Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 655 Hungtington Ave, Boston, MA 02115, USA.
Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, New Mulago Hill road, Mulago, Kampala, Uganda.
Int J Qual Health Care. 2021 Sep 29;33(3). doi: 10.1093/intqhc/mzab128.
A shortage of competent health-care providers is a major contributor to poor quality health care in sub-Saharan Africa. To increase the retention of skilled health-care providers, we need to understand which factors make them feel satisfied with their work and want to stay in their job. This study investigates the relative contribution of provider, facility and contextual factors to job satisfaction and intention to stay on the job among health-care providers who performed obstetric care in Uganda and Zambia.
This study was a secondary analysis of data from a maternal and newborn health program implementation evaluation in Uganda and Zambia. Using a Likert scale, providers rated their job satisfaction and intention to stay in their job. Predictors included gender, cadre, satisfaction with various facility resources and country. We used the Shapley and Owen decomposition of R2 method to estimate the variance explained by individual factors and groups of factors, adjusting for covariates at the facility and provider levels.
Of the 1134 providers included in the study, 68.3% were female, 32.4% were nurses and 77.1% worked in the public sector. Slightly more than half (52.3%) of providers were strongly satisfied with their job and 42.8% strongly agreed that they would continue to work at their facility for some time. A group of variables related to facility management explained most of the variance in both job satisfaction (37.6%) and intention to stay (43.1%). Among these, the most important individual variables were satisfaction with pay (20.57%) for job satisfaction and opinions being respected in the workplace (17.52%) for intention to stay. Doctors reported lower intention to stay than nurses. Provider demographics and facility level and ownership (public/private) were not associated with either outcome. There were also differences in job satisfaction and intention to stay between Ugandan and Zambian health-care providers.
Our study suggests that managers play a crucial role in retaining a sufficient number of satisfied health-care providers providing obstetric care in two sub-Saharan African countries, Uganda and Zambia. Prioritizing and investing in health management systems and health managers are essential foundations for high-quality health systems.
在撒哈拉以南非洲地区，合格的医疗保健提供者短缺是导致医疗质量低下的主要原因之一。为了增加熟练医疗保健提供者的留用率，我们需要了解哪些因素使他们对自己的工作感到满意，并希望留在工作岗位上。本研究调查了乌干达和赞比亚从事产科护理的医疗保健提供者的提供者、设施和背景因素对工作满意度和工作意愿的相对贡献。
本研究是对乌干达和赞比亚产妇和新生儿保健方案实施情况评估的数据进行的二次分析。提供者使用李克特量表对工作满意度和继续留在工作岗位的意愿进行了评分。预测因素包括性别、职称、对各种设施资源的满意度以及国家。我们使用 Shapley 和 Owen 的 R2 方法分解来估计单个因素和因素组的方差解释，并在设施和提供者层面上调整协变量。
在纳入研究的 1134 名提供者中，68.3%为女性，32.4%为护士，77.1%在公共部门工作。略多于一半（52.3%）的提供者对自己的工作非常满意，42.8%强烈同意他们将在一段时间内继续在自己的医疗机构工作。一组与设施管理相关的变量解释了工作满意度（37.6%）和继续工作意愿（43.1%）的大部分方差。在这些变量中，最重要的个体变量是对薪酬的满意度（20.57%）对工作满意度和对工作场所意见的尊重（17.52%）对继续工作的意愿。医生报告的留职意愿低于护士。提供者的人口统计学特征以及设施层面和所有权（公共/私人）与这两个结果均无关。乌干达和赞比亚的医疗保健提供者在工作满意度和留职意愿方面也存在差异。
我们的研究表明，在乌干达和赞比亚这两个撒哈拉以南非洲国家，管理人员在留住足够数量的满意产科护理提供者方面发挥着至关重要的作用。优先考虑并投资于卫生管理系统和卫生管理人员是建立高质量卫生系统的必要基础。
