Understanding the factors influencing health-worker employment decisions in South Africa

Human Resources for Health (Impact Factor: 1.83). 04/2013; 11(1):15. DOI: 10.1186/1478-4491-11-15
Source: PubMed


The provision of health care in South Africa has been compromised by the loss of trained health workers (HWs) over the past 20 years. The public-sector workforce is overburdened. There is a large disparity in service levels and workloads between the private and public sectors. There is little knowledge about the nonfinancial factors that influence HWs choice of employer (public, private or nongovernmental organization) or their choice of work location (urban, rural or overseas). This area is under-researched and this paper aims to fill these gaps in the literature.

The study utilized cross-sectional survey data gathered in 2009 in the province of KwaZulu-Natal. The HWs sample came from three public hospitals (n = 430), two private hospitals (n = 131) and one nongovernmental organization (NGO) hospital (n = 133) in urban areas, and consisted of professional nurses, staff nurses and nursing assistants.

HWs in the public sector reported the poorest working conditions, as indicated by participants’ self-reports on stress, workloads, levels of remuneration, standard of work premises, level of human resources and frequency of in-service training. Interesting, however, HWs in the NGO sector expressed a greater desire than those in the public and private sectors to leave their current employer.

To minimize attrition from the overburdened public-sector workforce and the negative effects of the overall shortage of HWs, innovative efforts are required to address the causes of HWs dissatisfaction and to further identify the nonfinancial factors that influence work choices of HWs. The results highlight the importance of considering a broad range of nonfinancial incentives that encourage HWs to remain in the already overburdened public sector.

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    • "This was attributed to prestige, presence of role models for males and a controllable lifestyle due to family responsibility for females [23]. Similar findings were noted in studies carried out in Malawi [24] and South Africa [25]. There is lack of data on career preferences of medical students in Kenya. "
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    • "Further, data indicate that these strategies are not considered satisfactory or well understood by many health workers. These findings, consistent with other research on retention of health workers (HWs) [17,18], indicate the need for continued research to better understand the broad range of factors that contribute to HW motivation and retention, and the differing degrees to which different incentives influence their motivation and job satisfaction. Examples of research contibuting to this area include a recent study on HW motivation in rural health facilities in Zambia [19] which showed that gender, profession, type of training, and time in post each influence health workers’ motivation. "
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    • "Instead, HWs decision to consider moving is largely influenced by their age, their level of stress at work and the extent to which they feel happy in their current job. Public sector HWs are particularly susceptible to migration due a number of challenges which this and other studies have found [40]. Reasons for the desire to move out of the public sector and into the private sector or abroad revolve around both push and pull factors. "
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