Job satisfaction among local-level health workers following decentralization in Nepal

The impact of federalization on health workforce satisfaction remains inconclusive. Paucity of literature on how decentralization affects health personnel's motivation and performance, critically limits making policies and implementing actions toward optimal performance of health care systems. Nepal's transition to federalism has been ongoing for a decade, yet only few studies have examined its impact on health workers. It is essential to understand factors that affect satisfaction of health workforce in order to ensure seamless delivery of health care. Therefore, this study aimed at assessing the level of job satisfaction among local-level health workers in Sudurpashchim (Far western) province of Nepal.

A cross-sectional study was conducted among 444 health workers in Sudurpashchim Province. Job satisfaction was measured using a five-point Likert scale which had 31 items across three domains: working environment; employment adjustment process and policy; and local governance. The association between job satisfaction and independent variables were examined using Chi-squared test followed by multiple logistic regression.

The overall job satisfaction was 14.9%. Domain specific satisfaction was highest for the working environment (34.7%) and local governance (16.2%), but very low for employee adjustment processes and policies (4.3%). The Gazetted Officers were less likely to be satisfied (AOR: 0.48; 95% CI: 0.27, 0.86). Similarly, those with a master's or higher degree (AOR: 0.38; 95% CI: 0.16, 0.89) and employees from the Himalayan region (AOR: 0.38; 95% CI: 0.15, 0.99) were less likely to be satisfied with the working environment and local governance respectively. In contrast, municipal health section staff (AOR: 2.03; 95% CI: 1.12, 3.65) were more satisfied with local governance.

Job satisfaction among health workers was low (14.9%), with the lowest satisfaction reported regarding the employee adjustment process following Nepal's federalization. It is imperative that the state governments proactively engage with and address the discontent expressed by health workers regarding the adjustment mechanisms, while also prioritizing professional advancement opportunities, particularly in geographically marginalized, resource-constrained, and difficult regions such as the Himalayan areas.