What makes staff consider leaving the health service in Malawi?

Abstract

BackgroundMalawi faces a severe shortage of health workers, a factor that has contributed greatly to high maternal mortality in the country. Most clinical care is performed by mid-level providers (MLPs). While utilization of these cadres in providing health care is a solution to the current shortages, demotivating factors within the Malawian health system are pushing them into private, non-governmental, and other non-health related positions. This study aims to highlight these demotivating factors by exploring the critical aspects that influence MLPs’ intention to leave their jobs.MethodsThis descriptive qualitative study formed part of the larger Health Systems Strengthening for Equity (HSSE) study. Data presented in this paper were collected in Malawi using the Critical Incident Analysis tool. Participants were asked to narrate an incident that had happened during the past three months which had made them seriously consider leaving their job. Data were subjected to thematic analysis using NVivo 8 software.ResultsOf the 84 respondents who participated in a Critical Incident Analysis interview, 58 respondents (69%) indicated they had experienced a demotivating incident in the previous three months that had made them seriously consider leaving their job. The most commonly cited critical factors were being treated unfairly or with disrespect, lack of recognition of their efforts, delays and inconsistencies in salary payments, lack of transparent processes and criteria for upgrading or promotion, and death of patients.ConclusionStaff motivation and an enabling environment are crucial factors for retaining MLPs in the Malawian health system. This study revealed key ‘tipping points’ that drive staff to seriously consider leaving their jobs. Many of the factors underlying these critical incidents can be addressed by improved management practices and the introduction of fair and transparent policies. Managers need to be trained and equipped with effective managerial skills and staff should have access to equal opportunities for upgrading and promotion. There is need for continuous effort to mobilize the resources needed to fill gaps in basic equipment, supplies, and medicine, as these are critical in creating an enabling environment for MLPs.

Shifting human resources for health in the context of ART provision: qualitative and quantitative findings from the Lablite baseline study

“…As such, some tasks were shifted to lower level cadres prior to having undergone requisite training. Inequitable access to training has been noted elsewhere as a source of demotivation among health care workers [18]. Our data indicate that this was linked to availability of financial incentives during training.…”

Perceptions and predictors of organizational justice among healthcare professionals in academic hospitals in South-Eastern Nigeria

“…Perception of unfairness in salaries decreased perception of distributive justice among healthcare professionals [3,11,[13][14][15][16][17][18][19][20]. In Tanzania, the experience of being by-passed by colleagues with shorter working experience and longer formal training was most dissatisfying for health workers with longer working experience [14].…”

Management Matters: A Leverage Point for Health Systems Strengthening in Global Health

“…Both clinical and administrative staff can benefit from enhanced management capacity and can form a cadre of people who translate ministry-level and global strategies into practice at the front line, while also ensuring information from the front line is recognized in high-level strategy development. Although management has been recognized as fundamental to health worker performance and motivation, [14][15][16] peer-reviewed studies on management, including quality improvement efforts, in global health are limited in their size, scope, and rigor. About 2 dozen studies [21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] including a literature review 38 have examined the link between management and health system performance in low-and middle-income settings in the last 20 years.…”

“…Furthermore, ample evidence exists that health worker motivation and retention is highly influenced by the quality of management in their work setting. [14][15][16] Nevertheless, management education, largely reserved in low-and middleincome countries for business curricula, is limited in medical or public health training globally. As in just about every enterprise, good management is fundamental to high performance.…”