University of the Philippines Diliman, Quezon City, Philippines.
University of the Philippines Manila, Manila, Philippines.
BMC Health Serv Res. 2023 Feb 4;23(1):117. doi: 10.1186/s12913-022-08799-1.
Inequities in health access and outcomes persist in low- and middle-income countries. While strengthening primary care is integral in improving patient outcomes, primary care networks remain undervalued, underfunded, and underdeveloped in many LMICs such as the Philippines. This paper underscores the value of strengthening primary care system interventions in LMICs by examining their impact on job satisfaction and intention to stay among healthcare workers in the Philippines.
This study was conducted in urban, rural, and remote settings in the Philippines. A total of 36 urban, 54 rural, and 117 remote healthcare workers participated in the study. Respondents comprised all family physicians, nurses, midwives, community health workers, and staff involved in the delivery of primary care services from the sites. A questionnaire examining job satisfaction (motivators) and dissatisfaction (hygiene) factors was distributed to healthcare workers before and after system interventions were introduced across sites. Interventions included the introduction of performance-based incentives, the adoption of electronic health records, and the enhancement of diagnostic and pharmaceutical capabilities over a 1-year period. A Wilcoxon signed-rank test and a McNemar's chi-square test were then conducted to compare pre- and post-intervention experiences for each setting.
Among the factors examined, results revealed a significant improvement in perceived compensation fairness among urban (p = 0.001) and rural (p = 0.016) providers. The rural workforce also reported a significant improvement in medicine access (p = 0.012) post-intervention. Job motivation and turnover intention were sustained in urban and rural settings between periods. Despite the interventions introduced, a decline in perceptions towards supply accessibility, job security, and most items classified as job motivators was reported among remote providers. Paralleling this decline, remote primary care providers with the intent to stay dropped from 93% at baseline to 75% at endline (p < 0.001).
The impact of strengthening primary care on health workforce satisfaction and turnover intention varied across urban, rural, and remote settings. While select interventions such as improving compensation were promising for better-supported settings, the immediate impact of these interventions was inadequate in offsetting the infrastructural and staffing gaps experienced in disadvantaged areas. Unless these problems are comprehensively addressed, satisfaction will remain low, workforce attrition will persist as a problem, and marginalized communities will be underserved.
在中低收入国家，卫生服务获取和结果方面的不平等仍然存在。尽管加强初级保健对于改善患者的结果至关重要，但在菲律宾等许多中低收入国家，初级保健网络仍然被低估、资金不足且发展不足。本文通过考察初级保健系统干预措施对菲律宾卫生工作者的工作满意度和留职意愿的影响，强调了在中低收入国家加强初级保健系统干预措施的价值。
本研究在菲律宾的城市、农村和偏远地区进行。共有 36 名城市、54 名农村和 117 名偏远地区的卫生工作者参与了这项研究。参与者包括所有参与提供初级保健服务的家庭医生、护士、助产士、社区卫生工作者和工作人员。在向各地点引入系统干预措施之前，向卫生工作者分发了一份调查问卷，调查工作满意度（激励因素）和不满（卫生）因素。干预措施包括引入基于绩效的激励措施、采用电子健康记录以及在一年的时间内提高诊断和药物供应能力。然后进行了 Wilcoxon 符号秩检验和 McNemar 卡方检验，以比较每个地点干预前后的经验。
在所检查的因素中，结果显示城市（p = 0.001）和农村（p = 0.016）提供者对薪酬公平的感知有显著改善。农村劳动力在获得药物方面也有显著改善（p = 0.012）。城市和农村地区的工作动力和离职意愿在两个时期都保持不变。尽管引入了干预措施，但远程提供者报告了对供应可及性、工作保障以及大多数被归类为工作激励因素的项目的看法下降。与此下降相平行，远程初级保健提供者的留职意愿从基线时的 93%下降到期末时的 75%（p < 0.001）。
加强初级保健对卫生工作者满意度和离职意愿的影响因城市、农村和偏远地区的不同而有所不同。虽然改善薪酬等特定干预措施对支持力度更大的地区有希望，但这些干预措施的即时影响不足以弥补弱势地区所面临的基础设施和人员配备差距。除非这些问题得到全面解决，否则满意度仍将较低，劳动力流失将继续成为一个问题，边缘化社区将得不到服务。
