Background: The COVID-19 pandemic has highlighted the importance of a well-equipped and supported healthcare workforce, and Bangladesh still faces challenges in providing adequate and well-equipped healthcare services. This study aimed to assess the level of working environment/conditions of the clinical health workers in Bangladesh and their relative importance in delivering quality healthcare services. Some studies touch on aspects like job satisfaction, retention, and motivation in Bangladesh. However, a comprehensive overview is missing, which is crucial for enhancing care quality by addressing challenges. This research covered the clinical health workforce working environment in public health facilities, encompassing workload, pay, training, safety, layout, recognition, power supply, organizational factors, and more. It also assessed these aspects' importance for providing quality care. Results inform policymakers, healthcare managers, and researchers globally, shaping evidence-based strategies for better healthcare conditions, job satisfaction, retention, and population health.
Methods: The study adopted a cross-sectional design and analyzed primary data collected using quantitative methods from January to March 2022. A multi-stage sampling technique was utilized to select a representative clinical health workforce sample. From the Dhaka, Chattogram, Rajshahi, and Khulna divisions, four districts and eight upazilas were chosen as the study area. Interviews were conducted with 319 clinical workforces, comprising 109 physicians and 210 clinical staff. A questionnaire was developed based on 26 components of the working environment. Descriptive statistics and bivariate analysis were employed. Mean scores were calculated for each working condition component. Mean weight scores were also calculated to assess the relative importance of different components. Non-parametric tests were used to assess differences in responses among respondent categories. A psychometric analysis evaluated survey tool construct validity and reliability.
Results: The study found that the working environment of clinical health workers in primary and secondary healthcare facilities in Bangladesh was quite poor (3.4), with almost two-thirds of respondents showing negative views in 23 out of 26 indicators. The results also showed that working environments were significantly (p≤.05) higher in primary compared to secondary-level facilities. Moreover, men, younger workforce, and workforce with shorter length of service were more likely to report poor working environment than their counterparts. Lastly, receiving monthly salary in due time was top-ranked (99.15) in terms of importance for delivering quality healthcare, followed by availability of medicines (98.04), medical and surgical requisites (97.57), and adequate mentoring and support to perform duties (97.50).
Conclusion: The study highlights the poor working environment of clinical health workers in public health facilities in Bangladesh. It recommends that policymakers should prioritize improving the working environment by addressing the factors that are crucial for delivering quality healthcare. Improving the working environment will have a positive impact on the retention and motivation of workers, which will ultimately lead to better health outcomes for the population.
