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Improving attraction and retention of health workers in rural areas: perceptions of staff housing conditions

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• New buildings should have three bedrooms to allow sufficient accommodation for a fa- mily. If possible in individual cases, existing houses should be upgraded with an additio- nal room. New buildings should have sepa- rate bathrooms and toilets to
  Photo: Klaus ThiemePhoto: Klaus Thieme Schweizer Organisation für Gesundheit in AfrikaSwiss Organisation for Health in Africa Organisation suisse pour la santé en Afrique Improving attraction and retention of health workers inrural areas: perceptions of staff housing conditions The case of Sacred Heart Mission Hospital Katondwe, Luangwa District, Zambia References • Bortz, J. & Döring, N., 2002. Forschungsmethoden und Evalua-tion: für Human- und Sozialwissenschaftler. 3rd ed. Berlin: Springer.• Creswell, J., 2014. Research design : qualitative, quantitative, and mixed methods approaches. 4th ed. Los Angeles: SAGE. Authors: Dr Klaus Thieme 1  Martina Weber 2  Anna Häggblom 3   1  Project Manager, SolidarMed, Zambia, 2  Country Coordinator & Project Manager, SolidarMed, Zambia 3  Desk Officer, SolidarMed, Switzerland Introduction Zambia faces a human resource for health crisis (Schatz, 2008). Not only are too few professionals trained, health workers are additionally attracted to the private sector and donor funded projects as well as to foreign destinations (MoH, 2011). Especially ru-ral areas are heavily understaffed (Ferrinho, et al., 2011). Attracting and retaining health workers to ru-ral and marginal communities to improve in-country equity is needed. A study of the Retention Scheme for Zambian health workers showed that available and adequate housing is an important factor in at-tracting and retaining medical staff to rural and re-mote areas (Serneels, et al., 2010). Method The study is an exploratory qualitative non-experi-mental (Bortz & Döring, 2002) cross-sectional (Flick, 2010) analysis applying a mixed method approach (Creswell, 2014). Subject is the staff house situation in a rural hospital and their inhabitants. The object is how the inhabitants – health workers in a rural hos-pital – perceive their housing condition especially in relation to their job motivation.The study used the qualitative method of photo eli-citation to explore the health workers’ perception of their housing conditions and its impact on their own  job satisfaction. Furthermore the main characteris-tics of the existing staff houses were collected and tabled. The health workers’ housing recommenda-tions were summarized. Results The study shows no drastic gap between the objecti-ve and the perceived housing conditions. The houses are low to medium standard, but not all of them are fit for the hot climate in the Luangwa valley. The stu-dy group perceives two-bedroom-houses as too small to accommodate families with many children, i.e. own and those from the extended family. The heat affects work and private time equally. Therefore construc-tion of future buildings should consider adapting them to prevailing weather conditions.The life in rural areas, particularly in Katondwe, is perceived as better, easier and positive by the health workers, and set in contrast with life in polluted and congested urban areas. Nevertheless the hardships of living without constant supply of electric power, the heat and the insects are a topic. On the other hand, the modern standard water-flushed toilets and the connection of all houses to piped water are very much appreciated.The interviewed health workers predominantly ex-pressed that the housing condition does have an im-pact on job satisfaction and well-being as a health worker. Therefore, maintenance of the existing hou-ses and improved new houses should be envisaged. Conclusions • New buildings should have three bedrooms to allow sufficient accommodation for a fa-mily. If possible in individual cases, existing houses should be upgraded with an additio-nal room. New buildings should have sepa-rate bathrooms and toilets to allow the use of both facilities simultaneously.• New buildings should have extensive win-dows and sufficient ventilation blocks to al-low good ventilation. The roofs should be protruding to shade the walls. At existing houses, the extension of the roofs should be considered. The roofs should be thermally insulated to minimize heating of the house. At least ceiling boards should be in place.• Governments generally need to allocate more money to build and maintain more staff houses in rural areas at least as long as no private housing market is available. Sharing a house because of lack of accommodation can lead to an elevated stress level and con-flicts between occupants, and cause a nega-tive impact on teamwork at the hospital.• Septic tanks should be rehabilitated and new ones should be constructed far from the houses. Soakaways generally should be lar-ger; other layouts should be considered as for example infiltration trench-type soakaways which distribute the liquids over a longer distance.• Basic power supply for lighting, access to fresh water and protection from mosquitos needs to be offered for improved housing quality. Acknowledgements: • Ministry of Health, Government of Zambia • HILTI foundation Old staff house in Nyimba district. • Ferrinho, P., Siziya, S., Goma, F. & Dussaul, G., 2011. The human resource for health situation in Zambia: deficit and maldistri-bution. Human Resources for Health, 9(30).• Flick, U., 2010. Qualitative Sozialforschung - Eine Einführung. 3rd ed. Reinbeck bei Hamburg: Rowohlt.• MoH, 2011. National Health Strategic Plan 2011-2015. Lusaka: Ministry of Health and Government of the Republic of Zambia.• Schatz, J., 2008. Zambia’s health-worker crisis. The Lancet, Volume 371, p. 638–639.• Serneels, P. et al., 2010. Who wants to work in a rural health post? The role of intrinsic motivation, rural background and faith-based institutions in Ethiopia and Rwanda. Bulletin of the World Health Organization, Volume 88, p. 342–349. Improved housing has an impact on retention and work motivation of health workers.
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