Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda
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Date
2017
Journal Title
Journal ISSN
Volume Title
Publisher
Global Health Action
Abstract
Health worker retention in rural and underserved areas remains a persisting
problem in many low and middle income countries, and this directly affects the quality of
health services offered.
Objective: This paper explores the drivers of long-term retention and describes health worker
coping mechanisms in rural Uganda.
Methods: A descriptive qualitative study explored the factors that motivated health workers
to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews
conducted among health workers who have been retained for at least 10 years explored
factors motivating the health workers to stay within the district, opportunities, and the
benefits of staying.
Results: Twenty-one health workers participated. Ten of them male and 11 female with the
age range of 33–51 years. The mean duration of stay among the participants was 13, 15, and
26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to
personal factors, such as having family ties, community ties, and opportunities to invest. The
decentralization policy and pension benefits also kept workers in place. Opportunities for
promotion or leadership motivated long stay only if they came with financial benefits.
Workload reportedly increased over the years, but staffing and emoluments had not
increased. Multiple job, family support, and community support helped health workers
cope with the costs of living, and holding a secure pensionable government job was valued
more highly than seeking uncertain job opportunities elsewhere.
Conclusion: The interplay between the costs of leaving and the benefit of staying is demonstrated.
Family proximity, community ties, job security, and pension enhance staying, while
higher costs of living and an unpredictable employment market make leaving risky. Health
workers should be able to access investment opportunities in order to cope with inadequate
remuneration. Promotions and leadership opportunities only motivate if accompanied by
financial benefits.
Description
Keywords
Human resource management, Retention, Implementation science, Uganda
Citation
Suzanne Namusoke Kiwanuka, Martha Akulume, Moses Tetui, Rornald Muhumuza Kananura, John Bua & Elizabeth Ekirapa-Kiracho (2017) Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda, Global Health Action, 10:sup4, 1345494, DOI: 10.1080/16549716.2017.1345494