Objective <p>Few studies have examined the impact of health on the resilience of very small businesses (VSBs). This study analyzes absenteeism in Moroccan VSBs and the role of healthcare in productivity.</p> Materials and methods <p>This cross-sectional study was conducted between July and November 2024 using a structured survey to collect demographic, health, and productivity data. Participants were selected based on their availability, with inclusion criteria requiring them to be Moroccan nationals, aged 18 years or older, and either employees or owners of a VSB. A total of 488 respondents were included, comprising 112 business owners and 376 employees.</p> Results <p>The main causes of absenteeism were illness (96.7%) and medical visits (93.4%), confirming the strong influence of health on workforce stability. The absenteeism rate from illness was 1.76% (95% CI: 0.97%–3.47%), resulting in an annual payroll loss of 6.77% (95% CI: 4.99%–9.16%).Chronic diseases were frequent: diabetes (28.7%), hypertension (16.8%), and cardiac or vision disorders (16.4%). Most participants (78.3%) were unaware of their serological status, while positive cases of Hepatitis B, Hepatitis C, or HPV were rare. Despite 88.5% having medical coverage, access to care was limited: 61.5% consulted a physician less than once per year, only 16% received additional vaccinations, and 78% postponed consultations for financial or time reasons. Age and chronic illness were significant predictors of absenteeism and presenteeism.</p> Conclusion <p>These findings highlight the link between healthcare access and VSBs’ economic resilience. Workplace health programs and improved medical access are essential to reduce absenteeism and improve productivity.</p>