Experiences from the Philippine grassroots: impact of strengthening primary care systems on health worker satisfaction and intention to stay

Impact of primary care system interventions on healthcare worker satisfaction and intention to stay in the Philippines: a follow-up study

BACKGROUND

The Philippines has a shortage and uneven distribution of healthcare workers (HCWs). Job satisfaction is an important element to HCW retention and attracting new HCWs into the health system.

OBJECTIVE

This study measured HCWs' intent to stay and HCWs' satisfaction after implementation of multiple interventions intended to strengthen the primary care system, and determine factors significantly associated with HCWs' intent to stay.

METHODOLOGY

This is a serial cross-sectional study in urban, rural and remote primary care sites in the Philippines. All physicians, nurses, midwives, dentists, community health workers and support staff were invited to participate. Baseline HCWs' intent to stay and satisfaction were obtained using a self-administered questionnaire prior to implementation of interventions. The same survey was again conducted in the years 2021 and 2022, corresponding to 5 and 6 years after initial implementation for the urban site, and 2 and 3 years for the rural and remote sites. We used multiple logistic regression to determine factors associated with intent to stay.

RESULTS

There were 430 survey respondents (89.4% response rate) for year 2021, and 417 survey respondents (97.4% response rate) for year 2022. The urban and rural sites had significant increase in several HCW satisfaction domains, while the remote site had significant decrease in several HCW satisfaction domains. There was no significant difference in the intent to stay in the three sites. Factors that decreased intent to stay included length of employment, job involvement and employment as a nurse, while factors that increased intent to stay included job satisfaction, enjoyment and working in the urban site.

CONCLUSION

HCW satisfaction improved in the urban site and rural site, while HCW satisfaction declined in the remote site. Intention to stay of primary care HCWs did not significantly change.

Restructuring an internal medicine rotation to take on a fully virtual experience in a resource-limited setting: A mixed-methods study

BACKGROUND

During the coronavirus disease 2019 (COVID-19) pandemic, medical schools in the Philippines accelerated the adoption of virtual learning. Course developers were challenged to provide equal opportunities for clinical exposure given the differential access of students to technology. This study describes the modifications in the course design of an internal medicine rotation for third-year medical students and the perceptions of the faculty and students toward these changes.

MATERIALS AND METHODS

Course evaluations by students and faculty were reviewed. Using a concurrent mixed-methods approach, we analyzed the quantitative and qualitative responses and triangulated the results of the faculty and student surveys.

RESULTS

Shifting to a virtual learning platform decreased the number of student-patient interactions. Observing a telemedicine consultation done by faculty substituted for real patient encounters. In consideration of students with limited Internet access, synchronous activities were made nongraded. The survey response rate was 51% (93/181) for students and 34% (32/94) for faculty. Survey participants indicated high overall satisfaction toward the virtual course with a general agreement between students and faculty respondents in most domains. Recurrent themes were the demand for more patient encounters, more synchronous activities, and better evaluation tools. Only the faculty were critical of technical issues, such as audibility and Internet connectivity.

CONCLUSION

The experiences of a single institution in redesigning and implementing an undergraduate medical course in internal medicine for a fully virtual platform were described. Strategies for augmenting patient exposure and tailored clinical assessment tools are needed to improve stakeholder satisfaction. In resource-limited settings, access to appropriate technology must be considered to ensure equitable learning.