Motivation and retention of primary healthcare workers in rural health facilities: An exploratory qualitative study of Chipata and Chadiza Districts, Zambia

ABSTRACT

Rural areas have the greatest health needs and yet they face the largest shortage of human resources for health which negatively impacts health systems capacity to deliver quality care as they struggle to motivate and retain healthcare workers in such settings. This study explored factors that shape motivation and retention of primary healthcare workers in rural health facilities in Chipata and Chadiza Districts of Zambia using a phenomenological research design. The data consisted 28 in-depth interviews with rural primary healthcare workers and were analysed using thematic analysis. Three main themes of factors shaping motivation and retention of rural primary healthcare workers were identified. Firstly, professional development with emergent themes of career advancement and opportunities for attending capacity-building workshops. Secondly, the work environment with emergent themes of challenging and stimulating tasks, availability of opportunities for promotion and co-workers’ recognition and supportive relationships. Thirdly, rural community dynamics with emergent themes of reduced cost of living, community recognition and support, and easy access to farmland for economic and consumption purposes. Interventions that are contextually relavant, which can streamline career progression pathways, enhance rural working environments, offer suitable incentives, and rally community support for rural primary healthcare workers are required.

KEYWORDS:

• human resources
• healthcare workers
• motivation
• retention
• primary healthcare
• Zambia

ABBREVIATIONS:

• EHT
• environmental health technician
• HW
• healthcare worker
• HRH
• human resources for health; IDI
• in-depth interviews; MoH
• Ministry of Health; WHO
• World Health Organization

Acknowledgments

The authors are grateful for the support provided by the Department of Health Policy and Management, School of Public Health, University of Zambia. The authors also wish to thank Dr Simon Manda, Tulani Matenga, Margarate Nzala Munakampe for the contribution made to this study. The authors are indebted to the leadership at the district health office in Chipata and Chadiza for authorising the study, health facility, as well as rural health workers for participating in the study. K. M., M. M. K., A. M., and P. H. contributed to the study design. K. M. and A. S. conducted the data collection. K. M. and A. M. analysed the data. K. M. drafted the manuscript. A. M., M. M. K., and P. H. contributed to the revision and refining of the manuscript. P. H. gave approval for the final version of the manuscript. All authors read and approved the final manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The datasets during and/or analysed during the current study are available from the corresponding author on reasonable request.