title: To serve or to leave: a question faced by public sector healthcare providers in Pakistan.
abstract: BACKGROUND
  The availability of properly trained and motivated providers is a prerequisite for provision of easily accessible healthcare. Pakistan has been listed by the World Health Organization in its World Health Report 2006 as one of 57 countries with a critical health workforce deficiency. This study examines the factors associated with the willingness of public sector healthcare providers to leave government service and recommends measures that can be adopted to attract and retain staff in the country's public healthcare system.
  
  
  METHODS
  A stratified, random sampling methodology was adopted to recruit a nationally representative sample of 1,296 public sector healthcare providers, including paramedics, medical doctors, and specialists. A semi-structured questionnaire was used to interview these providers. Logistic regressions measured the association with determinants of their willingness to leave the public health sector for better prospects elsewhere.
  
  
  RESULTS
  A third of all healthcare providers who were interviewed were of the view that, provided the opportunity, they would leave government service. The odds of willingness to leave service were highest among providers from the region of Azad Jammu and Kashmir (adjusted odds ratio [AOR] = 4.33; 95% CI, 2.49-7.54) followed by the province of Balochistan (AOR = 4.21; 95% CI, 2.41-7.33), and the region of Gilgit Baltistan (AOR = 3.34; 95% CI, 1.67-6.67). Providers who expressed dissatisfaction in the manner their performance was evaluated and those who were dissatisfied with the current salary, each had higher odds of considering leaving government service (AOR = 1.67; 95% CI, 1.18-2.40 and AOR = 2.03; 95% CI, 1.47-2.81, respectively). Providers who reported experiencing interference in their work by influential politicians of the area were more inclined to leave (AOR = 1.44; 95% CI, 1.05-1.98).
  
  
  CONCLUSIONS
  This study clearly highlights the need to implement more focused strategies in the public healthcare system in Pakistan in order to build sufficient staff motivation and prevent providers from leaving government service. In order to improve coverage of healthcare services in Pakistan, the government will have to introduce more focused interventions to attract and retain healthcare providers, especially in remote and rural areas of the country.
authors.affiliation: Population Council, Islamabad, Pakistan. amir@popcouncil.org.
authors.forename: Ali Mohammad
authors.initials: AM
authors.lastname: Mir
authors.affiliation: Population Council, Islamabad, Pakistan. amir@popcouncil.org.
authors.forename: Muhammad Saleem
authors.initials: MS
authors.lastname: Shaikh
authors.affiliation: Population Council, Islamabad, Pakistan. amir@popcouncil.org.
authors.forename: Gul
authors.initials: G
authors.lastname: Rashida
authors.affiliation: Population Council, Islamabad, Pakistan. amir@popcouncil.org.|Aahung, Karachi, Pakistan. amir@popcouncil.org.
authors.forename: Neha
authors.initials: N
authors.lastname: Mankani
mesh_terms: D000328:Adult; D000488:Allied Health Personnel; D001291:Attitude of Health Personnel; D003695:Delivery of Health Care; D005260:Female; D006282:Health Personnel; D006296:Health Services; D006297:Health Services Accessibility; D006801:Humans; D007588:Job Satisfaction; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010154:Pakistan; D010820:Physicians; D017150:Public Sector; D012456:Salaries and Fringe Benefits; D011795:Surveys and Questionnaires; D000078329:Workforce; D055815:Young Adult