Healthcare provider satisfaction with environmental conditions in rural healthcare facilities of 14 low- and middle-income countries

https://doi.org/10.1016/j.ijheh.2021.113802Get rights and content

Highlights

  • Assessed rural provider satisfaction with WaSH infrastructure and IPC in 14 LMICs.

  • 86% of providers were unsatisfied with at least one element of WaSH infrastructure.

  • Mobility-accessible WaSH resources are associated with higher HCP satisfaction.

  • Adequate hygiene and IPC supplies are associated with higher HCP satisfaction.

  • On premises, improved water service is important to healthcare provider satisfaction.

Abstract

Healthcare provider (HCP) satisfaction is important for staff retention and effective health service delivery. Inadequate resources, understaffing, and ineffective organizational structure may reduce HCP satisfaction in low- and middle-income countries (LMICs). Some qualitative studies have described links between environmental conditions and job satisfaction in HCPs; however, few studies have explored this link using survey data. This study explores associations between HCP satisfaction and water, sanitation, and hygiene (WaSH) infrastructure, cleanliness, and infection prevention and control (IPC) practices in rural healthcare facilities (HCFs) in LMICs.

This study analyzes 2002 HCFs in rural areas of 14 LMICs. Generalized linear mixed-effects logistic regression models were used to analyze the association between HCP satisfaction, WaSH infrastructure, and cleanliness and IPC practices.

Most respondents reported that they were unsatisfied with water (65%), sanitation (68%), and hygiene infrastructure (54%) at their HCF. Insufficient supply and poor quality of WaSH resources were the most commonly reported reasons for provider dissatisfaction. Respondents were less likely to report dissatisfaction with cleanliness and IPC practices (36%). Dissatisfaction with cleanliness and IPC were most reported because patients and staff did not wash their hands at the correct times or with proper materials, or because the facility was not clean. Several characteristics of the WaSH environment were significantly associated with provider satisfaction at their HCFs, including acceptable water quality, readily available supply of water (on premises and improved), accessible supply of WaSH infrastructure to people with reduced mobility, accessible supplies of sanitation and hygiene materials, and sufficient training and budgeting for WaSH or IPC needs.

Our results suggest that the provision of on premises, improved water service accessible to people with reduced mobility, interventions that prioritize the acceptability of sanitation facilities within the local context, and the provision of hygienic materials are key interventions to improve HCP satisfaction. Dedicated funding and oversight should be established at the HCF level to ensure access to consumable hygiene and IPC products and maintenance of WASH infrastructure. Improvements to WaSH in HCF may improve HCP satisfaction and ultimately patient outcomes.

Introduction

Job satisfaction is “the attitude towards one's work and the related emotions, beliefs, and behavior,” and “results from complex interactions between on-the-job experience, organizational environment, and motivation” (Peters et al., 2010). Healthcare providers (HCPs) who are more satisfied with their job and work environment are more likely to demonstrate higher levels of effort towards quality improvement, provide lower-risk care for patients, and have less turnover (Alhassan et al., 2013; Mbaruku et al., 2014; Stewart et al., 2011).

The job of HCPs in rural areas of low- and middle-income countries (LMICs) can be especially demanding, and they often have little resources and institutional support (O'Neill and Sheffel, 2013). Increased pressure in the work environment affects job satisfaction, worker retention and health service delivery in rural settings (Mbaruku et al., 2014). Understaffing can lead to job dissatisfaction, in turn causing further staff shortages, labor unrest, and absenteeism (Gross et al., 2012; Mubyazi et al., 2012; Rowe et al., 2005). Dissatisfaction on the part of service providers can be passed on to patients in the form of impatient, distracted, or uncourteous behavior (Kruk et al., 2009). Improving the job satisfaction of HCPs in these settings is critical for improved patient and provider outcomes in healthcare facilities (HCFs).

The physical work environment – such as water, sanitation, and hygiene (WaSH) infrastructure, lighting, and infection control supplies – affects HCP job satisfaction. Peters et al. found that more than 90% of HCPs in India reported that “good physical conditions” were important in the “ideal job” and often ranked “good physical conditions” above “income” in importance (Peters et al., 2010). HCP dissatisfaction with staffing, poorer cleanliness and less orderliness of the workplace were associated with a greater risk for needlestick injury and pathogen exposure for HCPs (Lundstrom et al., 2002). Inadequate environmental conditions were linked to employee job frustration in HCFs in South Africa; rural HCPs had worse service delivery outcomes and expressed that transferring to another location with more resources would allow them to do their job more effectively (Tawana et al., 2019). In Ghana, HCPs in public and private facilities expressed that a major source of job dissatisfaction was due to the physical work environment of their clinics, and the low availability of resources and drugs (Alhassan et al., 2013). Insufficient resources were cited as a reason for job dissatisfaction for HCPs in government and public HCFs in Kenya, who were less likely to report adequate resources and safe water in the workplace (Ojakaa et al., 2014).

Understanding how the physical work environment impacts job satisfaction in HCPs can improve healthcare service delivery. Despite some qualitative evidence on job satisfaction in HCPs in rural, LMIC settings, few studies have explored this using survey data. We analyzed data from surveys conducted in 14 LMICs to explore the relationship between environmental conditions and HCP job satisfaction in HCFs, and to understand the factors influencing satisfaction with WaSH infrastructure and cleanliness and infection prevention and control (IPC) practices in rural HCFs in LMICs.

Section snippets

Materials and methods

Between July and December 2017, an evaluation of WaSH conditions in 14 low- and middle-income countries was conducted for the international non-governmental organization World Vision. As part of this evaluation, public clinics (such as health posts and health centers) in rural areas of Ethiopia, Ghana, Honduras, India, Kenya, Malawi, Mali, Mozambique, Niger, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe were assessed. Survey methods are described in detail by A. Z. Guo and Bartram (2019) but

Results

Across the 14 studied countries, respondents at 2002 HCFs (over 98% of those contacted) consented to survey. The characteristics of facilities in the final sample are discussed in detail elsewhere (A. Z. Guo and Bartram, 2019). Respondents from India and Honduras reported consistently high satisfaction with environmental conditions compared to study countries in sub-Saharan Africa and in particular Malawi, Zambia, and Uganda, where respondents reported consistently low satisfaction with

Discussion

We assessed HCP satisfaction with WaSH infrastructure and IPC practices and cleanliness at 2002 rural HCFs across 14 LMICs. This is one of the first studies to quantitatively assess HCP satisfaction with water, sanitation and hygiene infrastructure and IPC practices in LMICs. HCP satisfaction directly affects patient outcomes (Alhassan et al., 2013; Mbaruku et al., 2014; Stewart et al., 2011) and may be especially important in rural and LMIC settings where a small staff with few financial

Conclusions

Our study suggests that governments and non-governmental organizations (NGOs) should facilitate substantial improvements to HCF WaSH infrastructure in order to improve both HCP satisfaction and patient outcomes in public, rural clinics of LMICs. With regards to water, our findings suggest that governments and NGOs working in this space should prioritize provision of on premises, improved-type water service accessible to people with reduced mobility at HCFs. This single intervention could

Declaration of competing interest

Authors JBT and OO are both employed by World Vision, the sponsor for the original collection of data, but do not declare any influence from World Vision in their role in this manuscript. The other authors declare no conflicts of interest.

Acknowledgements

We thank the doctors and nurses who participated for their time and responses, and the enumerators from research consulting firms that helped to carry out the program evaluation. We would also like to thank those from The Water Institute at UNC who supported this project and evaluation. We thank Wren Tracy, Hayley Schram, and Raymond Tu for their feedback on the early stages of this manuscript.

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