Predictors of workforce retention among Malawian nurse graduates of a scholarship program: a mixed-methods study.
BACKGROUND
Malawi faces critical health care worker shortages of both physicians and nurses. The Global AIDS Interfaith Alliance (GAIA) began a nursing scholarship program in Malawi that requires graduates to work in the public sector for 4-5 years following graduation. The main objective of this study was to identify job satisfaction and retention factors of scholarship recipients after graduation.


METHODS
We conducted a mixed-methods study consisting of 30 individual qualitative interviews and 56 quantitative surveys that evaluated job satisfaction, factors associated with retention, and impact of the GAIA Nursing Scholarship Program. Participants included GAIA scholarship recipients who had graduated. We used thematic analysis to analyze qualitative interviews. Kruskal-Wallis, Spearman correlation, and chi-squared tests were used to analyze survey data.


RESULTS
The majority of survey and interview participants indicated it was unlikely that they would leave the public sector (70% and 90%, respectively). Most interview and survey participants cited a lack of supplies, inadequate human resources, and high workload as major challenges to their work. Poor working relationships with management or coworkers was significantly correlated with consideration of changing jobs in the next 6 months (correlation coefficient -0.28, P < .05 and -0.36, P < .01, respectively). Low salaries, high workload, poor accommodations, and a lack of appreciation were the most common reasons given for considering leaving the public sector while job security, desire to pursue further education, and public service agreement were primary motivations for continuing to work in the public system. Participants felt supported by GAIA staff and expressed a desire to serve their communities in return by working in government-supported health facilities.


CONCLUSIONS
Despite the many challenges faced by public-sector nurses, low-income countries such as Malawi can employ non-remuneration strategies to retain nurses in the public sector, including adequate housing, availability of supplies, advancement opportunities, and positive work environments. Scholarship programs with close follow-up of graduates may also help increase retention.
University of California, San Francisco, Global Health Sciences, San Francisco, CA, USA.
Kelly
K
Schmiedeknecht
Global AIDS Interfaith Alliance (GAIA), Limbe, Malawi. University of California, San Francisco, School of Nursing, San Francisco, CA, USA. melanie.perera@ucsf.edu.
Melanie
M
Perera
Global AIDS Interfaith Alliance (GAIA), Limbe, Malawi.
Ellen
E
Schell
Global AIDS Interfaith Alliance (GAIA), Limbe, Malawi.
Joyce
J
Jere
Global AIDS Interfaith Alliance (GAIA), Limbe, Malawi.
Elizabeth
E
Geoffroy
University of California, San Francisco, Global Health Sciences, San Francisco, CA, USA. University of California, San Francisco, School of Nursing, San Francisco, CA, USA.
Sally
S
Rankin
D000328:Adult; D001291:Attitude of Health Personnel; D002321:Career Choice; D003906:Developing Countries; D004506:Education, Nursing / Q000191:economics; D004651:Employment; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D007588:Job Satisfaction; D008295:Malawi; D008297:Male; D008875:Middle Aged; D009042:Motivation; D009726:Nurses / Q000600:supply & distribution*; D010560:Personnel Selection; D010820:Physicians; D017150:Public Sector; D012456:Salaries and Fringe Benefits; D016526:Workload; D017132:Workplace; D055815:Young Adult