Predictors of job satisfaction and intention to stay in the job among health-care providers in Uganda and Zambia

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Uganda; Zambia; health-care provider; intention to stay; job satisfaction.

Figure 1

Contribution of explanatory variables to the explained variance in satisfied with the job and intention to stay in the job among health-care providers in Uganda and Zambia, n = 1134. Demographics included age, gender and on-site training. Cadre included seven types of providers based on the length of training: (i) nurse assistant, (ii) enrolled nurse, (iii) enrolled midwife, (iv) registered nurse, (v) registered midwife, (vi) clinical officer and (vii) general doctor, doctor specialist and medical licentiate. Facility characteristics included facility type and public vs. private ownership. Work environment: inputs category included three independent variables measuring provider’s opinion on the facility’s equipment, the level of staffing and whether they were satisfied with their current pay compared to similar jobs in other organizations. Work environment: management category included four independent variables measuring provider’s opinion on clinical supervision, whether their workload was manageable, whether their facilities provided adequate in-service (continuing) education to improve their clinical skills and whether they felt like their opinions were respected at work. Context covariates included urban/rural location, intervention/control districts and country (Uganda or Zambia).