Abstract
Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of and risk factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is an important problem across various health care providers in LMICs. Further studies are required to better measure the prevalence, causes and consequences of burnout, and guide the development of effective interventions to reduce or prevent burnout.
Highlights
Primary health care (PHC) includes provision of services for the prevention, treatment, management, rehabilitation, and palliation of disease, and is integral to achieving global health security, universal health coverage and the Sustainable Development Goals[1,2,3,4,5,6,7]
We developed a broad search strategy for each key term: ‘burnout’, ‘healthcare providers’, and ‘low and middle-income countries (LMICs)’, through a combination of text words, words in the abstract or title, and Medical Subject Headings (MeSH)
We updated the search on January 23, 2016; we identified 770 articles and identified 9 additional articles that met our eligibility criteria (S2 Supplementary Material)
Summary
Primary health care (PHC) includes provision of services for the prevention, treatment, management, rehabilitation, and palliation of disease, and is integral to achieving global health security, universal health coverage and the Sustainable Development Goals[1,2,3,4,5,6,7]. A robust PHC system requires an adequate number of trained and motivated health care providers[6,8,9]. Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Articles were reviewed to identify prevalence of factors associated with provider burnout. Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
