Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Department of Pediatrics and Child Health, Muhimbili University of Health and Allied Sciences (MUHAS), Dar es Salaam, Tanzania.
Hum Resour Health. 2017 Sep 6;15(1):61. doi: 10.1186/s12960-017-0235-y.
Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV (i.e., lifelong antiretroviral treatment for all pregnant and breastfeeding mothers living with HIV) was initiated in Tanzania in 2013. While there is evidence that this policy has benefits for the health of the mother and the child, Option B+ may also increase the workload for health care providers in resource-constrained settings, possibly leading to job dissatisfaction and unwanted workforce turnover.
From March to April 2014, a questionnaire asking about job satisfaction and turnover intentions was administered to all nurses at 36 public-sector health facilities offering antenatal and PMTCT services in Dar es Salaam, Tanzania. Multivariable logistic regression models were used to identify factors associated with job dissatisfaction and intention to quit one's job.
Slightly over half (54%, 114/213) of the providers were dissatisfied with their current job, and 35% (74/213) intended to leave their job. Most of the providers were dissatisfied with low salaries and high workload, but satisfied with workplace harmony and being able to follow their moral values. The odds of reporting to be globally dissatisfied with one's job were high if the provider was dissatisfied with salary (adjusted odds ratio (aOR) 5.6, 95% CI 1.2-26.8), availability of protective gear (aOR 4.0, 95% CI 1.5-10.6), job description (aOR 4.3, 95% CI 1.2-14.7), and working hours (aOR 3.2, 95% CI 1.3-7.6). Perceiving clients to prefer PMTCT Option B+ reduced job dissatisfaction (aOR 0.2, 95% CI 0.1-0.8). The following factors were associated with providers' intention to leave their current job: job stability dissatisfaction (aOR 3.7, 95% CI 1.3-10.5), not being recognized by one's superior (aOR 3.6, 95% CI 1.7-7.6), and poor feedback on the overall unit performance (aOR 2.7, 95% CI 1.3-5.8).
Job dissatisfaction and turnover intentions are comparatively high among nurses in Dar es Salaam's public-sector maternal care facilities. Providing reasonable salaries and working hours, clearer job descriptions, appropriate safety measures, job stability, and improved supervision and feedback will be key to retaining satisfied PMTCT providers and thus to sustain successful implementation of Option B+ in Tanzania.
2013 年，坦桑尼亚开始推行 B+方案，用于预防母婴传播艾滋病毒（即所有感染艾滋病毒的孕妇和哺乳期妇女终身接受抗逆转录病毒治疗）。虽然有证据表明该政策对母婴健康有益，但 B+方案也可能增加资源有限环境下医疗保健提供者的工作量，从而导致工作满意度下降和不必要的员工流失。
2014 年 3 月至 4 月，对达累斯萨拉姆 36 家提供产前和 PMTCT 服务的公共部门卫生机构的所有护士进行了一项关于工作满意度和离职意愿的问卷调查。采用多变量逻辑回归模型来确定与工作满意度低和离职意愿相关的因素。
略超过一半（54%，114/213）的提供者对当前工作不满意，35%（74/213）的提供者打算离职。大多数提供者对低工资和高工作量不满意，但对工作场所和谐以及能够遵循自己的道德价值观感到满意。如果提供者对工资（调整后的优势比（aOR）5.6，95%置信区间（CI）1.2-26.8）、防护装备的可用性（aOR 4.0，95%CI 1.5-10.6）、工作描述（aOR 4.3，95%CI 1.2-14.7）和工作时间（aOR 3.2，95%CI 1.3-7.6）不满意，则报告对工作整体不满意的可能性较高。认为客户更喜欢 PMTCT B+方案会降低工作满意度（aOR 0.2，95%CI 0.1-0.8）。以下因素与提供者离开当前工作的意愿相关：工作稳定性不满（aOR 3.7，95%CI 1.3-10.5）、不受上级认可（aOR 3.6，95%CI 1.7-7.6）和对整体单位绩效的反馈不佳（aOR 2.7，95%CI 1.3-5.8）。
达累斯萨拉姆公共部门孕产妇保健机构的护士工作满意度和离职意愿相对较高。提供合理的工资和工作时间、更明确的工作描述、适当的安全措施、工作稳定性以及改善监督和反馈，将是留住满意的 PMTCT 提供者并在坦桑尼亚维持成功实施 B+方案的关键。
