Factors affecting retention and motivation of doctors working in basic health units of district Abbottabad
Date of Award
2009
Document Type
Thesis
Degree Name
Master of Science in Health Policy & Management (MSc Health Policy & Mgmt)
Department
Community Health Sciences
Abstract
Background: Workforce retention and motivation is a key function of Human Resource Management. Equitable distribution, retention and motivation of health workforce are core issues for health policy-makers. Retention and motivation of doctors in rural settings is important in order to improve the service delivery and quality of health care. Pakistan has a vast Primary Health Care infrastructure and these facilities are present all across the country. Primary Health Care is universally acknowledged as a way of improving health of poor by providing accessible, affordable and appropriate services. Despite huge Primary Health Care infrastructure, Pakistan's health indicators are not impressive. Main reasons are under-utilization of facilities and low patients' satisfaction, staff absenteeism, insensitive attitude and many other Human Resource Management issues. Many signs reflect poor motivation which leads to poor retention of doctors in health facilities. Formal research on retention and motivation of doctors is lacking in Pakistani context and in order to make Primary Health Care more effective and to improve the human resource issues, it is important to identify and address factors affecting retention and motivation of doctors in Primary Health Care facilities. Objectives: To identify factors affecting retention and motivation of doctors working in Basic Health Units and determine relative importance of these factors in order to propose concrete, genuine and practical strategies for improvement of retention and motivation of doctors in BHUs. Methodology: This study adopted an exploratory research design and qualitative methods were employed to meet the study objectives. Study was approved by Ethical Review Committee of the Aga Khan University, Karachi and it was conducted in Abbottabad District. Study population comprised of doctors working in BHUs, selected through universal sampling and district and provincial health managers, selected through purposive sampling technique. Findings from interviews with doctors working in BHUs were triangulated with the help of interviews with health managers and a documents' review. Interview transcription and data analysis was done manually. Results: Our study findings suggest that doctors' retention and motivation in BHUs is serious issue though exact magnitude of the problem at provincial level is not known. Based on the conceptual framework, three levels of retention and motivation factors were identified including organizational, individual and external environmental factors. Overall the organizational factors emerged as most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits have important role to play. Gender and marital status of female doctors was regarded as most important individual factor whereas political interference, quackery and remoteness of facilities appeared as key factors, in external environment, affecting retention and motivation of doctors at the BHUs. Conclusion and Recommendations: Our study has attempted to document the complexity of the retention and motivation of doctors in BHUs and highlighted the importance of this issue in Pakistani context. We identified windows of opportunity through a conceptual framework for further research and advocacy to improve retention and motivation of doctors. Our study advocates that capitalizing on these opportunities; service delivery can be made more responsive by improving the quality of healthcare and reducing urban-rural disparities in human resource for health distribution, thus responsible for creating inequalities in access to health care. Our study recommends that a human resource management policy should be in place on provincial level to regulate the retention and motivation issues of doctors. To tackle the remoteness issues, we recommend geographical categorization of BHUs to channelize incentives according to their level of remoteness. An appropriate and sustainable mix of incentives coupled with consideration for professional growth and special career benefits must be offered to retain and motivate doctors to work in BHUs. Our study findings suggest that doctors' retention and motivation in BHUs is serious issue though exact magnitude of the problem at provincial level is not known. Based on the conceptual framework, three levels of retention and motivation factors were identified including organizational, individual and external environmental factors. Overall the organizational factors emerged as most significant whereby human resource policy, career growth structure, performance appraisal and monetary benefits have important role to play. Gender and marital status of female doctors was regarded as most important individual factor whereas political interference, quackery and remoteness of facilities appeared as key factors, in external environment, affecting retention and motivation of doctors at the BHUs. Conclusion and Recommendations: Our study has attempted to document the complexity of the retention and motivation of doctors in BHUs and highlighted the importance of this issue in Pakistani context. We identified windows of opportunity through a conceptual framework for further research and advocacy to improve retention and motivation of doctors. Our study advocates that capitalizing on these opportunities; service delivery can be made more responsive by improving the quality of healthcare and reducing urban-rural disparities in human resource for health distribution, thus responsible for creating inequalities in access to health care. Our study recommends that a human resource management policy should be in place on provincial level to regulate the retention and motivation issues of doctors. To tackle the remoteness issues, we recommend geographical categorization of BHUs to channelize incentives according to their level of remoteness. An appropriate and sustainable mix of incentives coupled with consideration for professional growth and special career benefits must be offered to retain and motivate doctors to work in BHUs.
Recommended Citation
Shah, S. M. (2009). Factors affecting retention and motivation of doctors working in basic health units of district Abbottabad (Unpublished doctoral thesis). Aga Khan University, Karachi, Pakistan.