Retention of health workers in Malawi: perspectives of health workers and district management

Manafa, Ogenna; McAuliffe, Éilish; Maseko, Fresier; Bowie, Cameron; MacLachlan, Malcolm; Normand, Charles

doi:10.1186/1478-4491-7-65

Cited by 124 publications

(137 citation statements)

References 11 publications

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“…Transparency in promotions in Tanzania 42 was linked with better satisfied health workers. Results from this study were consistent with studies from developing countries like Malawi 43 and Ghana, 44 which also explained the demotivation among physicians as an effect of lack of sufficient professional and career growth opportunities at their jobs. The notion of 'job security' was also a reason for staff absenteeism and frequent transfers out of rural districts, as seen in this study.…”

Section: Discussionsupporting

confidence: 90%

Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan

Shah

Zaidi

Ahmed

et al. 2016

Int J Health Policy Manag

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Background: Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan. Methods: An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental factors. Qualitative research methods comprising of semi-structured interviews with doctors working in basic health units (BHUs) and in-depth interviews with district and provincial government health managers were used. Document review of postings, rules of business and policy actions was also conducted. Triangulation of findings was carried out to arrive at the final synthesis. Results: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies and medical facilities contributed to lack of motivation among both male and female doctors. The physicians accepted government jobs in BHUs with a belief that these jobs were more secure, with convenient working hours. Male physicians seemed to be more motivated because they faced less challenges than their female counterparts in BHUs especially during relocations. Overall, the organizational factors emerged as the most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits played an important role. Gender and marital status of female doctors was regarded as most important individual factor affecting retention and motivation of female doctors in BHUs. Conclusion: Inadequate remuneration, unreasonable facilities at residence, poor work environment, political interference, inadequate supplies, and medical facilities contributed to lack of motivation in physicians in our study. Our study advocates that by addressing the retention and motivation challenges, service delivery can be made more responsive to the patients and communities in Pakistan and other similar settings.

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Section: Discussionsupporting

confidence: 90%

Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan

Shah

Zaidi

Ahmed

et al. 2016

Int J Health Policy Manag

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“…Some health workers have been reported to stay in their posts because of the opportunity to be able to assist mankind [36], In our study, some health workers viewed their work as a vocation to the community, rather than just work which they are required to do [3,44]. More females than males tended to mention the ‘call to serve’ as a factor that motivated their long stay.…”

Section: Discussionmentioning

confidence: 88%

“…Authorities respond to the restricted wage bill by opting to recruit more junior staff to close the staffing gaps rather than promote existing staff. Subsequently, infrequent and delayed promotions usually demotivate staff [36]. There needs to be a rational and predictable promotion mechanism so as to retain health workers in rural posts [29].…”

Section: Discussionmentioning

confidence: 99%

Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda

Kiwanuka

Akulume

Tetui

et al. 2017

Global Health Action

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Background: Health worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered. Objective: This paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda. Methods: A descriptive qualitative study explored the factors that motivated health workers to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews conducted among health workers who have been retained for at least 10 years explored factors motivating the health workers to stay within the district, opportunities, and the benefits of staying. Results: Twenty-one health workers participated. Ten of them male and 11 female with the age range of 33–51 years. The mean duration of stay among the participants was 13, 15, and 26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to personal factors, such as having family ties, community ties, and opportunities to invest. The decentralization policy and pension benefits also kept workers in place. Opportunities for promotion or leadership motivated long stay only if they came with financial benefits. Workload reportedly increased over the years, but staffing and emoluments had not increased. Multiple job, family support, and community support helped health workers cope with the costs of living, and holding a secure pensionable government job was valued more highly than seeking uncertain job opportunities elsewhere. Conclusion: The interplay between the costs of leaving and the benefit of staying is demonstrated. Family proximity, community ties, job security, and pension enhance staying, while higher costs of living and an unpredictable employment market make leaving risky. Health workers should be able to access investment opportunities in order to cope with inadequate remuneration. Promotions and leadership opportunities only motivate if accompanied by financial benefits.

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“…Algunos estudios refieren que ítems como la educación médica es inadecuada en las zonas rurales (9,18,19) , siendo necesario brindarles los recursos para poder desarrollarse profesionalmente (3,7) ; sin embargo, no hemos encontrado referencia que precedan a nuestro hallazgo. Según nuestros resultados las coberturas de aseguramiento entre las entidades que regulan la sede, sean del MINSA u otras, el sexo del profesional y la clasificación de pobreza de la sede son significativos con más del 10% de diferencia a partir del mes de octubre.…”

Section: Discussionunclassified

“…A los tres meses de iniciado su contrato, el 6,6% (19) de los médicos recién egresados contaban con Seguro Social en caso de accidentes y muerte, esto fue aumentando conforme pasaban los meses, septiembre (17,9%); octubre (61,7%); noviembre (66,2%); diciembre (69,7%); enero (69,7%); febrero (69,7%); marzo (71,0%), hasta llegar a su máximo el último mes de su contrato, abril (72,1%). Quince (5,2%) médicos que realizaron atención primaria de la salud tuvieron cobertura de Seguro Social a los nueve meses y 76 (26,2%) no lo tuvieron en ninguno.…”

Section: Hallazgosunclassified

Deficiente cobertura de aseguramiento a médicos durante el servicio rural y urbano-marginal en Perú

Mejía

Quiñones-Laveriano

Espinoza

et al. 2014

Rev Peru Med Exp Salud Publica

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RESUMENCon el objetivo de determinar la cobertura del aseguramiento en salud que recibieron los médicos recién graduados de universidades de Lima, que realizaron el Servicio Rural y Urbano Marginal en Salud (SERUMS) durante el periodo 2012 -2013, realizamos un seguimiento mensual de los datos de afiliación al Seguro Social de Salud (Essalud). De un total de 290 médicos el 6,6% (19) tenía activado su seguro al fin de los tres primeros meses, incrementándose al 72% (209) el último mes, el 26,2% no tuvieron afiliación en ninguno de los meses. Se encontraron diferencias en la cobertura de aseguramiento según entidad que regula la sede (p<0,01), el sexo del médico (p=0,03) y la clasificación de pobreza de la sede (p=0,02). Se concluye que existe una deficiente cobertura de aseguramiento hacia los profesionales que realizan atención primaria de la salud en zonas alejadas del país, lo cual es un problema que debe ser vigilado. Palabras clave: Seguridad social; Recursos humanos; Trabajadores rurales; Atención primaria de salud (fuente:DeCS BIREME) POOR COVERAGE INSURANCE IN MEDICAL GRADUATES FOR THE SERVICE RURAL AND URBAN-MARGINAL IN PERÚ ABSTRACTThe aim of this study was to describe the concentration of lead in umbilical cord blood (UCB) of neonates born from primiparous women who live in northern Lima. A cross sectional study was carried out at Cayetano Heredia National Hospital, from July 2011 to January 2012. 100 neonates born from primiparous women who lived in northern Lima in the previous 5 years or more were included. Umbilical cord lead levels were measured by the atomic adsorption method, and the demographic information and risk factors of the neonates were filled in a patient record designed to this purpose. 30% of the neonates had concentration of lead in UCB that was considered as increased risk (≥ 3,0 μg/dL), 16% of the cases had had toxic concentration of lead in UCB (≥ 5 μg/dL). We conclude that there are a high percentage of neonates contaminated with lead in the northern Lima. Citar como: Mejía CR, Quiñones-Laveriano DM, Espinoza KG, Quezada-Osoria C. Deficiente cobertura de aseguramiento en médicos durante el servicio rural y urbano-marginal en salud. Rev Peru Med Exp Salud Publica. 2013;30(2):220-3.

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Retention of health workers in Malawi: perspectives of health workers and district management

Cited by 124 publications

References 11 publications

Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan

Motivation and Retention of Physicians in Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan

Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda

Deficiente cobertura de aseguramiento a médicos durante el servicio rural y urbano-marginal en Perú

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