Experiences from the Philippine grassroots: impact of strengthening primary care systems on health worker satisfaction and intention to stay

Abstract

Background Inequities in health access and outcomes persist in low- and middle-income countries. While strengthening primary care is integral in improving patient outcomes, primary care networks remain undervalued, underfunded, and underdeveloped in many LMICs such as the Philippines. This paper underscores the value of strengthening primary care system interventions in LMICs by examining their impact on job satisfaction and intention to stay among healthcare workers in the Philippines. Methods This study was conducted in urban, rural, and remote settings in the Philippines. A total of 36 urban, 54 rural, and 117 remote healthcare workers participated in the study. Respondents comprised all family physicians, nurses, midwives, community health workers, and staff involved in the delivery of primary care services from the sites. A questionnaire examining job satisfaction (motivators) and dissatisfaction (hygiene) factors was distributed to healthcare workers before and after system interventions were introduced across sites. Interventions included the introduction of performance-based incentives, the adoption of electronic health records, and the enhancement of diagnostic and pharmaceutical capabilities over a 1-year period. A Wilcoxon signed-rank test and a McNemar’s chi-square test were then conducted to compare pre- and post-intervention experiences for each setting. Results Among the factors examined, results revealed a significant improvement in perceived compensation fairness among urban (p = 0.001) and rural (p = 0.016) providers. The rural workforce also reported a significant improvement in medicine access (p = 0.012) post-intervention. Job motivation and turnover intention were sustained in urban and rural settings between periods. Despite the interventions introduced, a decline in perceptions towards supply accessibility, job security, and most items classified as job motivators was reported among remote providers. Paralleling this decline, remote primary care providers with the intent to stay dropped from 93% at baseline to 75% at endline (p < 0.001). Conclusion The impact of strengthening primary care on health workforce satisfaction and turnover intention varied across urban, rural, and remote settings. While select interventions such as improving compensation were promising for better-supported settings, the immediate impact of these interventions was inadequate in offsetting the infrastructural and staffing gaps experienced in disadvantaged areas. Unless these problems are comprehensively addressed, satisfaction will remain low, workforce attrition will persist as a problem, and marginalized communities will be underserved.

Impact of primary care system interventions on healthcare worker satisfaction and intention to stay in the Philippines: a follow-up study

“…The study results are consistent with our initial study comparing HCW satisfaction before and 1 year after implementation, which reported a decline in several factors in the remote site. 7 This follow-up study showed that the decline in HCW satisfaction persisted until year 2022, 3 years after implementation. In contrast, the urban and rural sites had significant improvement in several factors.…”

“…Baseline HCW intention to stay and satisfaction were obtained using a self-administered questionnaire in September 2016 for the urban site and in January 2017 for the rural site and November 2017 for the remote site, prior to implementation of interventions. 7 …”

“…This study used the same prevalidated and translated self-administered Stayers questionnaire used to evaluate HCW intention to stay at baseline and 1 year post-implementation. 7 The questionnaire consisted of 18 items, with 5 items related to sociodemographic characteristics of the participants, 11 items related to HCW satisfaction and 2 items related to intent to stay.…”

“…The six hygiene factors in the questionnaire were manageable workload, access to supplies, equipment and medicines, job security and fairness of compensation. 7 …”

“…Intent to stay remained the same for HCWs in the urban and rural sites, but there was a decline in intent to stay in the remote site. 7 …”