Panati, Samatha2015-04-272015-04-2720142014https://hdl.handle.net/2144/11021Thesis (Dr.P.H.)--Boston UniversityBackground: Retention of health workers (HWs) in rural areas is a challenge in many sub-Saharan countries, including Zambia. Health systems, health facility and personal factors interact in retaining HWs. Facility-level working conditions (infrastructure, resources, and salaries) is a factor previously reported to influence retention . The Saving Mothers, Giving Life (SMGL) program aimed to improve maternal health in Kalomo District by enhancing working conditions. This study investigated if improved working conditions influenced HW job satisfaction and retention. Methods: Mixed quantitative and qualitative methods were used. Sixty-one percent of qualified HWs (46/75) from 28 rural health centers participated in a survey. Structured interviews were conducted with 60 percent (3/5) of the district health care administrators. Existing data from another study were used to capture health facility-level changes and baseline HW job satisfaction. Results: The SMGL program made significant improvements to health facility- level working conditions that contributed to improved maternal care. However, HWs' job satisfaction levels did not change before and after the SMGL program. The reported job satisfaction was fairly high (Mean=4.1, out of possible 5 and SO = 1.3) at baseline and continued to remain high (Mean =4.1, SO =1.0). The intention to stay score was also high at endline (Mean =4.0, SO =0.9). No association was found between HWs' job satisfaction and their intention to stay. Despite the high intention to stay score, HWs' perceived that improved housing, staffing levels, career advancement opportunities, recognition, pay and reduced workload are factors that would improve HW retention in rural areas. Conclusion: Current retention policies in Zambia focus on health facility factors. Personal and systems factors should also be addressed to improve HW retention. The Kalomo District Community Medical Office should (i) assess HW housing needs (ii) advocate for redefining all rural health centers as hard-to- reach areas to benefit from the existing retention program and (iii) improve supportive supervision and appreciation of HWs. The Ministry of Health and Ministry of Community Development, Mother and Child Health should (i) strengthen rural health centers by improving housing and availability of at least two qualified HWs and (ii) generate better evidence on factors that improve retention.en-USThesis/Dissertation