Appraisal of Health Workforce Retention in Rural Areas of Amuru District, Uganda

ABSTRACT 

The research findings noted that there is greater unmet health needs in rural and remote locations than in pen-urban areas of Amuru district. The study sought answers to the following research questions: - is there health workforce imbalances and deficit in rural areas of Amuru district; what factors compel health workers to come, to stay and leave in rural areas of Amuru district; and what specific health workforce retention strategies are in rural areas of Amuru district? The qualitative descriptive study design was used so as to facilitate exploration of the issues in the study objective. The study used two primary methods of data collection- the questionnaires and interview guide for key informants at the management levels. The overall health workers motivation is very poor and there is need for government to act as soon as possible. More than half of the health workers may leave if working conditions does not improve. Access to equipment, supplies, drugs, electricity and water are seriously unavailable. Other incentives should include training opportunities, study leave, housing, transport allowances and clear career structures. The majority of the health facilities do not have the required minimum number of health workers. Health facilities in pen-urban areas have more number of health staffs. It is recommended that the retention schemes are established, mobilize stakeholders, build local government management capacities, design financial incentives, and monitor demographic trends of health workforce in rural and remote areas.

TABLE OF CONTENTS

Table of contents Page

Title

Declaration A ii

Declaration B iii

Dedication iv

Acknowledgement v

Table of contents vi

List of figures x

List of tables xi

List of acronyms xiii

Abstract xv

CHAPTER ONE: THE PROBLEM AND ITS SCOPE 1

Background of the study 1

Statement of the problem 5

Purpose of the study 6

General objectives 6

Demographic objectives 7

Research objectives 7

Research questions 7

Research hypothesis 7

Scope 8

Significance of the study 9

Operational definition of key terms 9

CHAPTER TWO REVIEW OF RELATED LITERATURE 12

Concepts, ideas, opinions from authors / experts 12

Theoretical perspectives 15

Related studies 19

CHAPTER THREE METHODOLOGY 25

Research Design 25

Research Population 25

Sample Size 25

Sampling Procedures 26

Research Instruments 26

Validity and reliability of the instruments 27

Data gathering procedures 28

Data analysis 29

Ethical considerations 30

Limitations of the study 31

CHAPTER FOUR: PRESENTATION, ANALYSIS AND

INTERPRETATION OF DATA 32

Demographic Characteristics of the Respondents 32

Research questions 1: Is there health workforce imbalance and deficit in rural areas of Amuru 35

Research question 2: What factors compel health workers to come, to stay and leave in rural areas of Amuru district 41

Research question 3: What specific health workforce retention strategies are in rural areas of Amuru district .......................~... 54

CHAPTER FIVE: FINDNGS, CONCLUSIONS, RECOMMENDATIONS

Findings 60

Research question 1: Is there imbalances and deficit of health workforce in rural areas of Amuru district 60

Distribution ofhealth workforce in rural areas ofAmuru district 60

Location Variation ofHealth Workforce 63

The Mal-dLctribution of Health Workers in rural health facilities ..... 64

Research question 2: What factors compel health workers to come to, stay and leave in rural areas of Amuru district7 65

Poor remuneration and incentive package 65

Pull factors- the come, stay and leave factors 66

Push factors- send, discouraging factors 67

Late and poor salary payments 67

Poor working conditions and facilties 68

Understaffing ofhealth workforce 69

Research question 3: What specific health workforce retention strategies are in rural areas of Amuru district 69

Decentralized health workers recruitment 70

Institutional conflicts 71

Medicine and supplies management 72

Conclusions 74

Recommendations 76

REFERENCES 81

APPENDIX I: TRANSMITTAL LETTER 88

APPENDIX II: RESEARCH INSTRUMENT- QUESTIONAIRES 89

APPENDIX III: RESEARCH INSTRUMNET-INTERVIEW GUIDE 99

APPENDIX IV: RESEARCHER’S CURRICULUM VITAE 100