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

Abstract

BackgroundRural areas have the most pressing health needs in most low-and-middle-income countries and yet they face the largest shortage of human resources for health. This reality cripples the already fragile local healthcare systems as they struggle with how best to motivate and retain health workers in rural areas. This study sought explore the factors that shape motivation and retention of primary health workers in rural facilities of Chipata and Chadiza Districts, Zambia.MethodsThe study adopted a qualitative research study design using a phenomenological and exploratory approach. The data consisted of 28 in-depth interviews and observations with health workers at selected rural health facilities in Chipata and Chadiza Districts of the Eastern province of Zambia. Data were analyzed using thematic analysis approach with the use of NVivo software. ResultsThree thematic categories were identified by the participants as factors that influence the motivation and retention of primary health workers in rural facilities. Firstly, opportunities for career advancement through study leave and attendance of workshops accounted for motivation and retention. The second factor was related to the work environment which comes with stimulating tasks, promotion opportunities as well as co-worker recognition and relationships. Thirdly, the rural community dynamics of reduced cost of living, recognition, community and local support, and access to land for farming were found to contribute to the motivation and retention of rural health workers. ConclusionWhile motivational factors vary, opportunities for career advancement, stimulating and challenging tasks, opportunities for promotion, and co-worker recognition are core factors that can engender retention of rural health workers. Interventions are required to enhance rural health worker motivation and retention, including strengthening the supervision system, developing career progression pathways, and ensuring clear and transparent incentives. Strategies around retention need to be addressed as these would better enable rural primary health workers to cope with the challenging conditions they work in rural areas.