Developing a Tool to Measure Satisfaction among Health Professionals in Sub-Saharan Africa

"In sub-Saharan Africa, lack of motivation and job dissatisfaction have been cited as causes of poor healthcare quality and outcomes. Measurement of health workers’ satisfaction adapted to sub-Saharan African working conditions and cultures is a challenge. The objective of this study was to develop a valid and reliable instrument to measure satisfaction among health professionals in the sub-Saharan African context."

These researchers cited the link between job dissatisfaction (job satisfaction being closely linked to motivation) and low quality of health care as a challenge in this region. Because instruments to measure job satisfaction often fail to take into account "certain dimensions of satisfaction that may be specific to a country, continent or culture, such as the value of work, social organization and religion, thereby compromising their validity," this study attempts to develop a measurement instrument more appropriately designed for sub-Saharan Africa. [Footnotes have been removed by the editor.]

"Several studies have shown that in low-income countries, where social organization is less individualistic, intrinsic job characteristics such as challenge, recognition, autonomy and the work itself were less associated with job satisfaction, whereas extrinsic characteristics such as salary, job security and working conditions were very strongly associated with job satisfaction." Researchers recognise that self-esteem may play a part, but often autonomy and advancement are less important, depending on the degree of individualism or collectivism in the culture and social organisation. Religion may also play a part in job satisfaction in healthcare work as well.

In order to attempt to develop an instrument applicable to a number of professions and in a number of countries, researchers experimented with an instrument with four dimensions: supervision, work, work environment, and salary and career. They did a literature review and an expert consultation after which "one dimension was changed (from supervision to continuing education) and two dimensions were added: management style and moral satisfaction. The number of items to be tested grew to 42." It was tested in Senegal and Mali in 2008, 2010, and 2011 in various versions. The final version was tested among 962 care providers (doctors, midwives, nurses and technicians) practicing in 46 hospitals. It comprises 8 dimensions and 24 items.

The instrument showed the importance of: financial factors, tools and supports for work, ongoing training, supervision without favouritism and with transparency, and working conditions. Satisfaction with professional accomplishments is higher when there is recognition by colleagues and superiors. Respectful relationships, especially among doctors and nurses, were also found to be key.

The instrument proved to have high validity but was not as reliable in measuring the moral dimension of work satisfaction, due in part to the differences in the two country test sites. The researchers concluded that: "With some adjustments, this instrument can be used in very different settings, as well as with different professional groups. Other studies in different sub-Saharan African countries will help to get a better understanding of this complex phenomenon."