[Perceptions and motivations of public sector physicians in Dakar (Senegal)]

To guide the human resources department within the Ministry of Health to optimize their capacities and skills, this study sought to evaluate perceptions and motivations among public sector physicians in the Dakar region, in Senegal.

This descriptive study included 246 of the 307 public sector physicians in Dakar (80.1%). They were interviewed by three investigators, using a pretested and revised questionnaire. Three categories of variables were studied: social, demographic and professional (remuneration, work conditions, involvement in decision-making, career perspectives, key motivating factors). Data were entered and analyzed with Epi Info 3.3.2 software, and averages and frequencies were calculated.

The physicians' mean age was 41.7 years, and they had been practicing for a mean of 11 years: 26% were women, 82% married, 74% hospital staff physicians, and 88% general practitioners. 77% considered their remuneration insufficient; all had additional income, which 48% judged insignificant and 19% irregular. Most lived in a rented home (50%); and only 45% had a personal car. Overall, 55% reported the work environmental as poor, and 65% considered the department's equipment and supplies insufficient. Relationships with their supervisors were good for 37%, with colleagues 62%, with subordinates 51%, and with patients 54%. Overall, 23% reported no involvement in decision-making, and 60% no involvement in designing or setting up health programs. Letters of congratulations from supervisors, considered important by 96%, were obtained only by 59%. Ten percent of doctors belonged to a political party, 13% to a syndicate (union), and 25% to an association. Globally, 83% participated in continuing medical education; and 93% wanted specialist training. Their priorities for their professional careers were: management (27%), autonomy (25%), solidarity (23%), security (13%), and creativity (12%). In decreasing order of frequency, the key factors motivating them were: the work environment (41%), remuneration (38%), promotion (12%), and involvement in the planning process (9%).

The primary motivating factors were not satisfactory for public sector physicians in the Dakar region, which the bulk of public sector resources are concentrated. Its performance affects the global results of the national health system. Recommendations for action by the State, by supervisors, and by medical personnel, concerning the work environment and remuneration might help to improve population health in Senegal.