This country study maps and assesses incentives for retaining heath workers, particularly non-financial incentives. It explores existing policies, their relevance to current factors driving exit and retention, and proposes guidelines for introducing and managing incentives for health worker retention to maximise their positive impact.
Swaziland faces severe shortages of skilled health professionals, with many doctors, nurses, laboratory technicians and social workers emigrating to high income countries. The report found that six factors significantly influenced decisions by health care professionals to either change institution or to actively look for work in a different institution. Factors positively associated with retention were job satisfaction, equality/treatment by employer, job discretion and helping others. Negative factors were the employee's attitude towards their institution and support.
Recommendations for retention of health workers include:
- collaboration between the health ministry, employers and the training institutions is needed to develop management training programmes for front line managers, as well as changes in the payment system, such as output-related payments;
- government needs to introduce additional annual leave days, either paid or unpaid; additional sick leave or carers' leave; flexible working times and specialist training to meet employee interests;
- institutions should provide human related quality management tools, such as supervision, feedback, and staff appraisals;
- health institutions need to show employees they are valued and treat them with respect;
- unions and health institutions must engage in frank and open discussion as to whether collective agreements present recruitment and/or retention barriers.
These issues are relevant in most developing countries and especially in mountain areas, where not only do countries face shortages in the country as a whole, but finds it very different to find health workers willing to live in the remote areas.
