Job satisfaction and turnover intentions among health care staff providing services for prevention of mother-to-child transmission of HIV in Dar es Salaam, Tanzania

Results From a Multimethod Exploratory Scale Development Process to Measure Authoritarian Provider Attitudes in Democratic Republic of Congo and Togo

BACKGROUND

Health care providers' actions can significantly influence clients' experiences of care, adherence to recommendations, and likelihood of re-engaging with health services. There are currently no validated scales that measure provider attitudes that could affect service delivery in multiple health areas.

METHODS

We developed provider attitude measures in 3 phases. In phase 1 (2019), survey items were developed based on literature reviews, and quantitative items were tested through a health facility survey conducted in the Democratic Republic of the Congo (DRC). Health care providers (N=1,143) completed a 23-question survey focused on 3 subdomains: provider perceptions of clients, provider roles, and gender roles. In phase 2 (2021), cognitive interviews were administered to 17 health care providers in DRC to assess and improve respondents' understanding and interpretation of questionnaire items and response options. In phase 3 (2021), 52 family planning providers were sampled from urban health facilities in Togo to retest and validate the improved measures.

RESULTS

Phase 1 showed the provider attitude items had low scale reliability, and 8 survey items had low variability. In phase 2, results from the cognitive interviews of the 21 items retained from phase 1 found 16 questions were not well understood or had low response variability and thus modified, and 4 survey items were added to test different iterations of specific survey items. In phase 3, exploratory factor analysis resulted in 1 provider attitude scale of 14 items reflecting authoritarian attitudes related to the 3 initial subdomains.

CONCLUSION

This research highlights the importance of iteration and testing during scale development, implementable even across geographic locations. Provider behavior change programming should consider how authoritarian provider attitudes pertaining to professional roles, their clients, and gender norms may interact and influence the quality of health services provided.

Methods and Measures to Assess Health Care Provider Behavior and Behavioral Determinants in Reproductive, Maternal, Newborn, and Child Health: A Rapid Review

BACKGROUND

Health care provider behavior is the outcome of a complex set of factors that are both internal and external to the provider. Social and behavior change (SBC) programs are increasingly engaging providers and introducing strategies to improve their service delivery. However, there is limited understanding of methods and measures applied to assess provider behavioral outcomes and strengthen provider behavior change programming.

METHODS

Using PubMed, we conducted a rapid review of published research on behaviors of health workers providing reproductive, maternal, newborn, and child health services in low- and middle-income countries (2010-2021). Information on study identifiers (e.g., type of provider), select domains from Green and Kreuter's PRECEDE-PROCEED framework (e.g., predisposing factors such as attitudes), study characteristics (e.g., study type and design), and evidence of theory-driven research were extracted from a final sample of articles (N=89) and summarized.

RESULTS

More than 80% of articles were descriptive/formative and examined knowledge, attitudes, and practice, mostly related to family planning. Among the few evaluation studies, training-focused interventions to increase provider knowledge or improve competency in providing a health service were dominant. Research driven by behavioral theory was observed in only 3 studies. Most articles (75%) focused on the quality of client-provider interaction, though topics and modes of measurement varied widely. Very few studies incorporated a validated scale to measure underlying constructs, such as attitudes and beliefs, and how these may be associated with provider behaviors.

CONCLUSION

A need exists for (1) theory-driven approaches to designing and measuring provider behavior change interventions and (2) measurement that addresses important internal and structural factors related to a provider's behavior (beyond knowledge-enhancing training approaches). Additional investment in implementation research is also needed to better understand which SBC approaches are shifting provider behavior and improving client-provider interactions. Finally, theory-driven approaches could help develop empirically measurable and comparable outcomes.

The perceived benefits and effectiveness of patient feedback systems in strengthening patient-provider relationships in Rural Tanzania

INTRODUCTION

Patient feedback system (PFS) forms an important entry point for the medical personnel and healthcare administrators to identify healthcare service delivery gaps and develop responsive interventions. This may foster patient trust consequently increasing healthcare-seeking, engagement in decision, continuity, and satisfaction. However, research on the PFS in rural primary healthcare settings appears limited.

OBJECTIVE

The paper examines the perceived role and effectiveness of PFS in improving therapeutic relationships building on the recent research on patient-provider relationships in rural Tanzania.

METHODS

The paper examines the findings of qualitative descriptive research conducted in the Shinyanga Region which employed a human-centred design (HCD) approach to co-create an intervention package for improving nurse-client relationships between January and September 2022. The study used semi-structured interviews in Swahili to first explore drivers of poor provider-patient relationships with purposefully selected providers, patients, and administrators. The findings guided the co-designing of an intervention package in subsequent HCD steps. Interviews were concurrently translated and transcribed, then systematically coded to facilitate the development of themes using a deductive thematic analysis approach.

RESULTS

PFS emerged as one of the key themes in the deductive analysis when examining factors shaping provider-client relationships. The PFS theme was characterized by three major subthemes, which included perceived benefits, availability and accessibility, and perceived effectiveness. The perceived benefits of PFS cited by most participants included: reducing patients' confusion around the complaints process, promoting patients' positivity towards providers and hospitals, and reducing tensions between patients and providers. Suggestion boxes (SBs) were the most frequently cited PFS, but there were widespread concerns and disagreements among participants about their accessibility and effectiveness. Despite the providers (nurses) and administrators describing SBs as widely available, they stated that they had not received feedback or complaints from patients for a very long time. In contrast, most patients stated that SBs were either unavailable or ineffective in many facilities, with concerns about non-user friendliness and lack of responsiveness as the main issues when discussing effectiveness.

CONCLUSION

Despite the many benefits of PFS in improving healthcare service quality, their availability, user-friendliness, and responsiveness still pose challenges. A call is made to providers, health administrators and researchers to prioritize the PFS as both a useful entry point to reducing tensions in therapeutic relationships and, a tool for improving patient service uptake, continuity of care and satisfaction.

Turnover intention among healthcare workers in Ethiopia: a systematic review and meta-analysis

OBJECTIVE

To determine the pooled prevalence of turnover intention among healthcare workers in Ethiopia.

DESIGN

A systematic review and meta-analysis was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline.

DATA SOURCES

Electronic databases of Science Direct, Medline, African Journals Online, Excerpta Medica Database, Scopus and Google Scholar were searched to identify studies published in the English language before 31 December, 2021.

ELIGIBILITY CRITERIA

Studies were included with following criteria: (1) studies conducted or published until 31 December 2021; (2) observational studies; (3) Studies conducted on healthcare workers; (4) reporting turnover intention; (v) studies conducted in Ethiopia and (vi) tudies published in the English language were included.

DATA EXTRACTION AND SYNTHESIS

Three independent reviewers screened all the papers for eligibility criteria. Data were extracted by two independent investigators using a standardised data extraction format. Random effects model meta-analysis using STATA V.14.0 statistical software was conducted to estimate the pooled prevalence of turnover intention with 95% CI. Funnel plot and Forest plot were used to check publication bias and heterogeneity between studies, respectively. Leave-one-out sensitivity analysis was done.

PRIMARY OUTCOME

Prevalence of turnover intention.

RESULT

A total of 29 cross-sectional studies with 9422 participants met the inclusion criteria. The estimated pooled prevalence of turnover intention among healthcare workers in Ethiopia was 58.09% (95% CI 54.24 to 61.93; p value <0.001, I²=93.5%).

CONCLUSION

The finding of this systematic review and meta-analysis showed high prevalence of turnover intention among healthcare workers in Ethiopia. The Government and policy makers should come up with different mechanisms including a wide variety of healthcare workers retention strategies in order to reduce turnover intention of healthcare workers and retain them.

What Factors Explain Low Adoption of Digital Technologies for Health Financing in an Insurance Setting? Novel Evidence From a Quantitative Panel Study on IMIS in Tanzania

BACKGROUND

Digital information management systems for health financing are implemented on the assumption thatdigitalization, among other things, enables strategic purchasing. However, little is known about the extent to which thesesystems are adopted as planned to achieve desired results. This study assesses the levels of, and the factors associated withthe adoption of the Insurance Management Information System (IMIS) by healthcare providers in Tanzania.

METHODS

Combining multiple data sources, we estimated IMIS adoption levels for 365 first-line health facilities in2017 by comparing IMIS claim data (verified claims) with the number of expected claims. We defined adoption as abinary outcome capturing underreporting (verified

RESULTS

We found a median (interquartile range [IQR]) difference of 77.8% (32.7-100) between expected and verifiedclaims, showing a consistent pattern of underreporting across districts, regions, and months. Levels of underreportingvaried across regions (ANOVA: F=7.24, P<.001) and districts (ANOVA: F=4.65, P<.001). Logistic regression resultsshowed that higher service volume, share of people insured, and greater distance to district headquarter were associatedwith a higher probability of underreporting.

CONCLUSION

Our study shows that the adoption of IMIS in Tanzania may be sub-optimal and far from policy-makers'expectations, limiting its capacity to provide the necessary information to enhance strategic purchasing in the healthsector. Countries and agencies adopting digital interventions such as openIMIS to foster health financing reform areadvised to closely track their implementation efforts to make sure the data they rely on is accurate. Further, our studysuggests organizational and infrastructural barriers beyond the software itself hamper effective adoption.

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Key Words

• Adoption
• Digital Health Intervention
• Health Financing
• Health Insurance
• Strategic Purchasing
• Tanzania

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MESH Headings

• Humans
• Tanzania
• Healthcare Financing
• Digital Technology
• Insurance, Health
• Universal Health Insurance

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Affiliation(s)

Leon Schuetze Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany
Siddharth Srivastava Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland University of Basel, Basel, Switzerland
Naasegnibe Kuunibe Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany Faculty of Integrated Development Studies, University for Development Studies, Wa, Ghana
Elizeus Josephat Rwezaula Health Promotion and System Strengthening Project (HPSS), Dodoma, Tanzania
Abdallah Missenye Kongwa District Council, Dodoma, Tanzania
Manfred Stoermer Swiss Tropical and Public Health Institute (Swiss TPH), Basel, Switzerland University of Basel, Basel, Switzerland
Manuela De Allegri Heidelberg Institute of Global Health, Medical Faculty and University Hospital, University of Heidelberg, Heidelberg, Germany

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Vertical HIV transmission within 18 months post partum among women on lifelong antiretroviral therapy for HIV in Dar es Salaam, Tanzania: a prospective cohort study

BACKGROUND

The UNAIDS estimate of vertical HIV transmission in Tanzania is high (11%), despite 84% uptake of antiretroviral therapy (ART) among pregnant women with HIV. We aimed to evaluate vertical transmission and its determinants by 18 months post partum among women on lifelong ART in routine health-care settings in Tanzania.

METHODS

We conducted a prospective cohort study in 226 health facitilies across Dar-es-Salaam, Tanzania. Eligible participants were pregnant women of any age with HIV, and later their infants, who enrolled in routine health-care services for the prevention of vertical transmission. We prospectively followed up mother-infant pairs at routine monthly visits until 18 months post partum and extracted data from the care and treatment clinic (CTC2) database, a national electronic database that stores patient-level HIV care and treatment clinic data. The primary outcome was time from birth to HIV diagnosis, defined as a positive infant HIV DNA PCR or antibody test from age 18 months. We used the Kaplan-Meier method to estimate cumulative risk of vertical transmission by 18 months post partum and Cox proportional hazards regression with shared frailties to account for potential clustering in health facilities to evaluate predictors of transmission.

FINDINGS

Between Jan 1, 2015, and Dec 31, 2017, 22 930 pregnant women with HIV (median age 30 years, IQR 25-34) enrolled on a care programme. After excluding 9140 (39·9%) women and 539 (2·4%) infants with missing outcome data, 13 251 (59·0%) mother-infant pairs were analysed, of whom 6072 (45·8%) women were already on ART before pregnancy. By 18 months post partum, 159 (1·2%) of 13 251 infants were diagnosed with HIV, equivalent to a risk of vertical transmission of 1·4% (95% CI 1·2-1·6). In the complete case analysis, the rates of vertical transmission were higher among women who enrolled in the third trimester of pregnancy than among those who enrolled in the first trimester (adjusted hazard ratio 3·01, 95% CI 1·59-5·70; p=0·0003), among women with advanced HIV disease than among those with early-stage disease (1·89, 1·22-2·93; p=0·0046), and among women who were on a second-line ART regimen than among those on a first-line regimen (3·58, 1·08-11·82; p=0·037). By contrast, the rate of vertical transmission was lower among women who were already on ART at enrolment than among those starting ART at enrolment (0·39, 0·25-0·60; p<0·0001) as well as among women in high-volume clinics than among those in low-volume clinics (0·46 (0·24-0·90; p<0·0097).

INTERPRETATION

Provision of ART for life (WHO's option B+ recommendation) has reduced the risk of vertical transmission to less than 2% among pregnant women with HIV in routine care settings in urban Tanzania. There is still a need to improve timely HIV diagnosis and ART uptake, and to optimise follow-up for the prevention of vertical transmission and the uptake of infant HIV testing.

FUNDING

Swedish International Development Cooperation Agency.

Self-reported turnover intention and associated factors among health professionals in Kafa Zone, Southwest Ethiopia

Objective

The aim of this study was to assess turnover intention and its associated factors among health professionals in Kafa Zone, Southwest, Ethiopia, 2018.

Methods

Cross-sectional study design relied on institution that was employed from 1-30 May 2019. Questionnaires were distributed to 427 participants who were selected by simple random sampling technique from selected health facilities. Epi Data Statistical software version 3.1 for data entry and Statistical Package for Social Sciences software version 21.0 for data analysis were used. Binary logistic regression analysis was used to identify factors associated with turnover intention. Odds ratios with 95% confidence intervals were used to examine associations, and a p-value less than 0.05 was considered significant.

Result

Overall, 427 questionnaires were distributed, and 389 were returned making 91.1% response rate. Majority of the respondents were between the age of 21 and 30 years and more than half were male. More than half, 219 (56.3%), of the participants reported that they intended to leave their institution. Being female (adjusted odds ratio 2.65, 95% confidence interval (1.62-4.33)), married (adjusted odds ratio 0.57, 95% confidence interval (0.34-0.96)), degree holders (adjusted odds ratio 0.55, 95% confidence interval (0.34-0.89)), autonomous (adjusted odds ratio 0.51, 95% confidence interval (0.31-0.84) and not satisfied with living place condition (adjusted odds ratio 1.68, 95% confidence interval (1.0-2.83)) were found to have statistically significant association with intention to leave among health professionals in Kafa Zone.

Conclusion

Turnover intention of health professionals was high in study area. Sex, educational status, marital status, autonomous, and living place condition were the identified predictors of turnover intention among health professionals. The health managers and stakeholders at different levels should have a discussion session with staff to cut the intention to leave the organization.

Impact of reliable light and electricity on job satisfaction among maternity health workers in Uganda: A cluster randomized trial

BACKGROUND

Maintaining a motivated health workforce is critical to health system effectiveness and quality of care. Scant evidence exists on whether interventions aimed to strengthen health infrastructure in low-resource settings affect health workers. This study evaluated the impact of an intervention providing solar light and electricity to rural maternity facilities in Uganda on health workers' job satisfaction.

METHODS

We used a mixed-methods design embedded in a cluster randomized trial to evaluate whether and how the We Care Solar Suitcase intervention, a solar electric system providing lighting and power, affected health workers in rural Ugandan maternity facilities with unreliable light. Facilities were randomly assigned to receive the intervention or not without blinding in a cluster-randomized controlled trial. Outcomes were assessed through two rounds of surveys with health workers. We used regression analyses to examine the intervention's impact on job satisfaction. We used an inductive approach to analyze qualitative data to understand the study context and interpret quantitative findings.

RESULTS

We interviewed 85 health workers across 30 facilities, the majority of whom were midwives or nurses. Qualitative reports indicated that unreliable light made it difficult to provide care, worsened facility conditions, and harmed health workers and patients. Before the intervention, only 4% of health workers were satisfied with their access to light and electricity. After the installation, satisfaction with light increased by 76 percentage points [95% confidence interval (CI): 61-92 percentage points], although satisfaction with electricity did not change. Experience of negative impacts of lack of overhead light also significantly decreased and the intervention modestly increased job satisfaction. Qualitative evidence illustrated how the intervention may have strengthened health workers' sense of job security and confidence in providing high-quality care while pointing towards implementation challenges and other barriers health workers faced.

CONCLUSIONS

Reliable access to light and electricity directly affects health workers' ability to provide maternal and neonatal care and modestly improves job satisfaction. Policy makers should invest in health infrastructure as part of multifaceted policy strategies to strengthen human resources for health and to improve maternal and newborn health services. Trial registration socialscienceregistry.org: AEARCTR-0003078. Registered June 12, 2018, https://www.socialscienceregistry.org/trials/3078 Additionally registered on: ClinicalTrials.gov: NCT03589625, Registered July 18, 2018, https://clinicaltrials.gov/ct2/show/NCT03589625 ).

Qualitative assessment of community health workers' perspective on their motivation in community-based primary health care in rural Malawi

BACKGROUND

Community Health Workers (CHWs) have a positive impact on the provision of community-based primary health care through screening, treatment, referral, psychosocial support, and accompaniment. With a broad scope of work, CHW programs must balance the breadth and depth of tasks to maintain CHW motivation for high-quality care delivery. Few studies have described the CHW perspective on intrinsic and extrinsic motivation to enhance their programmatic activities.

METHODS

We utilized an exploratory qualitative study design with CHWs employed in the household model in Neno District, Malawi, to explore their perspectives on intrinsic and extrinsic motivators and dissatisfiers in their work. Data was collected in 8 focus group discussions with 90 CHWs in October 2018 and March-April 2019 in seven purposively selected catchment areas. All interviews were audiotaped, transcribed verbatim, coded, and analyzed using Dedoose.

RESULTS

Themes of complex intrinsic and extrinsic factors were generated from the perspectives of the CHWs in the focus group discussions. Study results indicate that enabling factors are primarily intrinsic factors such as positive patient outcomes, community respect, and recognition by the formal health care system but can lead to the challenge of increased scope and workload. Extrinsic factors can provide challenges, including an increased scope and workload from original expectations, lack of resources to utilize in their work, and rugged geography. However, a positive work environment through supportive relationships between CHWs and supervisors enables the CHWs.

CONCLUSION

This study demonstrated enabling factors and challenges for CHW performance from their perspective within the dual-factor theory. We can mitigate challenges through focused efforts to limit geographical distance, manage workload, and strengthen CHW support to reinforce their recognition and trust. Such programmatic emphasis can  focus on enhancing motivational factors found in this study to improve the CHWs' experience in their role. The engagement of CHWs, the communities, and the formal health care system is critical to improving the care provided to the patients and communities, along with building supportive systems to recognize the work done by CHWs for the primary health care systems.

How clinicians manage routinely low supplies of personal protective equipment

BACKGROUND

Recommended personal protective equipment (PPE) is routinely limited or unavailable in low-income countries, but there is limited research as to how clinicians adapt to that scarcity, despite the implications for patients and workers.

METHODS

This is a qualitative secondary analysis of case study data collected in Liberia in 2019. Data from the parent study were included in this analysis if it addressed availability and use of PPE in the clinical setting. Conventional content analysis was used on data including: field notes documenting nurse practice, semi-structured interview transcripts, and photographs.

RESULTS

Data from the majority of participants (32/37) and all facilities (12/12) in the parent studies were included. Eighty-three percent of facilities reported limited PPE. Five management strategies for coping with limited PPE supplies were observed, reported, or both: rationing PPE, self-purchasing PPE, asking patients to purchase PPE, substituting PPE, and working without PPE. Approaches to rationing PPE included using PPE only for symptomatic patients or not performing physical exams. Substitutions for PPE were based on supply availability.

CONCLUSIONS

Strategies developed by clinicians to manage low PPE likely have negative consequences for both workers and patients; further research into the topic is important, as is better PPE provision in low-income countries.

The Impact of the Coronavirus Disease (COVID-19) Pandemic on Nurses' Turnover Intention: An Integrative Review

The COVID-19 pandemic has increased the demand and workload on nurses. In addition, the number of critical cases, the uncertainty about the disease, and the incidence rate of death from the disease impose a psychological stress on nurses. Considering the alarming issues of stress, burnout, and turnover among nurses even before the pandemic, the pandemic might have amplified such issues. Thus, the impact of the COVID-19 pandemic on nurses' turnover and turnover intention warrants investigation. The aim of this review is to appraise and integrate the current pre- and post-coronavirus disease (COVID-19) literature on nurse turnover, published between 2016 and 2021. Forty-three studies on nurses' turnover intention were appraised and synthesized. The reviewed literature suggested that nurses' turnover intention increased significantly after the COVID-19 pandemic. Post-COVID-19-pandemic studies focused more on predicting nurses' turnover intention through the pandemic's negative impact on the nurses' psychological wellbeing. The findings of this review should be considered by nurse managers and leaders in the development of policies and programs to reduce the negative impact of COVID-19 on nurse retention.

The Interactive Effect of COVID-19 Risk and Hospital Measures on Turnover Intentions of Healthcare Workers: A Time-Lagged Study

COVID-19 has led to a global health emergency worldwide. As a result, healthcare workers undergo distress mainly due to the perceived risk of contracting the virus. Such stress might cause them to leave their jobs. In this context, the current study: (1) introduced the concept of perceived risk of COVID-19 and measured it by adapting and validating an existing scale available on the risk of infectious diseases and (2) investigated its outcomes, underlying mechanisms, and boundary conditions for healthcare workers. With the support of conservation of resources theory, the current study aimed to investigate the association between perceived risk of COVID-19 and turnover intentions among healthcare workers, particularly Doctors, nurses, and paramedics staff. This study also aimed to investigate the mediating role of perceived fear of COVID-19 between perceived risk of COVID-19 and turnover intention. The current study also aimed to examine the buffering role that perceptions of hospital measures against COVID-19 could have on diminishing workers’ turnover intentions. Data were collected through a three time-lag email survey of healthcare workers in Pakistan (N = 178) who currently provide treatment to COVID-19 patients. The results supported the hypothesis that perceived risk of COVID-19 enhances fear of COVID-19 among healthcare workers and, consequently, their turnover intentions. Perceptions of hospital measures against COVID-19 weaken the relationship between perceived risk of COVID-19 and fear of COVID-19, which reduces turnover intentions of health care workers. The current study offers implications for theory, practitioners, and society.

Care for the Carers: An Evaluation of Job Satisfaction of Community Healthcare Workers in Charge of Infectious Disease Prevention and Control in Vietnam

PURPOSE

This study explored job satisfaction and associated factors among community healthcare workers (HCWs) during the COVID-19 pandemic.

METHODS

A cross-sectional study was conducted among 319 HCWs in charge of infectious disease prevention and control activities at all commune healthcare centers in Ho Chi Minh City. Participants completed a self-administered questionnaire which included the 36-item Job Satisfaction Survey (JSS).

RESULTS

Most participants were male (56.7%), and the mean age was 34.7 (SD=7.1) years. The overall job satisfaction was relatively low. Among 9 aspects measured, coworker was found to have the highest level of satisfaction (19.6±3.9), followed by supervision (19.3±4.1). In contrast, the lowest level of satisfaction was observed in operating condition (11.4±3.4) and contingent rewards (14.3±3.8). The total score of the JSS indicated that only half of HCWs were satisfied with their job in general. Older male HCWs who were married and those who had higher income reported a higher level of job satisfaction in several aspects measured. However, there was no association between job satisfaction and other HCW's characteristics, including specialty, occupation type, and working experience.

CONCLUSION

Since this is the crucial workforce in the battle against infectious diseases, urgent interventions are needed to increase job satisfaction in this population.

Turnover among medical clowns early in their career

In recent years, several investigations of the medical clowning profession have appeared in the literature. However, few studies have focused on factors associated with turnover among medical clowns early in their careers. The current study examined whether individual differences in humor disposition predicted turnover behavior. Participants were 111 medical clowns in a three-phase longitudinal study. Humor disposition was measured in the first week of their training, clowns' job satisfaction two months later, and turnover six months after that. Results showed that humor appreciation decreased actual turnover through the mediating role of job satisfaction, whereas individual differences in humor creation directly decreased turnover. In addition, previous traumatic experiences moderated the associations between humor appreciation and turnover. Overall, our research findings support the notion that humor disposition can help predict which clowns remain in the hospital.

Nurses' intention to leave their job in sub-Saharan Africa: A systematic review and meta-analysis

INTRODUCTION

Nurses' intention to leave their job is a worldwide concern. Internal and external brain drain factors are the main reason for nurses' intention to leave their job. So far, in Sub Sahara Africa, several observational studies have been done on nurses' intention to leave their job. However, a comprehensive review that would have a lot of evidence for designing an intervention is lacking. Hence, this study aimed to the pooled status of nurses' intention to leave their job.

METHODS

In the current meta-analysis, the target variables were searched from different electronic databases. These electronic databases are Pub Med, Google Scholar, Science Direct, African Index Medicus, African Journal Online, EMB ASE, and the Cochran Library. To determine the pooled proportion of intention to leave their job in Sub- Saharan Africa, all the necessary data was extracted by using a standardized data extraction format. We analyzed the data by using Stata 15 statistical software. Heterogeneity between the primary studies assessed by Cochran Q and I-square tests. A random-effect model computes to estimate the pooled nurses' intention to leave their job.

RESULT

We included fifteen full-text studies in the current meta-analysis. The findings of this meta-analysis revealed that the pooled proportion of nurses' intention to leave their job in sub-Saharan Africa was 50.74% (95% CI; 41.33, 60.14; I2 = 95.80%). The subgroup analysis showed that the highest pooled proportion of intention to leave their job (58.03% (95% CI: 47.93, 68.12)) in East Africa. The lowest pooled estimation to leave their job among nurses showed that South Africa (33.04% (95%CI: 20.45, 45.63)).

CONCLUSION

In the current study, there was a high proportion of nurses indentation to leave their job. Nurses' intention to leave their job also varied from region to region in the study area. Therefore, health managers and stakeholders focus on design sufficient development and career opportunities, positive working atmosphere, and secure their autonomy.

Human Resource Management for Ghanaian Nurses: Job Satisfaction Versus Turnover Intentions

The study has the aim of exploring the determinants of turnover intentions and job satisfaction of nurses. A survey of 163 nurses from two public and two private hospitals in the capital of Ghana, Accra, who completed a questionnaire in English, was conducted. The study uses SEM analysis to evaluate the goodness-of-fit of the model and to test hypotheses. Regarding the findings, pay rise, pay structure/administration and job satisfaction were significantly and negatively related to turnover intentions. However, the effect of benefits on turnover intentions was nonsignificant and was negatively associated with turnover intentions. The antecedents of nurses’ job satisfaction, all the constructs, i.e., pay level, pay rise, benefits, and pay structure/administration, had positive and statistically significant impacts. The influence of pay level, pay structure/administration and pay rise had the most important effect on nurses’ job satisfaction. In addition, the age status as a control variable had negative and significant effects on turnover intentions. However, gender status as a control effect had a nonsignificant impact on turnover intentions. It is recommended that the government of Ghana, the Ministry of Health, and the Ghana Health Service must institute measures such as the provision of competitive salaries and a quality work environment to entice nurses to stay in order to reduce the exodus of nurses outside the shores of Ghana. One limitation of this study is that there are other factors that could cause employees to quit their jobs, such as employee commitment, engagement, and leadership behaviours but these variables were not tested. Therefore, future studies must control these variables in studies regarding pay satisfaction and turnover intentions.

Influence of nurse and midwife managerial leadership styles on job satisfaction, intention to stay, and services provision in selected hospitals of Rwanda

Background

Nurses and midwives are a critical part of the healthcare team and make up the largest section of health professionals. Leadership styles are believed to be an important determinant of job satisfaction and retention making effective leadership within nursing and midwifery crucial to health systems success. In Rwanda, there are gaps in knowledge of managerial leadership styles of nurses and midwives and the influence of these styles on job satisfaction and retention for nurses and midwives who report to them, as well as their influence on the provision of health services. This study describes the managerial leadership styles adopted by nurses/midwives and examines the relationship between managerial leadership styles and job satisfaction, intention to stay, and service provision.

Methods

The Path-Goal Leadership questionnaire was adopted and used to collect data on leadership styles while other questionnaires with high validity and reliability were used to collect data on job satisfaction, intention to stay and service provision. The study involved 162 full-time nurses and midwives practicing in 5 selected hospitals with a minimum of 6 months of experience working with their current direct managers. Regression analysis was used to draw conclusions on relationships between variables.

Results

Nurses and midwives managers were more inclined to the directive leadership style followed by a supportive leadership style, and the participative leadership style. The nurse and midwife's managerial leadership styles together significantly explained 38, 10 and 23% of the variance in job satisfaction, intention to stay and service provision, respectively.

Conclusion

The findings of this study indicate that managerial leadership styles play a substantial role in enhancing job satisfaction, intention to stay and service provision.

The implication for nursing and midwifery management

There is a need to develop a comprehensive formal professional continuous development course on leadership styles and ensure that all nurses and midwives managers benefit from this course prior to or immediately after being appointed as a manager. Having such a course may even prepare future leaders for their role early in their career. Effective leadership in nursing and midwifery should be enhanced at all levels to improve the job satisfaction of nurses and midwives, address the issue of retention in their respective health facilities and strengthen service provision.

Training Exposure and Self-Rated Competence among HIV Care Providers Working with Adolescents in Kenya

Lack of health care worker (HCW) training is a barrier to implementing youth-friendly services. We examined training coverage and self-reported competence, defined as knowledge, abilities, and attitudes, of HCWs caring for adolescents living with HIV (ALWH) in Kenya. Surveys were conducted with 24 managers and 142 HCWs. Competence measures were guided by expert input and Kalamazoo II Consensus items. Health care workers had a median of 3 (interquartile range [IQR]: 1-6) years of experience working with ALWH, and 40.1% reported exposure to any ALWH training. Median overall competence was 78.1% (IQR: 68.8-84.4). In multivariable linear regression analyses, more years caring for ALWH and any prior training in adolescent HIV care were associated with significantly higher self-rated competence. Training coverage for adolescent HIV care remains suboptimal. Targeting HCWs with less work experience and training exposure may be a useful and efficient approach to improve quality of youth-friendly HIV services.

Factors affecting nurses' intention to leave their current jobs in Saudi Arabia

OBJECTIVE

It is known that job satisfaction and quality of life influence nurses' intention to resign from their jobs. However, health-care systems should examine all the possible factors that contribute to nurse turnover to retain them for the long term. To this purpose, this study further explores the aspects that affect the intention of nurses who work in Saudi Arabia to leave their current jobs.

METHODS

A sample of 318 staff nurses working in two public hospitals in Saudi Arabia was surveyed in this cross-sectional study. A questionnaire was used to assess job satisfaction, stress, quality of life, and intention of recruited nurses to leave their current jobs. Data were collected between April and May 2018.

RESULTS

Quality of life dimensions, such as physical and psychological health, predict nurses' intention to resign from their current workplaces. We found that being single or of Filipino or Indian origin, working in the medical and surgical department, or having a low monthly gross salary is correlated with a high intention to leave.

CONCLUSION

The results present a unique theoretical underpinning that expands on the previous knowledge and literature on the factors that affect nurses' intent to leave their organizations. The findings of this study can be used as a guide to establish human resource policies toward satisfying nurses' needs and improving job satisfaction and quality of life to promote retention.

The relationship between psychosocial risk factors, burnout and quality of life among primary healthcare workers in rural Guangdong province: a cross-sectional study

BACKGROUND

Healthcare workers are often exposed to stressful working conditions at work which affect their quality of life. The study investigated the relationship between psychosocial risk factors, stress, burnout, and quality of life among primary healthcare workers in general medical practice in Qingyuan and Chaozhou cities in Guangdong province.

METHOD

The cross-sectional study was conducted in 108 primary health facilities including 36 community health centers (CHCs) across two developing cities in Guangdong province. A total of 873 healthcare workers completed the questionnaires. Quality of life was evaluated using The World Health Organization Quality of Life Questionnaire (WHOQOL-BREF) and psychological risk factors were evaluated by the Copenhagen Psychosocial Questionnaire (COPSOQ). General quality of life and the quality of life domains were transformed into a score range from minimum 0 to 100 maximum. Higher scores indicated better quality of life and vice versa. Significant associations were verified using multiple regression analysis.

RESULTS

Poor quality of life was observed in 74.6% of healthcare workers surveyed. General poor quality of life was significantly higher among workers who reported higher burnout (Beta = - 0.331, p < 0.001). In addition, workers with high levels of burnout, unmarried workers and female workers had a higher possibility of physical health. A greater risk of poor psychological health was observed among workers with high burnout, poor sense of community and those with lower educational levels. Workers who lacked social support, those with fewer possibilities for development had increased probability of poor quality of life in the social domain. Poor quality of life in the environmental domain was observed among workers who were dissatisfied with their jobs and workers with low salaries.

CONCLUSIONS

Primary healthcare workers in developing cities in China have a highly demanding and strained working environment and poor quality of life. Reducing job stress and improving work conditions may ultimately improve the well-being of primary healthcare workers.

Health care worker vaccination against Ebola: Vaccine acceptance and employment duration in Sierra Leone

Health care workers (HCW) are at high risk of Ebola virus disease (EVD) infection during epidemics and may contribute to onward transmission, and therefore HCW-targeted prophylactic vaccination strategies are being considered as interventions. To assess the feasibility of preventive HCW vaccination, we conducted a pilot survey on staff turnover and vaccine acceptance amongst 305 HCW in Freetown and Kambia districts of Sierra Leone. Multivariable logistic regression demonstrated which demographic and behavioural factors were associated with acceptance of a hypothetical new vaccine. We quantified the duration of employment of HCW, and used multivariable gamma regression to detect associations with duration of employment in current or any health care position. Finally, we simulated populations of HCW, to determine the likely future immunisation coverage amongst HCW based on our estimates of vaccine acceptance and employment duration. Most HCW we surveyed had a positive opinion of EVD vaccination (76.3%). We found that being a volunteer HCW (vs being on the government payroll) was associated with increased vaccine acceptance. We found that HCW have stable employment, with a mean duration of employment in the health sector of 10.9 years (median 8.0 years). Older age and being on the government payroll (vs volunteer HCW) were associated with a longer duration of employment in the health sector. Assuming a single vaccine campaign, with 76.3% vaccine acceptance, 100% vaccine efficacy and no waning of vaccine-induced protection, immunisation coverage was sustained over 50% until 6 years after a vaccination campaign. If vaccine-induced immunity wanes at 10% per year, then the immunisation coverage among HCW would fall below 50% after 3 years. Vaccinating HCW against EVD could be feasible as employment appeared stable and vaccine acceptance high. However, even with high vaccine efficacy and long-lasting immunity, repeated campaigns or vaccination at employment start may be necessary to maintain high coverage.

Why doctors are not satisfied with their job-current status in tertiary care hospitals

OBJECTIVE

To determine level and factors of job satisfaction among doctors working in tertiary care hospitals in Pakistan.

METHODS

This is a multi-center cross-sectional survey conducted among Post graduate trainees, medical officers, consultants and faculty doctors. Job satisfaction was measured using 35 specific questions about sources of work-related stress and sources of work-related satisfaction. Satisfaction was defined if mean score of a factor was≥3.0, where factors were rated using a 5-point Linkert scale ranging from 1 (completely dissatisfied) to 5 (completely satisfied).

RESULTS

In this study 373 doctors participated, out of which 215(57.6%) were males. Over all mean satisfaction score was of 2.69 ±0.37. Departmental mean satisfaction scores were Internal medicine 2.71 ±0.35, Medical subspecialties 2.63 ±0.38, Surgical and allied 2.73 ±0.45. Designation means were Consultant 2.87 ±0.38, Faculty 2.78 ±0.44, Medical officer/ Registrar 2.50 ±0.32, Post graduate trainee 2.71 ±0.45. Public and private sector means satisfaction scores were 2.53 ±0.80 and 2.92 ±0.84 respectively.

CONCLUSION

Job dissatisfaction was seen among doctors from all the tiers and departments. Public sector doctors were more dissatisfied than private sector doctors. Increasing age, duration of current posting and working experience, positively correlated with satisfaction level.

Costs of streamlined HIV care delivery in rural Ugandan and Kenyan clinics in the SEARCH Studys

Objectives/design:

As antiretroviral therapy (ART) rapidly expands in sub-Saharan Africa using new efficient care models, data on costs of these approaches are lacking. We examined costs of a streamlined HIV care delivery model within a large HIV test-and-treat study in Uganda and Kenya.

Methods:

We calculated observed per-person-per-year (ppy) costs of streamlined care in 17 health facilities in SEARCH Study intervention communities (NCT: 01864603) via micro-costing techniques, time-and-motion studies, staff interviews, and administrative records. Cost categories included salaries, ART, viral load testing, recurring goods/services, and fixed capital/facility costs. We then modeled costs under three increasingly efficient scale-up scenarios: lowest-cost ART, centralized viral load testing, and governmental healthcare worker salaries. We assessed the relationship between community-specific ART delivery costs, retention in care, and viral suppression.

Results:

Estimated streamlined HIV care delivery costs were $291/ppy. ART ($117/ppy for TDF/3TC/EFV [40%]) and viral load testing ($110/ppy for 2 tests/year [39%]) dominated costs versus salaries ($51/ppy), recurring costs ($5/ppy), and fixed costs ($7/ppy). Optimized ART scale-up with lowest-cost ART ($100/ppy), annual viral load testing ($24/ppy), and governmental healthcare salaries ($27/ppy), lowered streamlined care cost to $163/ppy. We found clinic-to-clinic heterogeneity in retention and viral suppression levels versus streamlined care delivery costs, but no correlation between cost and either retention or viral suppression.

Conclusions:

In the SEARCH Study, streamlined HIV care delivery costs were similar to or lower than prior estimates despite including viral load testing; further optimizations could substantially reduce costs further. These data can inform global strategies for financing ART expansion to achieve UNAIDS 90–90–90 targets.