Drivers of retention of the HIV workforce transitioned from PEPFAR support to the Uganda government payroll
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Date
2022
Journal Title
Journal ISSN
Volume Title
Publisher
Research Square
Abstract
Health worker (HW) retention in the public health sector in Uganda is an enduring health system
constraint. Although previous studies have examined the retention of in-service HWs, there is little
research focusing on donor-recruited HWs with private-sector work backgrounds. The objective of this
study was to explore drivers of retention of the HIV workforce transitioned from PEPFAR support to the
Uganda government payroll between 2015 and 2017.
Methods
We conducted ten focus group discussions with HWs (n = 87) transitioned from PEPFAR support to the
public sector payroll in 10 purposively selected districts across Uganda. Qualitative interviews were
conducted with national-level stakeholders (n = 17), district health and personnel officers (n = 15) and
facility in-charges (n = 22). Data were analyzed by thematic approach as guided by the analytical
framework proposed by Schaefer and Moos regarding individual-level and organizational-context drivers.
Results
At the individual level, job security in the public sector was the most compelling driver of health worker
retention. Community embeddedness of HWs in the study districts, opportunities for professional
development and career growth and the ability to secure salary loans due to ‘permanent and pensionable’
terms of employment and the opportunity to work in ‘home districts’ where they could serve their
‘kinsmen’ were identified as enablers. HWs with prior private sector backgrounds perceived public
facilities as offering more desirable challenging professional work. Organizational context enablers
identified include perceptions that public facilities had relaxed supervision regimes and more flexible
work environments. Work environment barriers to long-term retention include frequent stock-out of
essential commodities, heavy workloads, low pay and scarcity of rental accommodation, particularly in
rural Northern Uganda. Compared to mid–cadres (such as nurses and midwives), higher-calibre cadres,
such as physicians, pharmacists and laboratory technologists, indicated a higher affinity to seek
alternative employment in the private sector in the immediate future.
Conclusion
Overall, job security was the most compelling driver of retention in public service for the health workforce
transitioned from PEPFAR support to the Uganda government payroll. Monetary and non-monetary policy
strategies are needed to enhance the retention of upper cadre HWs, particularly physicians, pharmacists
and laboratory technologists in rural districts of Uganda.
Description
Keywords
HIV, PEPFAR, Human Resources for Health, Implementation Research, Health systems, Resource limited settings, Health workforce
Citation
Zakumumpa, H., Rujumba, J., Kyomuhendo, M., Stempler, I., & Amde, W. (2022). Drivers of retention of the HIV workforce transitioned from PEPFAR support to the Uganda government payroll. https://doi.org/10.21203/rs.3.rs-2378724/v1