Department of Global Health, University of Washington, Seattle, United States of America.
College of Medicine and Applied Health Sciences, University of Sierra Leone, Freetown, Sierra Leone.
Hum Resour Health. 2018 Sep 24;16(1):50. doi: 10.1186/s12960-018-0311-y.
Sierra Leone's health outcomes rank among the worst in the world. A major challenge is the shortage of primary healthcare workers (HCWs) in rural areas due to especially high rates of attrition. This study was undertaken to determine the drivers of job dissatisfaction and poor retention among Sierra Leone's rural HCWs.
Interviews were conducted with 58 rural and 32 urban primary HCWs in Sierra Leone's public health sector, complemented by key informant discussions and review of national policy documents. HCW interviews included (1) semi-structured discussion, (2) questionnaire, (3) card sort about HCW priorities, and (4) free-listing of most pressing challenges and needs. Sampling for HCW interviews was stratified purposive, emphasizing rural HCWs.
Among 90 HCWs interviewed, 67% were dissatisfied with their jobs (71% rural vs 52% urban) and 61% intended to leave their post (75% rural vs 38% urban). While working and living conditions and remuneration were significant factors, a major reason for rural HCW disenchantment was their inability to access worker rights, benefits, and advancement opportunities. This was caused by HCWs' lack of knowledge about human resource (HR) policies and procedures, as well as ambiguity in many policies and inequitable implementation. HCWs reported feeling neglected and marginalized and perceived a lack of transparency. These issues can be attributed to the absence of systems for regular two-way communication between the Ministry of Health and HCWs; lack of official national documents with up-to-date, clear HR policies and procedures for HCWs; pay statements that do not provide a breakdown of financial allowances and withholdings; and lack of HCW induction.
HCWs in Sierra Leone lacked accurate information about entitlements, policies, and procedures, and this was a driver of rural HCW job dissatisfaction and attrition. System-oriented, low-cost initiatives can address these underlying structural causes in Sierra Leone. These issues likely apply to other countries facing HCW retention challenges and should be considered in development of global HCW retention strategies.
塞拉利昂的健康状况在全球排名最差之列。一个主要挑战是农村地区初级卫生保健工作者（HCWs）短缺，尤其是流失率特别高。本研究旨在确定塞拉利昂农村 HCWs 工作不满和保留率低的驱动因素。
对塞拉利昂公共卫生部门的 58 名农村和 32 名城市初级 HCWs 进行了访谈，同时进行了重点信息提供者讨论和国家政策文件审查。HCW 访谈包括：（1）半结构化讨论，（2）问卷调查，（3）HCW 优先事项卡片分类，（4）最紧迫挑战和需求的自由列表。HCW 访谈的抽样是有目的的分层抽样，强调农村 HCWs。
在接受访谈的 90 名 HCWs 中，有 67%对其工作不满意（农村 71%，城市 52%），有 61%打算离职（农村 75%，城市 38%）。虽然工作和生活条件以及薪酬是重要因素，但农村 HCW 失望的主要原因是他们无法获得工人权利、福利和晋升机会。这是由于 HCWs 缺乏对人力资源（HR）政策和程序的了解，以及许多政策的模糊性和不公平执行所致。HCWs 报告感到被忽视和边缘化，认为缺乏透明度。这些问题可归因于缺乏卫生部与 HCWs 之间定期双向沟通系统；缺乏正式的国家文件，其中包含最新、明确的 HCW 人力资源政策和程序；工资单不提供财务津贴和扣除的细目；以及缺乏 HCW 入职培训。
塞拉利昂的 HCWs 缺乏有关权利、政策和程序的准确信息，这是农村 HCW 工作不满和流失的驱动因素。以系统为导向、低成本的举措可以解决塞拉利昂这些潜在的结构性问题。这些问题可能适用于其他面临 HCW 保留挑战的国家，在制定全球 HCW 保留战略时应予以考虑。
