Abstract
BackgroundCritical shortages of health human resources (HHR), associated with high turnover rates, have been a concern in many countries around the globe. Of particular interest is the effect of such a trend on the primary healthcare (PHC) sector; considered a cornerstone in any effective healthcare system. This study is a rare attempt to investigate PHC HHR work characteristics, level of burnout and likelihood to quit as well as the factors significantly associated with staff retention at PHC centers in Lebanon.MethodsA cross-sectional design was utilized to survey all health providers at 81 PHC centers dispersed in all districts of Lebanon. The questionnaire consisted of four sections: socio-demographic/ professional background, organizational/institutional characteristics, likelihood to quit and level of professional burnout (using the Maslach-Burnout Inventory). A total of 755 providers completed the questionnaire (60.5% response rate). Bivariate analyses and multinomial logistic regression were used to determine factors associated with likelihood to quit.ResultsTwo out of five respondents indicated likelihood to quit their jobs within the next 1–3 years and an additional 13.4% were not sure about quitting. The top three reasons behind likelihood to quit were poor salary (54.4%), better job opportunities outside the country (35.1%) and lack of professional development (33.7%). A U-shaped relationship was observed between age and likelihood to quit. Regression analysis revealed that high levels of burnout, lower level of education and low tenure were all associated with increased likelihood to quit.ConclusionsThe study findings reflect an unstable workforce and are not conducive to supporting an expanded role for PHC in the Lebanese healthcare system. While strategies aiming at improving staff retention would be important to develop and implement for all PHC HHR; targeted retention initiatives should focus on the young-new recruits and allied health professionals. Particular attention should be dedicated to enhancing providers’ role satisfaction and sense of job security. Such initiatives are of pivotal importance to stabilize the workforce and ensure its longevity.
Highlights
Thirty years after the Alma-Ata Declaration, which officially launched Primary Healthcare (PHC) in 1978, primary healthcare (PHC) remains high on the international agenda
The health promotion and disease prevention services have been expanding over the last few years, it is noteworthy to mention that the focus of PHC centers services in Lebanon has been on delivery of curative and diagnostic services
PHC settings are anticipated to place a lower degree of stress on health human resources (HHR) as compared to the high stress environment of acute hospital care, in which patients are of higher acuity level [37]; our findings indicate a relatively elevated degree of stress
Summary
Thirty years after the Alma-Ata Declaration, which officially launched Primary Healthcare (PHC) in 1978, PHC remains high on the international agenda It was the theme of the World Health Report in 2008 entitled “Primary Health Care: more than ever” [1]. Critical shortages of health human resources (HHR), associated with high turnover rates, have been a concern in many countries around the globe. HHR literature concurs in reporting critical shortages of health workers in many countries around the globe, shortages in physicians and nurses [8,9,10]. Such shortages are confirmed within the context of the Eastern Mediterranean Region (EMR), in low and middle income countries [11]. HHR has been largely a neglected component of the health-system development; in best cases not given the due importance that they deserve
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