The hidden toll of colleague absenteeism: exploring its impact on emotional strain and burnout among frontline health workers in Nigeria

Background: Absenteeism among health workers is a persistent challenge in resource-constrained health systems, increasing workloads for those who remain present and undermining service quality. While its operational consequences are well documented, the emotional and psychological impact on frontline workers remains underexplored. This study examines how unscheduled colleague absenteeism contributes to emotional strain and burnout among primary healthcare (PHC) workers in Nigeria. Methods: The study was conducted in Enugu and Kano States, using 24 in-depth interviews with PHC workers purposively selected from urban, semi-urban, and rural facilities, based on their direct experience with colleague absenteeism. Participants included both women and men, reflecting variation in workforce composition across settings. A multi-stakeholder co-creation workshop provided contextual and institutional perspectives. Data were analyzed thematically using the job demands-resources (JDR) framework, with interview data as the primary basis for analysis. Findings: Colleague absenteeism substantially increased job demands, with participants describing emotional exhaustion from repeatedly covering multiple clinical and non-clinical roles or managing facilities alone. These experiences generated significant emotional strain, manifesting as frustration, isolation, sadness, and moral distress. Effects were shaped by organizational conditions, including weak supervision, inconsistent shift management, and perceived unfairness linked to favoritism and limited accountability. Informal power structures, such as godfatherism, allowed some staff to be absent without consequence, while others assumed additional responsibilities, thereby intensifying perceptions of inequity. Gendered expectations further amplified emotional burden in settings where the PHC workforce was predominantly female. Conclusion: Unscheduled colleague absenteeism has profound emotional and psychological consequences for frontline PHC workers, contributing to burnout and diminished morale. Addressing these impacts requires workforce strategies that extend beyond staffing numbers to include transparent scheduling, supportive supervision, recognition of emotional labor, equitable accountability mechanisms, and gender-sensitive policies that prioritize the well-being of those who consistently remain present.