Screen Shot 2019-12-18 at 11.59.50.pngOne of the findings of this study from Malawi is an apparent association between recent training and (paradoxically) low psychological wellbeing among a diverse group of Malawian maternal health professionals (clinical officers, medical assistants, registered/enrolled nurse/midwives, nurse-midwife technicians).

‘Whether the respondent had received any professional training in the last year was negatively associated with PW. One possible explanation is that health workers having recently received training might be more aware of their suboptimal working conditions which make the provision of high-quality services very difficult, negatively weighing on their PW. Possible alternative explanations include poor training quality, or factors concurrently associated with PW and actively seeking out training, such as anxiety.’

CITATION: Psychological wellbeing in a resource-limited work environment: examining levels and determinants among health workers in rural Malawi
Julia Lohmann, Olzhas Shulenbayev, Danielle Wilhelm, Adamson S. Muula & Manuela De Allegri
Human Resources for Health, volume 17, Article number: 85 (2019)

Background: A competent, responsive, and productive health workforce is central to a well-performing health system capable of providing universal access to high-quality care. Ensuring health workers’ psychological wellbeing is critical to sustaining their availability and productivity. This is particularly true in heavily constrained health systems in low- and lower-middle-income countries. Research on the issue, however, is scarce. This study aimed to contribute to filling the gap in knowledge by investigating levels of and factors associated with psychological wellbeing of mid-level health workers in Malawi.

Methods: The study relied on a cross-sectional sample of 174 health workers from 33 primary- and secondary-level health facilities in four districts of Malawi. Psychological wellbeing was measured using the WHO-5 Wellbeing Index. Data were analyzed using linear and logistic regression models.

Results: Twenty-five percent of respondents had WHO-5 scores indicative of poor psychological wellbeing. Analyses of factors related to psychological wellbeing showed no association with sex, cadre, having dependents, supervision, perceived coworker support, satisfaction with the physical work environment, satisfaction with remuneration, and motivation; a positive association with respondents’ satisfaction with interpersonal relationships at work; and a negative association with having received professional training recently. Results were inconclusive in regard to personal relationship status, seniority and responsibility at the health facility, clinical knowledge, perceived competence, perceived supervisor support, satisfaction with job demands, health facility level, data collection year, and exposure to performance-based financing.

Conclusions: The high proportion of health workers with poor wellbeing scores is concerning in light of the general health workforce shortage in Malawi and strong links between wellbeing and work performance. While more research is needed to draw conclusions and provide recommendations as to how to enhance wellbeing, our results underline the importance of considering this as a key concern for human resources for health.

Best wishes, Neil

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