title: Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria.
abstract: The posting and transfer of health workers and managers receives little policy and research attention in global health. In Nigeria, there is no national policy on posting and transfer in the health sector. We sought to examine how the posting and transfer of frontline primary health care (PHC) workers is conducted in four states (Lagos, Benue, Nasarawa and Kaduna) across Nigeria, where public sector PHC facilities are usually the only form of formal health care service providers available in many communities. We conducted in-depth interviews with PHC workers and managers, and group discussions with community health committee members. The results revealed three mechanisms by which PHC managers conduct posting and transfer: (1) periodically moving PHC workers around as a routine exercise aimed at enhancing their professional experience and preventing them from being corrupted; (2) as a tool for improving health service delivery by assigning high-performing PHC workers to PHC facilities perceived to be in need, or posting PHC workers nearer their place of residence; and (3) as a response to requests for punishment or favour from PHC workers, political office holders, global health agencies and community health committees. Given that posting and transfer is conducted by discretion, with multiple influences and sometimes competing interests, we identified practices that may lead to unfair treatment and inequities in the distribution of PHC workers. The posting and transfer of PHC workers therefore requires policy measures to codify what is right about existing informal practices and to avert their negative potential. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd.
authors.affiliation: School of Public Health, University of Sydney, New South Wales, Australia.|National Primary Health Care Development Agency, Abuja, Federal Capital Territory, Nigeria.|The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Seye
authors.identifier: http://orcid.org/0000-0003-1294-3850
authors.initials: S
authors.lastname: Abimbola
authors.affiliation: School of Public Health, University of Texas Health Science Center at Houston, Texas, USA.
authors.forename: Titilope
authors.initials: T
authors.lastname: Olanipekun
authors.affiliation: Averting Maternal Death and Disability, Mailman School of Public Health, Columbia University, New York, USA.
authors.forename: Marta
authors.initials: M
authors.lastname: Schaaf
authors.affiliation: School of Public Health, University of Sydney, New South Wales, Australia.
authors.forename: Joel
authors.initials: J
authors.lastname: Negin
authors.affiliation: School of Public Health, University of Sydney, New South Wales, Australia.|The George Institute for Global Health, Sydney, New South Wales, Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Jan
authors.affiliation: School of Public Health, University of Sydney, New South Wales, Australia.|The George Institute for Global Health, Sydney, New South Wales, Australia.|Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.
authors.forename: Alexandra L C
authors.initials: ALC
authors.lastname: Martiniuk
mesh_terms: D006801:Humans; D009549:Nigeria; D016134:Organizational Policy; D010559:Personnel Management / Q000379:methods; D011320:Primary Health Care / Q000458:organization & administration; D058996:Quality Improvement / Q000458:organization & administration; D000078329:Workforce
keywords: Nigeria; community health committees; governance; human resources for health; primary health care