Factors influencing job satisfaction and work motivation among health personnel in health facilities in Nuwakot district: A mixed method study.

Thesis Report.

SUMMARY:

Background: Any health-care system relies heavily on human resources. Human
resources are the critical core of a health-care system, but they are underutilized, with
low and middle-income countries having fewer and less skilled workers than high
income countries.

Aim: To assess the factors influencing job satisfaction and work motivation among
health professional in Nuwakot, Nepal.
Design: A mixed-method study using a triangulation design.

Methods: The study included 346 health workers with at least two months of
experience taken from both public and private health facilities in Nuwakot, District. The
required numbers of respondents were selected using simple random sampling without
replacement from a list of health workers from each municipality. All the Palikas (rural
and urban municipalities) were sampled with proportionate allocation. A pretested, self
administered questionnaire in quantitative and an interview guide were used for the
qualitative study. Face-to-face interviews were taken and recorded with participants'
consent. The quantitative data was entered in Epi data version 3.1 and exported to
Excel, and analysis was done in EZR software using bi-variate logistic regression, whose
p< 0.25 was taken for multivariate analysis. The odds ratios with a p value < 0.05 were
calculated.

Result: More than half (55.78%) of respondents’ ages were less than or equal to the
median age (29 years). Among the total participants, 62% were female. Sixty three
percentage of the participants were married. This present study showed that more than
half of the participants (57.8%) were overall satisfied with their jobs. The multivariate
analysis showed that respondents from primary health care centers were 29.1
[AOR,95% CI (3.55-239)] times more likely to be satisfied with their job compared to
those from government hospitals. The respondents from the health post were 3.79 [AOR ,95% CI (3.55-239)] times more
likely satisfied, and the respondents from the Community Health Clinic (CHU) were 3.95
[AOR 95% CI (1.45-10.70)] times more likely satisfied with their job compared to the
government hospital after controlling other variables. The study showed that nine out of
ten (91.33%) of the respondents were overall motivated in their jobs. In bi-variate
logistic regression analysis, participant’s age, sex, marital status, monthly salary, job
title, health institution category, work duration and work in home district were
significant with work motivation. The result of multivariate logistic analysis showed the
female respondent was 2.73 [AOR, 95% CI (1.27–5.88)] times more likely to be
motivated by their job compared to the male after controlling other variables.
In the qualitative study, the majority of participants were not motivated in their current
work after federalization as they perceived a low reward and punishment system,
unclear health policy, a low salary, ineffective supervision and monitoring, and a high
work load, but the respect from clients, co-workers coordination, a good information
system, a good salary, and an allowance were motivating factors in their work. In the
qualitative study, the good coordination and timely supply of essential drugs and the
provision of necessary training were also necessary for job satisfaction. The majority of
participants were dissatisfied with their jobs due to perceived limited career
development opportunities for advancement, Political influences in working conditions,
and an unfair employee adjustment process.

Conclusion: This study showed that 58% of the 346 participants were generally satisfied
with their jobs, 2% were dissatisfied, and 40% were unsure or ambivalent about their
jobs. Job satisfaction was significantly related to age, marital status, monthly income,
type of healthcare facility, and job title-. According to the qualitative findings, the
majority of participants were dissatisfied with their current situation due to perceived
limited opportunities for advancement, unfavorable working conditions, and the
employee adjustment process. The qualitative findings showed that job satisfaction
required effective coordination, prompt supply of necessary medications, and training.