Measuring and managing the work environment of the mid-level provider – the neglected human resource

Abstract

Background: Much has been written in the past decade about the health workforce crisis that is crippling health service delivery in many middle-income and low-income countries. Countries having lost most of their highly qualified health care professionals to migration increasingly rely on mid-level providers as the mainstay for health services delivery. Mid-level providers are health workers who perform tasks conventionally associated with more highly trained and internationally mobile workers. Their training usually has lower entry requirements and is for shorter periods (usually two to four years). Our study aimed to explore a neglected but crucial aspect of human resources for health in Africa: the provision of a work environment that will promote motivation and performance of mid-level providers. This paper explores the work environment of mid-level providers in Malawi, and contributes to the validation of an instrument to measure the work environment of mid-level providers in low-income countries.

Understanding job satisfaction amongst mid-level cadres in Malawi: the contribution of organisational justice

“…16 This has not always been the case in Malawi, however, as found in two previous studies, one of mid-level providers working in maternal and obstetric care 18 and another of mid-level providers' work environment. 21 In the former, tensions between clinical officers and doctors were found, and in the latter, which was conducted with the same sample as this study, nursing cadres expressed more job satisfaction than clinical officers and medical assistants, who reported poorer working relationships.…”

“…Yet the role of managers in motivating and retaining staff is something that has largely been ignored in attempts to address the migration of health workers, even though managers who are unsupportive or inconsiderate can be a strong push factor. 21 Improving the attitudes of managers towards health workers is a relatively inexpensive approach that could have a significant impact on performance and retention.…”

“…Data collected on work environment are reported elsewhere. 21 The majority of the participants were under 35 years of age and in full-time permanent health service employment (Table 1).…”

“…17,18 There is concern that quality of care will suffer if they are not properly supported and motivated. 16,[18][19][20][21] One concept that connects how employees are treated with motivation and job satisfaction is that of organisational justice, 22 which generally encompasses three components: distributive justice, procedural justice and interactional justice. 23 Distributive justice refers to how fairly employees feel they are treated (in comparison to others) with regards to the distribution of resources and outcomes.…”

Impact of Organizational Factors on Adherence to Laboratory Testing Protocols in Adult HIV Care in Lusaka, Zambia

“…First, recent studies have measured structural factors of service delivery such as worker satisfaction and motivation [6][7][8][9] and have uncovered a number of predictors of dissatisfaction. These include public vs. private sector employment, workload, availability of resources, salaries [10], and low levels of staffing, management support and control over their practice [11]. Second, other studies have documented the gap between desired and actual quality of care along structure, process or outcome dimensions [12][13][14].…”