ArticleGlobal health action2017
Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda.
Article in Global health action, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Health-care worker retention in post-conflict settings: a systematic literature review.Health policy and planning · 2023Pooled it
- Maternal and neonatal implementation for equitable systems. A study design paper.Global health action · 2017Trial
- Gendered time use among specializing medical doctors at Makerere University, Uganda: a cross-sectional study.Global health action · 2026Article
- Reconfiguring retention: a qualitative exploration of the lived experiences of female nurses in an arid rural setting in Turkana County, Kenya.Global health action · 2026Article
- Challenges and coping practices of frontline health workers in newly created districts in Uganda: an exploratory qualitative study.BMJ open · 2025Article
- Bridging the gap between community health workers' digital health acceptance and actual usage in Uganda: Exploring key external factors based on technology acceptance model.PLOS digital health · 2025Article
- The Evolution of the Specialist Surgeon Workforce in East, Central and Southern Africa.World journal of surgery · 2025Article
- Drivers of retention of the HIV workforce transitioned from PEPFAR support to the Uganda government payroll.Human resources for health · 2023Article
- Accommodate or Reject: The Role of Local Communities in the Retention of Health Workers in Rural Tanzania.International journal of health policy and management · 2022Article
- Provision of cervical cancer prevention services in Northern Uganda: a survey of health workers from rural health centres.BMC health services research · 2021Article
- Estimating the cost of implementing a facility and community score card for maternal and newborn care service delivery in a rural district in Uganda.International journal for equity in health · 2021Article
- Assessing the level of institutionalization of donor-funded anti-retroviral therapy (ART) programs in health facilities in Uganda: implications for program sustainability.Global health action · 2018Article
- Maternal and newborn health implementation research: programme outcomes, pathways of change and partnerships for equitable health systems in Uganda.Global health action · 2017Article
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Authors and funding
6 authors.
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Abstract
backgroundHealth worker retention in rural and underserved areas remains a persisting problem in many low and middle income countries, and this directly affects the quality of health services offered.
objectiveThis paper explores the drivers of long-term retention and describes health worker coping mechanisms in rural Uganda.
methodsA descriptive qualitative study explored the factors that motivated health workers to stay, in three rural districts of Uganda: Kamuli, Pallisa, and Kibuku. In-depth interviews conducted among health workers who have been retained for at least 10 years explored factors motivating the health workers to stay within the district, opportunities, and the benefits of staying.
resultsTwenty-one health workers participated. Ten of them male and 11 female with the age range of 33-51 years. The mean duration of stay among the participants was 13, 15, and 26 years for Kamuli, Kibuku, and Pallisa respectively. Long-term retention was related to personal factors, such as having family ties, community ties, and opportunities to invest. The decentralization policy and pension benefits also kept workers in place. Opportunities for promotion or leadership motivated long stay only if they came with financial benefits. Workload reportedly increased over the years, but staffing and emoluments had not increased. Multiple job, family support, and community support helped health workers cope with the costs of living, and holding a secure pensionable government job was valued more highly than seeking uncertain job opportunities elsewhere.
conclusionThe interplay between the costs of leaving and the benefit of staying is demonstrated. Family proximity, community ties, job security, and pension enhance staying, while higher costs of living and an unpredictable employment market make leaving risky. Health workers should be able to access investment opportunities in order to cope with inadequate remuneration. Promotions and leadership opportunities only motivate if accompanied by financial benefits.
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