Psychological wellbeing in a resource-limited work environment: examining levels and determinants among health workers in rural Malawi

Abstract

BackgroundA competent, responsive, and productive health workforce is central to a well-performing health system capable of providing universal access to high-quality care. Ensuring health workers’ psychological wellbeing is critical to sustaining their availability and productivity. This is particularly true in heavily constrained health systems in low- and lower-middle-income countries. Research on the issue, however, is scarce. This study aimed to contribute to filling the gap in knowledge by investigating levels of and factors associated with psychological wellbeing of mid-level health workers in Malawi.MethodsThe study relied on a cross-sectional sample of 174 health workers from 33 primary- and secondary-level health facilities in four districts of Malawi. Psychological wellbeing was measured using the WHO-5 Wellbeing Index. Data were analyzed using linear and logistic regression models.ResultsTwenty-five percent of respondents had WHO-5 scores indicative of poor psychological wellbeing. Analyses of factors related to psychological wellbeing showed no association with sex, cadre, having dependents, supervision, perceived coworker support, satisfaction with the physical work environment, satisfaction with remuneration, and motivation; a positive association with respondents’ satisfaction with interpersonal relationships at work; and a negative association with having received professional training recently. Results were inconclusive in regard to personal relationship status, seniority and responsibility at the health facility, clinical knowledge, perceived competence, perceived supervisor support, satisfaction with job demands, health facility level, data collection year, and exposure to performance-based financing.ConclusionsThe high proportion of health workers with poor wellbeing scores is concerning in light of the general health workforce shortage in Malawi and strong links between wellbeing and work performance. While more research is needed to draw conclusions and provide recommendations as to how to enhance wellbeing, our results underline the importance of considering this as a key concern for human resources for health.

Assessing the impact of a motivational intervention to improve the working lives of maternity healthcare workers: a quantitative and qualitative evaluation of a feasibility study in Malawi

“…The total scores across all three scales are relatively low, suggesting low satisfaction with working life generally. Which is in keeping with a recent study which found low psychological well-being of healthcare workers in Malawi [14]. Because of these low scores, the overall changes in the mean scores occurred within a very small window and therefore determination of a change during or following the intervention is difficult.…”

“…Findings from our study of working lives support this [17]. The role of interpersonal relationships seems to be important to improve psychological wellbeing in Malawi [14,17]. We therefore decided that an organisational approach would allow us to be non-punitive; instead of suggesting 'you're not doing this well', we could ask 'how can the system change to... ' We identified Appreciative Inquiry (AI) as a motivational intervention fitting with our goals [18].…”

“…This is important as teams exhibiting less hierarchy, deliver better patient outcomes [38], in part because in hierarchies staff are not empowered to speak up [39]. Interpersonal relationships seem to be an important factor in the psychological well-being of staff [14], and the fact that AI could foster progress to improving these relationships is important for motivation as a whole.…”

“…Historically, there has been a focus on improving an individual's knowledge and skills; however, the evidence for this altering clinical outcomes is weak [13]. In Malawi, a negative association with psychological wellbeing has been found with attending a training course [14]. Supportive supervision can increase job satisfaction and motivation; however, it has little effect on clinical outcomes and it requires significant external support [15].…”

Online Affirmation and Peer Support are Effective for Reducing Medical Personnel Stress in Dealing with Covid-19 Patients

“…A three-step rapid development process included public involvement activities (PPIs. Maintaining staff mental health is essential because the psychological wellbeing of medical personnel will influence the duty performance (Langdon et al, 2016;Lohmann et al, 2019;Barzilay et al, 2020)resource and infrastructure sectors continues to expand as operations in rural and remote locations increasingly rely on fly-in, fly-out or drive-in, drive-out workforces in order to become economically competitive. The issues in effectively managing these workforces are becoming more apparent with reported high amounts of turnover and concerns for safety and performance.…”