Goma Fastone M, Tomblin Murphy Gail, MacKenzie Adrian, Libetwa Miriam, Nzala Selestine H, Mbwili-Muleya Clara, Rigby Janet, Gough Amy
Hum Resour Health. 2014;12 Suppl 1(Suppl 1):S1. doi: 10.1186/1478-4491-12-S1-S1. Epub 2014 May 12.
In response to Zambia's critical human resources for health challenges, a number of strategies have been implemented to recruit and retain health workers in rural and remote areas. Prior to this study, the effectiveness of these strategies had not been investigated. The purpose of this study was to determine the impacts of the various health worker retention strategies on health workers in two rural districts of Zambia.
Using a modified outcome mapping approach, cross-sectional qualitative and quantitative data were collected from health workers and other stakeholders through focus group discussions and individual interview questionnaires and were supplemented by administrative data. Key themes emerging from qualitative data were identified from transcripts using thematic analysis. Quantitative data were analyzed descriptively as well as by regression modelling. In the latter, the degree to which variation in health workers' self-reported job satisfaction, likelihood of leaving, and frequency of considering leaving, were modelled as functions of participation in each of several retention strategies while controlling for age, gender, profession, and district.
Nineteen health worker recruitment and retention strategies were identified and 45 health care workers interviewed in the two districts; participation in each strategy varied from 0% to 80% of study participants. Although a salary top-up for health workers in rural areas was identified as the most effective incentive, almost none of the recruitment and retention strategies were significant predictors of health workers' job satisfaction, likelihood of leaving, or frequency of considering leaving, which were in large part explained by individual characteristics such as age, gender, and profession. These quantitative findings were consistent with the qualitative data, which indicated that existing strategies fail to address major problems identified by health workers in these districts, such as poor living and working conditions.
Although somewhat limited by a small sample size and the cross-sectional nature of the primary data available, the results nonetheless show that the many health worker recruitment and retention strategies implemented in rural Zambia appear to have little or no impact on keeping health workers in rural areas, and highlight key issues for future recruitment and retention efforts.
为应对赞比亚卫生人力资源面临的严峻挑战，已实施多项战略以招募和留住农村及偏远地区的卫生工作者。在本研究开展之前，尚未对这些战略的有效性进行调查。本研究的目的是确定各种卫生工作者留用战略对赞比亚两个农村地区卫生工作者的影响。
采用改良的成果映射方法，通过焦点小组讨论和个人访谈问卷从卫生工作者及其他利益相关者收集横断面定性和定量数据，并辅以行政数据。使用主题分析法从转录本中确定定性数据中出现的关键主题。对定量数据进行描述性分析以及回归建模分析。在回归建模中，将卫生工作者自我报告的工作满意度、离职可能性和考虑离职频率的变化程度作为参与几种留用战略中每一种战略的函数进行建模，同时控制年龄、性别、职业和地区因素。
确定了19项卫生工作者招募和留用战略，并在两个地区对45名卫生保健工作者进行了访谈；参与每项战略的研究参与者比例从0%到80%不等。虽然为农村地区卫生工作者增加薪资被确定为最有效的激励措施，但几乎没有一项招募和留用战略是卫生工作者工作满意度、离职可能性或考虑离职频率的显著预测因素，这些很大程度上由年龄、性别和职业等个人特征所解释。这些定量研究结果与定性数据一致，定性数据表明现有战略未能解决这些地区卫生工作者所指出的主要问题，如生活和工作条件差。
尽管本研究在一定程度上受到样本量小和现有原始数据的横断面性质的限制，但结果仍表明，赞比亚农村地区实施的众多卫生工作者招募和留用战略似乎对留住农村地区的卫生工作者几乎没有影响，并突出了未来招募和留用工作的关键问题。
