Comparing the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa.
BACKGROUND
Job satisfaction is an important determinant of health worker motivation, retention, and performance, all of which are critical to improving the functioning of health systems in low- and middle-income countries. A number of small-scale surveys have measured the job satisfaction and intention to leave of individual health worker cadres in different settings, but there are few multi-country and multi-cadre comparative studies.


OBJECTIVE
The objective of this study was to compare the job satisfaction and intention to leave of different categories of health workers in Tanzania, Malawi, and South Africa.


METHODS
We undertook a cross-sectional survey of a stratified cluster sample of 2,220 health workers, 564 from Tanzania, 939 from Malawi, and 717 from South Africa. Participants completed a self-administered questionnaire, which included demographic information, a 10-item job satisfaction scale, and one question on intention to leave. Multiple regression was used to identify significant predictors of job satisfaction and intention to leave.


RESULTS
There were statistically significant differences in job satisfaction and intention to leave between the three countries. Approximately 52.1% of health workers in South Africa were satisfied with their jobs compared to 71% from Malawi and 82.6% from Tanzania (χ2=140.3, p<0.001). 18.8% of health workers in Tanzania and 26.5% in Malawi indicated that they were actively seeking employment elsewhere, compared to 41.4% in South Africa (χ2=83.5, p<0.001). The country differences were confirmed by multiple regression. The study also confirmed that job satisfaction is statistically related to intention to leave.


CONCLUSIONS
We have shown differences in the levels of job satisfaction and intention to leave between different groups of health workers from Tanzania, Malawi, and South Africa. Our results caution against generalising about the effectiveness of interventions in different contexts and highlight the need for less standardised and more targeted HRH strategies than has been practised to date.
Centre for Health Policy, School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. duane.blaauw@wits.ac.za
Duane
D
Blaauw
Prudence
P
Ditlopo
Fresier
F
Maseko
Maureen
M
Chirwa
Aziza
A
Mwisongo
Posy
P
Bidwell
Steve
S
Thomas
Charles
C
Normand
D000328:Adult; D000488:Allied Health Personnel / Q000523:psychology / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006282:Health Personnel / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007588:Job Satisfaction; D008295:Malawi; D008297:Male; D009721:Nurse Midwives / Q000523:psychology / Q000706:statistics & numerical data; D009726:Nurses / Q000523:psychology / Q000706:statistics & numerical data; D010563:Personnel Turnover / Q000706:statistics & numerical data*; D013019:South Africa; D011795:Surveys and Questionnaires; D013636:Tanzania
Malawi; South Africa; Tanzania; health worker; intention to leave; job satisfaction