Abstract
BackgroundOption B+ for the prevention of mother-to-child transmission (PMTCT) of HIV (i.e., lifelong antiretroviral treatment for all pregnant and breastfeeding mothers living with HIV) was initiated in Tanzania in 2013. While there is evidence that this policy has benefits for the health of the mother and the child, Option B+ may also increase the workload for health care providers in resource-constrained settings, possibly leading to job dissatisfaction and unwanted workforce turnover.MethodsFrom March to April 2014, a questionnaire asking about job satisfaction and turnover intentions was administered to all nurses at 36 public-sector health facilities offering antenatal and PMTCT services in Dar es Salaam, Tanzania. Multivariable logistic regression models were used to identify factors associated with job dissatisfaction and intention to quit one’s job.ResultsSlightly over half (54%, 114/213) of the providers were dissatisfied with their current job, and 35% (74/213) intended to leave their job. Most of the providers were dissatisfied with low salaries and high workload, but satisfied with workplace harmony and being able to follow their moral values. The odds of reporting to be globally dissatisfied with one’s job were high if the provider was dissatisfied with salary (adjusted odds ratio (aOR) 5.6, 95% CI 1.2–26.8), availability of protective gear (aOR 4.0, 95% CI 1.5–10.6), job description (aOR 4.3, 95% CI 1.2–14.7), and working hours (aOR 3.2, 95% CI 1.3–7.6). Perceiving clients to prefer PMTCT Option B+ reduced job dissatisfaction (aOR 0.2, 95% CI 0.1–0.8). The following factors were associated with providers’ intention to leave their current job: job stability dissatisfaction (aOR 3.7, 95% CI 1.3–10.5), not being recognized by one’s superior (aOR 3.6, 95% CI 1.7–7.6), and poor feedback on the overall unit performance (aOR 2.7, 95% CI 1.3–5.8).ConclusionJob dissatisfaction and turnover intentions are comparatively high among nurses in Dar es Salaam’s public-sector maternal care facilities. Providing reasonable salaries and working hours, clearer job descriptions, appropriate safety measures, job stability, and improved supervision and feedback will be key to retaining satisfied PMTCT providers and thus to sustain successful implementation of Option B+ in Tanzania.
Highlights
Option B+ for the prevention of mother-to-child transmission (PMTCT) of Human immunodeficiency virus (HIV) was initiated in Tanzania in 2013
Tanzania is among the 22 Global Plan priority countries identified by the Inter-Agency Task Team (IATT) on prevention and treatment of HIV infection in pregnant women, mothers and children based on the high number (86000) of pregnant women living with HIV who give birth every year [2]
Among the 213 questionnaires analysed, we found that 54% (N = 115) of the providers in these public PMTCT facilities were dissatisfied with their current job and 35% (N = 74) had thought of leaving their current job
Summary
Option B+ for the prevention of mother-to-child transmission (PMTCT) of HIV (i.e., lifelong antiretroviral treatment for all pregnant and breastfeeding mothers living with HIV) was initiated in Tanzania in 2013. Tanzania is among the 22 Global Plan priority countries identified by the Inter-Agency Task Team (IATT) on prevention and treatment of HIV infection in pregnant women, mothers and children based on the high number (86000) of pregnant women living with HIV who give birth every year [2]. Six years after the launch of the Global Plan (2009–2015), the proportion of pregnant women living with HIV who received antiretroviral medicines doubled, and a threefold decline in the rate of mother-to-child transmission (MTCT) was observed [2]. In the previous prevention of MTCT (PMTCT) strategies, only pregnant women living with HIV with low CD4 count (< 350 cells/μL) or advanced disease stage (WHO stages III and IV) were offered lifelong ART, while those with a high CD4 count (≥ 350 cells/μL) were only offered antiretroviral prophylaxis until the end of the breastfeeding period [6]
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