Why do people become health workers?Analysis from life histories in 4 post‐conflict and post‐crisis countries

Abstract

SummaryWhile there is a growing body of literature on how to attract and retain health workers once they are trained, there is much less published on what motivates people to train as health professions in the first place in low‐ and middle‐income countries and what difference this makes to later retention. In this article, we examine patterns in expressed motivation to join the profession across different cadres, based on 103 life history interviews conducted in northern Uganda, Sierra Leone, Cambodia, and Zimbabwe. A rich mix of reported motivations for joining the profession was revealed, including strong influence of “personal calling,” exhortations of family and friends, early experiences, and chance factors. Desire for social status and high respect for health professionals were also significant. Economic factors are also important—not just perceptions of future salaries and job security but also more immediate ones, such as low cost or free training. These allowed low‐income participants to access the health professions, to which they had shown considerably loyalty. The lessons learned from these cohorts, which had remained in service through periods of conflict and crisis, can influence recruitment and training policies in similar contexts to ensure a resilient health workforce.

Sex and Gender in Research on Healthcare Workers in Conflict Settings: A Scoping Review

“…Working conditions of healthcare workers in conflict settings were assessed in 21 (45%) studies. Among the articles that discussed sex/gender as a factor in shaping the work experiences of HCWs, eight studies found that females predominate low-paying positions, including nursing, midwifery and community health workers (CHWs), as well as other unpaid positions, while male workers predominate managerial and policy-maker positions [ 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ]. These studies attributed the difference in the allocation of job positions to gendered power relations, norms, and stereotypes, such that females are more likely to take on CHW jobs due to limited job opportunities and societal biases that see women only in care-giving roles [ 39 ].…”

“…Furthermore, studies reported that females are underrepresented in managerial positions due to lower educational levels attained, and difficulties in accessing professional training and development, as well as additional hindrances in promotion that males do not face [ 36 , 37 , 41 ]. Despite these differences, two studies found that both male and female HCWs commonly reported the escape from poverty, higher salaries, personal calling, status, and a sense of deservingness as motivations for joining the profession [ 39 , 40 ].…”

“…However, increased stress levels were reported by females compared to males; this study attributed these sex/gender differences to unmeasured variables in men and women [ 59 ]. Three additional studies found that separation from family for long periods of time was demotivating for female workers in conflict settings, especially in isolated rural areas with poor communication [ 40 , 43 , 48 ]. Other demotivating factors were common for both male and female HCWs, including limited financial incentives, difficult working conditions, and lack of career progression [ 43 , 48 ].…”

“…Many studies in our review reported that females predominate the healthcare profession in conflict zones [ 36 , 37 , 39 , 40 ]. These results are consistent with general findings in the health sector, where the World Health Organization estimated that women account for 70% of workers in the healthcare and social sector [ 29 ].…”

“…In addition, most of the studies that explored the gendered workforce found variations in job allocation among males and females. Women were more likely to work in low-paying and low-status occupations, mainly related to maternal and child health services and nursing, while men were more likely to work in high-wage jobs, such as doctors, and occupy managerial and decision-making positions [ 36 , 37 , 39 , 40 , 84 ].…”