting biometric attendance is ultimately about choosing progress over stagnation. Every profession evolves, and healthcare cannot remain tied to outdated systems that weaken both service delivery and public trust. Embracing this technology allows health workers to demonstrate true leadership, proving that accountability and humanity can work hand in hand. The transition may feel unfamiliar at first, but the legacy it leaves will be one of reliability, fairness, and renewed respect for the vital work done in our primary health centers. Change begins with a choice, and in this case, that choice is to stand present and be counted.

About the Author:

Olubunmi is a seasoned communications strategist with extensive experience in media engagement, strategic messaging, and stakeholder relations. As the Senior Programs Officer, Strategic Communications and Advocacy at the Natview Foundation for Technology Innovation (NFTI), he leads the foundation’s storytelling, advocacy, brand positioning, and public engagement efforts.