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Experiences from the Philippine grassroots: impact of strengthening primary care systems on health worker satisfaction and intention to stay

Authors :
Regine Ynez H. De Mesa
Jose Rafael A. Marfori
Noleen Marie C. Fabian
Romelei Camiling-Alfonso
Mark Anthony U. Javelosa
Nannette Bernal-Sundiang
Leonila F. Dans
Ysabela T. Calderon
Jayson A. Celeste
Josephine T. Sanchez
Mia P. Rey
Cara Lois T. Galingana
Ramon Pedro P. Paterno
Jesusa T. Catabui
Johanna Faye E. Lopez
Maria Rhodora N. Aquino
Antonio Miguel L. Dans
Source :
BMC Health Services Research, Vol 23, Iss 1, Pp 1-10 (2023)
Publication Year :
2023
Publisher :
BMC, 2023.

Abstract

Abstract Background Inequities in health access and outcomes persist in low- and middle-income countries. While strengthening primary care is integral in improving patient outcomes, primary care networks remain undervalued, underfunded, and underdeveloped in many LMICs such as the Philippines. This paper underscores the value of strengthening primary care system interventions in LMICs by examining their impact on job satisfaction and intention to stay among healthcare workers in the Philippines. Methods This study was conducted in urban, rural, and remote settings in the Philippines. A total of 36 urban, 54 rural, and 117 remote healthcare workers participated in the study. Respondents comprised all family physicians, nurses, midwives, community health workers, and staff involved in the delivery of primary care services from the sites. A questionnaire examining job satisfaction (motivators) and dissatisfaction (hygiene) factors was distributed to healthcare workers before and after system interventions were introduced across sites. Interventions included the introduction of performance-based incentives, the adoption of electronic health records, and the enhancement of diagnostic and pharmaceutical capabilities over a 1-year period. A Wilcoxon signed-rank test and a McNemar’s chi-square test were then conducted to compare pre- and post-intervention experiences for each setting. Results Among the factors examined, results revealed a significant improvement in perceived compensation fairness among urban (p = 0.001) and rural (p = 0.016) providers. The rural workforce also reported a significant improvement in medicine access (p = 0.012) post-intervention. Job motivation and turnover intention were sustained in urban and rural settings between periods. Despite the interventions introduced, a decline in perceptions towards supply accessibility, job security, and most items classified as job motivators was reported among remote providers. Paralleling this decline, remote primary care providers with the intent to stay dropped from 93% at baseline to 75% at endline (p < 0.001). Conclusion The impact of strengthening primary care on health workforce satisfaction and turnover intention varied across urban, rural, and remote settings. While select interventions such as improving compensation were promising for better-supported settings, the immediate impact of these interventions was inadequate in offsetting the infrastructural and staffing gaps experienced in disadvantaged areas. Unless these problems are comprehensively addressed, satisfaction will remain low, workforce attrition will persist as a problem, and marginalized communities will be underserved.

Details

Language :
English
ISSN :
14726963
Volume :
23
Issue :
1
Database :
Directory of Open Access Journals
Journal :
BMC Health Services Research
Publication Type :
Academic Journal
Accession number :
edsdoj.5604f5ffcc27468aa2d0895469ef197b
Document Type :
article
Full Text :
https://doi.org/10.1186/s12913-022-08799-1