Performance Management Function and Retention of Health Workers: A Mixed-Methods Study from Public District Hospitals in Rwanda

Abstract

Background: Human resources for health are the major component of the health system. Hence health workers are key to better health care service delivery. However, retention of the health workers is one of the major challenges facing the health system in Rwanda, especially in public district hospitals that serve as a major unit of health care service delivery in the country. The study investigated the effect of implementation of performance management function on the retention of professional health workers in public hospitals in Rwanda.Methods: The study used convergent parallel mixed-methods design. A sample of 252 health workers was selected from a population of 402 doctors, nurses, midwives, pharmacists and dentists. Data collection was conducted by use of questionnaire, interviews and focus group discussions. Quantitative data analysis used descriptive statistics and logistic regression models. Qualitative data were analysed by doing thematic analysis, by identifying themes in textual data. Triangulation used qualitative data to expound quantitative data. Data analysis was supported by Stata 13.1 and NVivo 10 softwares.Results: The findings from both quantitative and qualitative data show that health workers generally feel that there exists performance management function in hospitals with slight differences across its major indicators. The study also shows that while performance management planning and evaluation were found to be associated with health workers’ intentions to stay, there was no significant association between performance rewarding and intentions to stay. In fact, health workers who felt that performance management planning was at average and high level were 14.2 and 60 times more likely to stay (OR=14.2; P=0.000 and OR=60.13; P=0.000, respectively). Similarly, while health workers who rated performance evaluation exercise as average were more likely to stay (OR=1.472; P=0.029), perceiving a high level of implementation of performance evaluation in the hospital was associated with 2.215 odds of staying (OR=2.215; P=0.048). Conclusion: Generally, there are divergent levels perceptions on performance management indicators across respondents, and high levels of intentions to leave are noticed among health workers. Although performance planning and rewarding are associated with health workers’ intentions to stay, the existing level of implementation performance management function may have adversely affect retention of health workers.