Abstract
BackgroundMotivation and job satisfaction have been identified as key factors for health worker retention and turnover in low- and middle-income countries. District health managers in decentralized health systems usually have a broadened ‘decision space’ that enables them to positively influence health worker motivation and job satisfaction, which in turn impacts on retention and performance at district-level. The study explored the effects of motivation and job satisfaction on turnover intention and how motivation and satisfaction can be improved by district health managers in order to increase retention of health workers.MethodsWe conducted a cross-sectional survey in three districts of the Eastern Region in Ghana and interviewed 256 health workers from several staff categories (doctors, nursing professionals, allied health workers and pharmacists) on their intentions to leave their current health facilities as well as their perceptions on various aspects of motivation and job satisfaction. The effects of motivation and job satisfaction on turnover intention were explored through logistic regression analysis.ResultsOverall, 69% of the respondents reported to have turnover intentions. Motivation (OR = 0.74, 95% CI: 0.60 to 0.92) and job satisfaction (OR = 0.74, 95% CI: 0.57 to 0.96) were significantly associated with turnover intention and higher levels of both reduced the risk of health workers having this intention. The dimensions of motivation and job satisfaction significantly associated with turnover intention included career development (OR = 0.56, 95% CI: 0.36 to 0.86), workload (OR = 0.58, 95% CI: 0.34 to 0.99), management (OR = 0.51. 95% CI: 0.30 to 0.84), organizational commitment (OR = 0.36, 95% CI: 0.19 to 0.66), and burnout (OR = 0.59, 95% CI: 0.39 to 0.91).ConclusionsOur findings indicate that effective human resource management practices at district level influence health worker motivation and job satisfaction, thereby reducing the likelihood for turnover. Therefore, it is worth strengthening human resource management skills at district level and supporting district health managers to implement retention strategies.
Highlights
Motivation and job satisfaction have been identified as key factors for health worker retention and turnover in low- and middle-income countries
There was a noticeable shortage of middle-aged health workers in Upper Manya Krobo, as most respondents were below 30 years of age (67.9%), indicating problems with attraction and retention of experienced health professionals
Our study in Ghana showed that motivation and job satisfaction were significantly associated with turnover intention and that higher levels of both reduced the risk of health workers having this intention
Summary
Motivation and job satisfaction have been identified as key factors for health worker retention and turnover in low- and middle-income countries. Poor retention or high staff turnover negatively affects health care by increasing workload, undermining team morale, creating disruptions and inefficiencies in work processes, and causing a loss of institutional knowledge [3]. Several factors influence the decision of health workers to stay in or leave their posts. Among these are low pay, poor career structures, lack of opportunities for postgraduate training, and inadequate working and living conditions [4,5,6,7]. The challenge of retaining health workers is greatest in rural and remote areas, because health practitioners in these areas often face higher workloads, unsustainable work environments, and poor infrastructure, causing them to leave the workplace in search of more satisfactory working and living conditions in urban areas or abroad [8]
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