title: What elements of the work environment are most responsible for health worker dissatisfaction in rural primary care clinics in Tanzania?
abstract: BACKGROUND
  In countries with high maternal and newborn morbidity and mortality, reliable access to quality healthcare in rural areas is essential to save lives. Health workers who are satisfied with their jobs are more likely to remain in rural posts. Understanding what factors influence health workers' satisfaction can help determine where resources should be focused. Although there is a growing body of research assessing health worker satisfaction in hospitals, less is known about health worker satisfaction in rural, primary health clinics. This study explores the workplace satisfaction of health workers in primary health clinics in rural Tanzania.
  
  
  METHODS
  Overall, 70 health workers in rural Tanzania participated in a self-administered job satisfaction survey. We calculated mean ratings for 17 aspects of the work environment. We used principal components analysis (PCA) to identify groupings of these variables. We then examined the bivariate associations between health workers demographics and clinic characteristics and each of the satisfaction scales.
  
  
  RESULTS
  Results showed that 73.9% of health workers strongly agreed that they were satisfied with their job; however, only 11.6% strongly agreed that they were satisfied with their level of pay and 2.9% with the availability of equipment and supplies. Two categories of factors emerged from the PCA: the tools and infrastructure to provide care, and supportive interpersonal environment. Nurses and medical attendants (compared to clinical officers) and older health workers had higher satisfaction scale ratings.
  
  
  CONCLUSIONS
  Two dimensions of health workers' work environment, namely infrastructure and supportive interpersonal work environment, explained much of the variation in satisfaction among rural Tanzanian health workers in primary health clinics. Health workers were generally more satisfied with supportive interpersonal relationships than with the infrastructure. Human resource policies should consider how to improve these two aspects of work as a means for improving health worker morale and potentially rural attrition.
  
  
  BACKGROUND
  (ISRCTN 17107760).
authors.forename: Godfrey M
authors.initials: GM
authors.lastname: Mbaruku
authors.affiliation: Mailman School of Public Health, Columbia University, 722 West 168th Street, Room 603, 10032 New York, NY, USA. el2646@columbia.edu.
authors.forename: Elysia
authors.initials: E
authors.lastname: Larson
authors.forename: Angela
authors.initials: A
authors.lastname: Kimweri
authors.forename: Margaret E
authors.initials: ME
authors.lastname: Kruk
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities; D001291:Attitude of Health Personnel; D003625:Data Collection; D005260:Female; D006282:Health Personnel / Q000523:psychology*; D006295:Health Resources; D006297:Health Services Accessibility; D006801:Humans; D007398:Interpersonal Relations; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care; D019035:Rural Health Services; D012424:Rural Population; D012456:Salaries and Fringe Benefits; D011795:Surveys and Questionnaires; D013636:Tanzania; D014937:Work; D000078329:Workforce
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