title: The effects of health worker motivation and job satisfaction on turnover intention in Ghana: a cross-sectional study.
abstract: BACKGROUND
  Motivation 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.
  
  
  METHODS
  We 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.
  
  
  RESULTS
  Overall, 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).
  
  
  CONCLUSIONS
  Our 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.
authors.affiliation: Swiss Centre for International Health, Swiss Tropical and Public Health Institute, Socinstrasse 57, Basel 4002, Switzerland. marc.bonenberger@unibas.ch.
authors.forename: Marc
authors.initials: M
authors.lastname: Bonenberger
authors.forename: Moses
authors.initials: M
authors.lastname: Aikins
authors.forename: Patricia
authors.initials: P
authors.lastname: Akweongo
authors.forename: Kaspar
authors.initials: K
authors.lastname: Wyss
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002055:Burnout, Professional; D003430:Cross-Sectional Studies; D003906:Developing Countries; D005260:Female; D005869:Ghana; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D033182:Intention; D007588:Job Satisfaction; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009042:Motivation; D010563:Personnel Turnover; D011795:Surveys and Questionnaires; D016526:Workload
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