EVALUATION OF JOB SATISFACTION AND ASSOCIATED FACTORS AMONG

HEALTH WORKERS AT HARGEISA GROUP HOSPITAL IN SOMALILAND.

ADNAN ABDILAHI MATAN

2020-MPHFT-F05

A RESEARCH REPORT SUBMITTED TO THE INSTITUTE OF PUBLIC HEALTH

AND MANAGEMENT IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR

THE AWARD OF A MASTER OF SCIENCES IN PUBLIC

HEALTH OF CLARKE INTERNATIONAL

UNIVERSITY

FEB, 2022
 DECLARATION
I, Adnan Abdilahi Matan hereby declare that this research report submitted to the IPHM

In partial fulfillment for the awards of a Master of Public of Clarke International University

Have never been presented by anyone for the award of a degree. The work I have presented

In this research report is my own and any other materials contained herein are acknowledged.

Signature.............................................. Date...........3/2/2022..........

Student: Adnan Abdilahi Matan

Reg no: 2020MPHFT-F05

i
 APPROVAL
I do acknowledge that this research report entitled ― Evaluation of Job Satisfaction and

Associated Factors among Health Workers at Hargeisa Group Hospital in Somaliland. Has been

developed under my Guidance and supervision and is therefore deemed ready for submission as

partial fulfillment of the requirements for the award of a Master’s of Public Health of Clarke

International University.

Signature: ............................................... Date: ....................... 3/2/2022....

Supervisor: Jemimah k kyeyune

Lecturer at CIU

ii
 DEDICATION

ALLAH deserves all credit and gratitude for allowing me to successfully complete my study

paper without any setbacks. This work is dedicated to my beloved parents, my mother Nimo M J

and my father Abdilahi M J, as well as my lovely sisters Fathia A M and brothers Hassan A M

and Abdirahman A M, who toiled with me along this path of education and have been spiritually,

morally, and financially supportive in seeing me to this level in my academic struggle. May

ALLAH, the Almighty, graciously bless them with paradise.

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 ACKNOWLEDGEMENT

My thanks and gratitude go to the Almighty ALLAH for allowing me to accomplish this piece of

work and my educational endeavors in general. This study report would not have been possible

without the support and contributions of the individuals listed below. I'd want to express my

heartfelt appreciation to everyone who helped make my goal a reality. In this respect, my

heartfelt appreciation goes to my supervisor, Ms. Jemimah Kyeyune, for her efforts, direction,

patience, and all the assistance and advice she provided me during this exercise, which enabled

me to find the research exercise fun and successful. I also thank the administration of the

designated public health institution in Hargeisa Group Hospital in Hargeisa, management for

their willingness to offer the essential information when I visited them, without which this study

would not have been feasible. I'd want to thank my sisters Fathia A M and Aunt Safia M J, as

well as my brothers Hassan A M, Abdihakim S F, and Eid I D, for their encouragement and

support during this scholastic journey. Many thanks to the teachers at Clarke International

University in Uganda, who helped me attain this academic standing and write this research report

via their hard work.

May Allah, the Almighty, generously reward you.

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 OPERATIONAL DEFINITIONS

Health workers’ are people whose job is to protect and improve the health of their Communities

refers to employees of the hospital and this includes doctors, nurses, pharmacists, laboratory

technicians - and administrative and support staff such as finance officers, cooks, drivers and

cleaners are called health workers‖.

Job Satisfaction mentions fulfillment of one's wishes, expectations, or needs, or the pleasure

derived from this.

Job Dissatisfaction refers to unhappy or negative feelings about work or the work environment..

Work load: the amount of work performed or capable of being performed (as by a mechanical

Device) usually within a specific period.

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 Table of Contents
DECLARATION ........................................................................................................................................... i
APPROVAL ................................................................................................................................................. ii
DEDICATION ............................................................................................................................................. iii
ACKNOWLEDGEMENT ........................................................................................................................... iv
OPERATIONAL DEFINITIONS ................................................................................................................. v
LIST OF TABLES ....................................................................................................................................... ix
LIST OF FIGURES ...................................................................................................................................... x
LIST OF ACRONYMS ............................................................................................................................... xi
ABSTRACT .................................................................................................................................................. 1
CHAPTER ONE INTRODUCTION ............................................................................................................ 2
1.0 Introduction ............................................................................................................................................. 2
1.1 Background of the Study ........................................................................................................................ 2
1.2 Problem of Statement .............................................................................................................................. 6
1.3 objectives of the study ............................................................................................................................ 7
1.6 Significance of the Study ........................................................................................................................ 8
1.7 Conceptual framework ............................................................................................................................ 9
CHAPTER TWO: LITERATURE REVIEW ............................................................................................. 11
2.0 Introductions ......................................................................................................................................... 11
2.1 Theoretical review ................................................................................................................................ 11
2.2 Level of job satisfaction among health workers. .................................................................................. 12
2.3 individual characteristics among health workers .................................................................................. 16
2.4 job characteristics among health workers. ............................................................................................ 21
2.5 Summary of Literature Review ............................................................................................................. 28
CHAPTER THREE: METHODOLOGY ................................................................................................... 29
3.0 Introduction ........................................................................................................................................... 29
3.1 Study Area ............................................................................................................................................ 29
3.2 Scope of the Study ................................................................................................................................ 30
3.3 Research Design.................................................................................................................................... 30
3.4 Study Population ................................................................................................................................... 31
3.5 Inclusion and Exclusion Criteria ........................................................................................................... 31
3.6 Sample Size ........................................................................................................................................... 32
3.7 Sample Technique ................................................................................................................................. 33
3.7.1 Simple random sample ....................................................................................................................... 33

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3.8 Study Variables ..................................................................................................................................... 33
3.9 Data Source ........................................................................................................................................... 34
3.10 Data Collection Tools/ Instruments .................................................................................................... 34
3.11 Quality Control Measures ................................................................................................................... 35
3.12 Data Collection Procedures ................................................................................................................. 36
3.13 Data Presentation ................................................................................................................................ 36
3.14 Data Analysis ...................................................................................................................................... 37
3.15 Plan for dissemination ......................................................................................................................... 38
3.16 Ethical Considerations ........................................................................................................................ 38
3.17 Limitations of the Study ...................................................................................................................... 39
CHAPTER FOUR: PRESENTATION OF RESULTS............................................................................... 40
4.0 Introduction ........................................................................................................................................... 40
4.1 Univariate Analysis of Level of Job Satisfaction among Health Care Workers ................................... 40
4.2 Univariate Analysis of Demographic Characteristics of the Respondents ........................................... 42
4.3 Bivariate Analysis of Demographic Characteristics of the Respondents .............................................. 44
4.3 Univariate Analysis of Individual Characteristics Associated With Job Satisfaction among Health
Workers ....................................................................................................................................................... 45
4.4 Bivariate analysis of individual factors associated with job satisfaction .............................................. 47
4.5 Univariate Analysis of Jobs Characteristic Associated With Job Satisfaction among Health Workers 49
4.6 Bivariate Analysis of Job Characteristics Associated With Job Satisfaction ........................................ 52
4.6 Determinants of Job Satisfaction among Health Care Workers ............................................................ 53
CHAPTER FIVE: DISCUSSION OF RESULTS ...................................................................................... 56
5.0 Introduction ........................................................................................................................................... 56
5.1 Overall level of job satisfaction ............................................................................................................ 56
5.2 Demographic characteristics of the respondents associated with job satisfaction ................................ 57
5.3 Individual factors associated with job satisfaction................................................................................ 59
5.4 Job Characteristics Factors associated with job satisfaction ................................................................. 61
CHAPTER SIX CONCLUSION AND RECOMMENDATIONS ............................................................. 64
6.0 Introduction ........................................................................................................................................... 64
6.1 Conclusions ........................................................................................................................................... 64
6.2 Recommendations ................................................................................................................................. 65
REFERENCES ........................................................................................................................................... 67

APPENDECIS ............................................................................................................................................ 70

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APPENDIX I: CONSENT FORMS AND QUESTIONNAIRE ................................................................. 70

APPENDIX II: KEY INFORMER INTERVIEW GUIDE ......................................................................... 74

APPENDIX III: COVID 19 RISK MANAGEMENT PLAN ..................................................................... 75

APPENDIX IV: TIME FRAMEWORK ..................................................................................................... 80

APPENDIX V: RESEARCH BUDGET .................................................................................................... 81

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 LIST OF TABLES
Table 1sample size ........................................................................................................................ 32

Table 2: assessment of job satisfaction among respondents ........................................................ 40

Table 3: univariate analysis of demographic characteristics of respondents .............................. 42

Table 4: Bivariate analysis of demographic characteristics of respondents ................................ 44

Table 5: univariate analysis of individual factors associated with job satisfaction ..................... 45

Table 6: bivariate analysis of individual factors associated with job satisfaction ....................... 47

Table 7: univariate analysis of job characteristics Associated With Job Satisfaction among

Health Workers ............................................................................................................................. 49

Table 8: bivariate analysis of job characteristics associated with job satisfaction ..................... 52

Table 9 .model summary of factors associated with job satisfaction .......................................... 53

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 LIST OF FIGURES

Source primary field data 2022 Figure 1; the overall level of job satisfaction among health workers ..... 42

x
 LIST OF ACRONYMS

HGH Hargeisa Group Hospital

HW Health Workers

MoH Ministry of Health

WHO World Health Organization

KIG Key Informant Guide

SPSS Statistical Product for Social Services

CVI Content Validity Index

SDG Sustainable Development Goals

SAQ Self-Administered Questionnaire

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 ABSTRACT
Background; In Africa, several studies have shown that the job dissatisfaction of health workers

results from one or more attributes of the work environment, such as poor living and working

conditions, problems with leadership, inadequate equipment and supplies, lack of recognition for

good work, stress due to heavy workloads, and limited opportunities for career development and

advancement. The purpose of this study was to evaluate Job satisfaction and associated factors

among health workers at Hargeisa Group Hospital, Somaliland.

Methods; we employed a hospital-based analytical cross-sectional study and used both

qualitative and quantitative data collection approaches. Chi-square test and binary logistic
regression analysis and the results were reported using adjusted odds ratio at 95% level of
significance.
Result; one hundred eighty-eight respondents participated in this study and out of those, 79.79%

were found satisfied with jobs. The factors that significantly influenced job satisfaction included

workload (aOR=5.44; 95%CI: 1.387 to 21.33, p=0.015), self-confidence (aOR=3.405; 95%CI:

1.306 to 8.874, p=0.012). Job recognition (aOR=0.131; 95%CI: 0.043 to 0.398;p<0.001). Job

security (aOR=0.078; 95%CI: 0.022 to 0.281; p<0.001). Performance appraisal (aOR=48.913;

95%CI: 6.12 to 390, p<0.001), Performance appraisals (aOR=385; 95%CI: 1.303 to 11.379;

p=0.015) and equipments and supplies (aOR=0.039; 95%CI: 0.004 to 0.35, p=0.004).

Conclusion and recommendations; the overall level of job satisfaction are comparatively very

high thus; hospital management needs to improve on the factors that influenced health care

workers' satisfaction. For example, hospital management should create a performance

assessment program to allow management to monitor employees' performance while motivating

them by enhancing morale that leads to increased quality of health workers' practice.

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 CHAPTER ONE INTRODUCTION

1.0 Introduction
This chapter contains background of the study, problem statement, and purpose of the study,

research objectives, research question, and significance of the study, conceptual framework.

1.1 Background of the Study

Human resources are the key components to a successful health system functioning (WHO,

2013). All people involved in activities whose primary purpose or goal is to improve health are

called the health workforce. The importance of health workers is to maintain the health of human

beings through the request of evidence-based medicine. Based on the international standard

classification of occupations, health workers include medical doctors, nurse professionals,

midwifery professionals, dentists, medical laboratories, and pharmacists (WHO, 2013).

Worldwide, many studies show that many factors have an impact on job satisfaction among

health care workers, such as: level of education, work experience, way of organization of work,

working conditions, payment, working hours, promotions, and so on, but the impact of job

satisfaction among health care workers is not well known, so it still needs to be investigated. Job

satisfaction is among the key factors associated with the standard of health workers’ performance

in the health care system. In most European countries, many factors, such as staffing, salaries or

wages, promotion, collaboration and partnership development, are linked closely to the

productivity and quality of healthcare services within health facilities (Carroll&Aaron, 2012). A

study conducted by Vietnam among community health workers, age, areas of work and

expertise, professional education, residence, and sufficient number of staff were identified as

factors affecting job satisfaction, which therefore force them to be redundant at work, go into sit-

down strikes, and increase in turnover rates, hence leading to low service delivery of the hospital

(Tran BX, et al. 2013). This problem is compounded by Poor retention or high staff turnover
2
negatively affects health care by increasing workload, undermining team morale, creating

disruptions and inefficiencies in work processes, and causing a loss of institutional knowledge

(WHO, 2016).

It has been noted that recruitment, retention, turnover, and development of quality care in health

workers are global issues within the health care setting (Coomber & Louise Barriball, 2017). A

variety of factors influence the retention of health workers in adult care settings, including work

satisfaction, group cohesion, job stress, and work schedule. Health worker turnover is a costly

problem that will continue as healthcare faces an impending health worker shortage; a new

generation of health workers enters the workforce, and incentives provided to health workers to

work for institutions increase. All around the world, there is a shortage of healthcare workers in

many countries. A study by Coomber & Louise Barriball, 2017 shows that it is having an adverse

impact on health systems around the world. These are organized into five priority areas: policy

intervention; macroeconomics and health sector funding; workforce planning and policy,

including regulation; positive practice environments; retention and recruitment (including

migration); and health worker leadership.

The brain drain of clinical personnel from low- and middle-income countries is having an effect

on already weak healthcare systems. Health worker retention is critical for health system

performance and a key problem is how best to motivate and retain health workers. A study

conducted on the brain drain and retention of health workers in Africa showed that the continent

faces a health crisis due to the very low finance of health services and the deterioration of health

service structures. These factors threaten the performance of health workers and job satisfaction.

(Beyazin D, Ololo S, ET all.,2017) In Africa, several studies have shown that the job

dissatisfaction of health workers results from one or more attributes of the work environment,

3
such as poor living and working conditions, problems with leadership, inadequate equipment and

supplies, lack of recognition for good work, stress due to heavy workloads, and limited

opportunities for career development and advancement (Beyazin K, etal., 2017).

The greatest challenge facing healthcare systems in sub-Saharan Africa is the insufficiency of

human resources, from both the quantitative and the qualitative standpoints. These resources,

when available, tend to be concentrated in urban areas, either in the private sector or in

nongovernmental organizations, which often offer better working conditions and salaries.

International migration also contributes to the shortage of health workers in sub-Saharan Africa.

These shortages of health professionals are a major impediment to providing good-quality care it

has been estimated that sub-Saharan Africa still needs another one million or more physicians,

nurses and midwives to provide the basic services required to meet the 2015 Millennium

Development Goals.

Herzberg’s theory distinguishes between motivating factors, which are intrinsically linked with

work and determine job satisfaction, and demotivating factors, which are responsible for

dissatisfaction. The consequences of providers’ satisfaction and dissatisfaction have been the

subject of numerous studies. Dissatisfaction may lead to tardiness and absenteeism.

Many factors determine the job satisfaction of health care workers. A study conducted in South

Africa showed that factors affect the satisfaction of health workers, such as monthly salary,

sufficient number of available staff, comfortable working environment, workload, appreciation

of good performers, timely evaluation, responsibility, relationship with the staff and managers,

job security, career development, and other relevant behavioral and work environment factors.

(Pillay R, 2009). Similar studies done in Ethiopia showed more healthcare workers were not

4
happy with their work. The participants’ main reasons for their unhappiness were low salaries,

restricted educational options, and insufficient facilities and provisions (Temesgen K, Moges W,

Aycheh & Cheru T, 2018).

Hackman and Oldham proposed the job characteristics model, which is widely used as a

framework to study how particular job characteristics impact job outcomes, including job

satisfaction. The model states that there are five core job characteristics (skill variety, task

identity, task significance, autonomy, and feedback) which impact three critical psychological

states (experienced meaningfulness, experienced responsibility for outcomes, and knowledge of

the actual results), in turn influencing work outcomes (job satisfaction, absenteeism, work

motivation, etc.). Job satisfaction describes how content an individual is with his or her job. The

happier people are within their job, the more satisfied they are said to be. Job satisfaction is not

the same as motivation, although it is clearly linked. The most common method of measurement

of job satisfaction is the use of rating scales where employees report their reactions to their jobs.

Questions relate to the rate of pay, work responsibilities, variability of jobs, promotional

opportunities in the work itself, working hours of health workers, and coworkers' behaviors

(Oldham, G. R., Hackman, J. R, 2010).

In Somalia, a shortage of health workers poses a significant challenge for health service delivery.

The doctor/nurse ratio in Somalia is 0.4 health workers per 1000 population, which is well below

the WHO minimum standard of 4.5 nurses, doctors and midwives per 1000 population as stated

in a report by the World Health Organization (WHO, 2014). In many parts of the country, the

shortage of national health workers is partially addressed through the recruitment of expensive

expatriates. The number of these foreign health experts is unknown. Shortages are particularly

acute among mental health doctors, health equipment maintenance technicians and fully-trained

5
anesthetists. A recent study concluded that there were 6,918 salaried health workers in the public

sector. This showed the shortage of healthcare workers and still the country is facing a shortage

of the health workforce and the reasons are not well known.

Despite the collapse of health systems during the civil war in 1988, Somaliland has been

relatively peaceful and politically stable for almost three decades, and the government of

Somaliland has successfully re-established the national health system with partially functioning

primary and secondary services with limited finance. The government is committed to improving

coverage, access, staffing and service delivery. Overall, gains have been made in improving

health outcomes, particularly in the areas of reproductive health, maternal, neonatal and child

health, and capacities of public institutions have improved. However, health systems challenges

remain, including, financial constraints, human resource capacity, limited infrastructure, donor

dependency and fragmented health systems (UKPHS REPORT, 2017).

Furthermore, all available information on health workers' job satisfaction in one portion of the

country is lacking. As a result, the goal of this study aims to investigate the level of and factors

influencing health workers' job satisfaction in Hargeisa group hospital, Hargeisa-Somaliland.

1.2 Problem of Statement

According to the Health sector strategic plan for Somaliland - 2017-2021; Human resources for

Critical shortages of qualified health workers at all levels, poor terms and conditions of service

for health workers, a lack of a standardized remuneration and salary system, a lack of a staff

performance management system, a high attrition rate, and the absence of a structured career

pathway for most cadres are all examples of health weaknesses and challenges. Public health

personnel are underpaid and under motivated (Somali Federal Ministry of Health, 2017). All of

6
these variables may have an impact on job satisfaction among health professionals, exacerbating

the difficulty and threat of high turnover among health workers, particularly in the public health

system, increasing health worker shortages.

In Somaliland, the government spending a lot of funds on health and personnel compensation.

The health sector is labor-intensive and dependent on its workforce for the precise application of

the knowledge and technical skills in providing health care services. Despite this, there has been

no change in the satisfaction and working conditions of the health workers in the country,

especially in the public sector (Somali Federal Ministry of Health, 2017). Human resources in

the sector represent both strategic capital and a critical resource for the satisfaction of the health

system.

Currently, it is believed that the health workers job satisfaction of Hargeisa Group Hospital,

Hargeisa-Somaliland is dissatisfied with their jobs. Information of health worker’s availability,

performance and motivation as well as job satisfaction is lacking and yet the HSSP reveals that

there is a shortage of Human Resource (Hargeisa, 2018). It is in this regard that the researcher

aimed at investigates the evaluation of job satisfaction and its associated factors among health

workers job at Hargeisa group hospital in Somaliland so as to generate evidence based

information that can be useful in improving the quality of patient satisfaction in healthcare

provision from the view of the healthcare provider.

1.3 objectives of the study

1.3.1 Main objective

To examine evaluation of Job satisfaction and associated factors among health workers at

Hargeisa Group Hospital, Somaliland.

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1.3.2 Specific objectives

i. To determine level of job satisfaction among health workers at Hargeisa Group Hospital in

Somaliland.

ii. To assess individual characteristics associated with job satisfaction among the health workers

at Hargeisa Group Hospital in Somaliland

iii. To evaluate job characteristic associated with jobs satisfaction among the health workers at

Hargeisa Group Hospital in Somaliland.

1.3.3 Research questions

i. what is the level of job satisfaction among health workers at Hargeisa Group Hospital in

Somaliland?

ii. What are the individual characteristics associated with job satisfaction among the health

workers at Hargeisa Group Hospital in Somaliland?

iii. What is the job characteristic associated with jobs satisfaction among the health workers at

Hargeisa Group Hospital in Somaliland?

1.6 Significance of the Study

Management of health facilities in Hargeisa Group Hospital

The study helped the management of health workers in Hargeisa group hospital to gain a deeper

understanding of how to improve the satisfaction of healthcare workers in health facilities

Future Researchers

The study acted as a source of reference for future researchers that are interested in this topic.

Researcher

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 The study permitted or allowed the researcher to complete this Master’s Degree in Public Health

from Clarke International University in Kampala Uganda.

1.7 Conceptual framework

The conceptual framework shows the relationship between the dependent variable and
independent variable.
Independent Variable Dependent Variable

Individual characteristics
Socio demographic
Level of salary/incentives.
Job satisfaction
Years of work experience. Outcomes
Achievement.
Sense of vocational calling. Burn out,
Self-confidence. Advancement.
absenteeism,
Autonomy.
employee attrition
Espirit de corps.
Job characteristics
Creativity
Job cadre.
Job security.
Work load.
Equipment and supplies.
Performance appraisals.
Skills training.
Job recognition.

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Narrative conceptual framework

This study is based on two theories. Job characteristics model and Herzberg's motivator-hygiene

theory. The independent variables are level of job satisfaction, individual factors and job

characteristics. Herzberg's motivator-hygienetheory states that in order to achieve job

satisfaction, there are two essential factors known as the hygiene features and motivators.

Hygiene features are related with the job atmosphere and involve guidelines, administration,

remuneration, social relationships and working environment. Motivator is associated with career

and involves accomplishment, accountability, progression, acknowledgement and the work itself

(Herzberg, 1966). The Job Characteristics Model states that these characteristics influence

outcomes of motivation, satisfaction and performance. The model also includes intervening

variables of meaningfulness, responsibility, and knowledge of results. The dependent variable is

job satisfaction and they are Achievement, Advancement, Autonomy, Espirit de corps,

Creativity. The outcome is burn out, absenteeism, employee attrition.

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 CHAPTER TWO: LITERATURE REVIEW

2.0 Introductions
This chapter contains theoretical review, review of related literature based on the specific

objectives of the study this includes effect of level of job satisfaction, individual characteristic

and job characteristic affecting the health workers job satisfaction at Hargeisa group hospital in

Somaliland, summary of literature review and how this study intends to identify the gaps in the

literature.

2.1 Theoretical review

2.1.1Job characteristics model

This study based by Hackman and Oldham proposed the job characteristics model and the

theory is developed by Hackman and Oldham in 1975. As a framework, this is extensively used

to investigate how certain employment qualities affect outcomes, including job satisfaction. It

says there are five core job characteristics work outcomes are impacted by three important

psychological states (experienced meaningfulness, experienced accountability for outcomes, and

awareness of the actual results (job satisfaction, absenteeism, work motivation, etc.). It is a

measure of how satisfied an individual is at work. People are believed to be more pleased when

they are happy in their jobs. Motivation and job happiness are not the same thing, despite their

obvious connection. Employees rate their jobs on rating scales, which is the most frequent

approach to evaluate work satisfaction. Questions include income, work duties, job variety,

advancement prospects, working hours, and the conduct of coworkers (Oldham, G. R., Hackman,

J. R, 2010). Consequently, the link between fundamental job qualities and work outcomes may

change based on factors such as employees' growth-need strength, their knowledge, skill, and

context satisfaction.

2.1.2 Herzberg’s two-factor theory

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The study based on motivator hygiene theory the theory developed by Herzberg, in 1996.

Frederick Herzberg’s two-factor theory (a.k.a. motivator hygiene theory) consequently, the link

between fundamental job qualities and work outcomes may change based on factors such as

employees' growth-need strength, their knowledge, skill, and context satisfaction. A

subordinate's job satisfaction has a direct impact on an employee's motivation to work. Personal

and organizational goals are driven by motivation. Work-related variables that are motivating

include success, recognition, and advancement prospects, among others (Wikipedia, 2010).

2.2 Level of job satisfaction among health workers.

2.2.1 Achievement

The study done by Baah and Amoako (2011) described how the motivating elements (the nature

of the work, the performance of their work, their acknowledgement, their responsibility, and

their personal growth and advancement opportunities) enable employees in hospitals to identify

their own value in regard to the value supplied by their company. This supports a study done in

2014 by Marc Bonenberger and Moses Aikins in Ghana about the effects of health worker

motivation and job satisfaction on turnover intentions in Ghana: a cross-sectional study which

concluded that to increase motivation and job satisfaction of health workers, we should give

emphasis to an enabling environment, for example, through listening to and acting on staff

problems and priorities, or fostering team building. They may also engage in assisting the career

planning and paths of their subordinates. In-service training that is focused on the expressed

needs of health workers should be conducted. Motivation and job satisfaction have been

highlighted as significant variables in the retention and turnover of health workers in low- and

middle-income nations, and I tend to agree with that. They have a wider 'choice space' in

decentralized health systems, which allows them to favorably influence health workers'

12
motivation and job satisfaction, which in turn affects retention and performance at the district-

level.

This can also improve employee motivation, finally raising the employees' internal happiness

and satisfying them with internal pleasure. Hygiene can only lead to external happiness, but is

not as strong as it is to transform dissatisfaction into satisfaction. But still, its presence is too

important. This is, on the other hand, linked to the Herzberg Two Factor Theory, which attempts

to explain satisfaction and motivation in the workplace of healthcare workers. This theory states

that satisfaction and dissatisfaction are driven by different factors—motivation and hygiene

factors, respectively. An employee’s motivation to work is continually related to the job

satisfaction of a subordinate. Additionally, the study done by Rafiq et al. (2012) found that the

Extrinsic factors is negatively associated with employees’ job satisfaction, whereas extrinsic

rewards are the best motivator to cause job satisfaction.

2.2.2 Autonomy

The contentment of employees depends on numerous variables, and work autonomy is one of

them. Hackman and Oldham have described job autonomy as "the extent to which employment

gives employees considerable flexibility, independence, and choice in planning and the processes

that must be followed." A JD-R model can best explain the connection between job autonomy

and job fulfillment. In this approach, employees involved in health care are separated into

employment requirements and jobs. Although job requests are concerned with the costs of the

labor market, such as emotional demands on the physiological, social, psychological, and

organizational sides, employee resources lessen the impact of job needs and their cost in terms of

boosting certain learning levels and health workers' growth and development in the various work

parties (Oldham, G. R., Hackman, J. R., 2010). This is very interesting because it has regularly

13
been recognized to help satisfy health workers' jobs through giving them considerable flexibility,

independence, and choice in planning when they are doing their jobs. Due to their variable and

complicated nature, the demand for autonomy is perhaps higher in these advanced practices.

Work autonomy enables health workers, in accordance with their competence and experience, to

make choices. Due to the complexity of their work and to the varying job demands, job

independence allows them to make full use of their increased knowledge, handle problems

efficiently and enhance the responsibility for work outcomes. It can therefore be linked to the

JD-R theory, which explains that job autonomy is aligned with job resources, which seeks to

prevent the negative impact job demands will have. Therefore, the absence of job autonomy

raises the negatives of absenteeism, stress, repetitive strain, and ill health, whereas the presence

of job autonomy leads to higher employee job satisfaction.

2.2.3 Advancement

Advancement refers to the possibility of upward mobility within an organization. Concentrate on

future incentives for progress. Job content is enhanced by more promotion opportunities.

(Wamunyu Sarah, 2016). When a person perceives that the promotional system is fair, they are

more satisfied. If employees think they are not developing at their current firm, they will go

elsewhere for greater opportunities to further their careers in the future. The Wamunyu Sarah

(2016), a study of employees at local governments in Kenya, showed that employees were likely

to be happy with the capacity they had to make use of their job and to contribute towards work

planning, show the chance to exhibit initiative and to speak up in management choices.

This found in Asia, in the study of Use of appropriate healthcare skills: a cross-sectional study

in rural Zhejiang, China by Ren, etal. (2015) that adequate healthcare skills are a key approach

for increasing the availability and accessibility of healthcare services. In addition, it is unclear if

14
health professionals' job happiness can be sustained without special or continuous financial

assistance. This study investigated the level of job satisfaction among health workers job

satisfaction.

This variable of advancement used because it may be described as high workplace status by

working effectively; the status, position, and salary of the employees in the organization are

typically increased. It is regarded as the most important influence on the contentment of

employees, according to Parvin & Kabir (2011).

This just brings about the reality of Maslow’s hierarchy of needs, which states that people’s

needs range from basic to high level. Every human being has a hierarchy of needs, including

physiological, safety and security, social status, and self-actualization requirements. Unmet

needs may have an influence on subsequent needs. Needs of the lowest priority are met before

those of the highest priority, ensuring that needs are met in order.

2.2.4 Esprit de corps

Esprit de corps is well-known for increasing team involvement and putting strength behind team

force. Moradzadeh, Parmuzeh, Asoudeh, and Kord, (2015) Esprit de corps is an individual

group phenomenon that is founded on spirits and ideas that an organization employee has about

the group. Employees have strong relationships to share very actions and challenges in the

organization for better performance, which is commonly known as team spirit.

Ahmad's (2014) esprit de corps suggested a strong willingness to achieve organizational goals

and improve performance via teamwork and mutual support.

Ahmad (2014). Esprit de corps and work satisfaction were discovered to have a favorable link.

According to Halepota (2011), Esprit de Corps has a favorable link with work satisfaction.

15
Esprit de corps and work happiness have a favorable relationship and improve team performance

in order to improve an organization's image. W. Nafei (2015). However, according to Ahmad

(2014)'s study in the Korean public sector, some literature revealed a mixed perspective on Esprit

de Corps and work satisfaction. According to the study's findings, esprit de corps has a negative

impact on employees' workplace attitudes. According to a study done in Pakistan, esprit de corps

has little effect on job satisfaction, and employees of organizations prefer to work alone (Trimizi,

2011).

2.3 individual characteristics among health workers

2.3.1 Socio demographic

According to study, there are significant differences in satisfaction dependent on age. Due to the

enormous amount of contradictory findings, there is currently no consensus in studies on whether

age influences work happiness. Others feel there is no relationship between age and job

satisfaction, while others say job satisfaction diminishes with age (Cesar C,.et al, 2013). These

many studies are highly intriguing, and this one raises a lot of issues that need to be answered.

If health care professionals integrate their roles as health care providers, caretakers, spouses, and

parents into one, they may have a very full existence. By taking on multiple duties, it is possible

to be personally happy in several areas of one's life at the same time, and failures in one area can

be compensated for by success in another. Family relationships may be disturbed or supportive

therapy may be altered as a consequence of the demands of a health care provider's employment

(Dyrbye, 2010).

Divorce rates are an excellent predictor of the quality of marital ties in society. Healthcare

professionals divorce at a lower rate than non-healthcare workers, and female employees may be

16
more likely to divorce than male workers. Aside from money and social status, there are other

reasons why health care employees may stay in unhappy marriages.

According to a study by West Et al., (2011), The personal relationships of health workers are

frequently seen to deteriorate as a result of the demanding and time-consuming nature of their

employment. Despite these perceptions, there is no evidence that health practitioners have worse

relationships or are more likely to divorce. Similarly, a study done by Yan-Qiong Etal. (2019)

studied the association between marital status and job satisfaction and found that unmarried

health employees were dissatisfied with their employment more than married health workers and

that marriage substantially and positively connected with job happiness (Yan-Qiong Etal.,

2019). These research emphasized the significance of knowing the influence of marriage on the

job satisfaction of health care employees.

In terms of gender, there appears to be a pre-existing association between job satisfaction and the

gender of a health practitioner. It has been proposed that women's job satisfaction is a genetic

feature. Another study's authors stated that women had lower expectations for their job, which

would imply that women are happy than males since men have higher standards for their

professions that are more difficult to achieve (Cesar C, et al, 2013).

Furthermore, according to certain research, gender has little influence on work satisfaction.

Gender data for health-care professions in 2011, covering doctors, dentists, and stomatologists,

pharmacists, physiotherapists, nurses, and midwife certification. Women are gaining a greater

share of the health-care workforce. 70.97 percent have a pharmacy degree, 83.99 percent have a

nursing degree, and 93.91 percent have a midwifery degree. Female dentists and deontologists

account for 45.65 and 46.36 percent of their respective professions, respectively. Despite the fact

17
that there are no official data on nurse support employees, our research found that 6% of nurses

were male and 94% were female.

2.3.2 Level of salary /incentives

Salary and income inequality have an impact on health professionals. Relatively low income

may lead to dissatisfaction and motivation loss, as well as migration to higher-paying jobs. Low

wages and income, along with a lack of pension and insurance programs, have been connected to

low work satisfaction and insufficient oral health services, according to studies. Shemdoe and

colleagues (2016)

According to studies, essential rewards, such as income and compensation, motivate health

professionals, which has a direct influence on the employee's performance in health services

(Kalimullah, et al., 2010).

These technologies should help healthcare personnel be more effective since rewards are

management tools that influence individual or group behavior. Health institutions utilize pay,

promotion, incentives, and other types of compensation to inspire and motivate employees to

perform at high level intrinsic rewards.

Management should evaluate the importance of each position, performance-based remuneration,

personal or special allowances, fringe perks, and pensions when creating wage structures, etc

(Rukhmani, et al, 2010). Most health professionals in many countries make less than the

minimum living wage, and public sector workers' earnings are sometimes unjustly low when

compared to others in similar jobs, affecting the quality of care offered in hospitals. Because

equal pay will be difficult to achieve in many countries, health professionals may search for

ways to supplement their low salaries by working part-time.

18
Dessler (2012) the wage of an employee comprises all remuneration factors granted in return for

his work. Salary, according to Lai (2011), is one of the factors that reduces health professionals'

dissatisfaction when they are constrained. Golden (2012) contends that money does not purchase

happiness or pleasant enjoyment. Despite this, he argues that persons with lesser salaries may

place a larger importance on money than those with higher wages. However, it is the obligation

of the employer to assess the workers' tasks, efforts, good performance, and demands and

guarantee that they are appropriately.

2.3.3 Years of work experience

According to several results, health professionals' job happiness is related to their years of

experience, age, professional category, work environment, reward, and job recognition.

(Timalsina R, 2015, Temesgen K, Aycheh MW, Leshargie CT, 2018, Kumar R, etal, 2013), and

Cross-sectional Studies from Western Ethiopia [16] and Addis Ababa (Bekru ET, Cherie A,

Anjulo AA,2017) Compensation and benefits packages, as well as years of experience, were

found to be variables influencing health professionals' work satisfaction. Similarly, findings from

Ethiopia's Harari and Amhara regions (Temesgen K, 2018), as well as other African countries

such as South Africa, Malawi, and Tanzania (Blaauw D etal, 2013), revealed that service year,

type of health facility in which they work, age of health workers, benefit packages, and resource

availability were factors influencing health workers' job satisfaction.

Hossein Shahnazi etal (2014) discovered a substantial and unfavorable relationship between job

satisfaction from supervision and working experience. The findings of this investigation were

consistent with the findings of Tazhibi's study. According to his research, the greater the working

experience, the greater the job discontent. (M. Tazhibi, 2011) It appears that as supervisors'

working experience grows, they want their ideas to be used in decisions and their work to be

19
praised; nevertheless, administrative hierarchy will not always allow these expectations to be

satisfied.

2.3.5 Self confidence

Self-esteem or self-confidence refers to one's sentiments about his or her own worth, or the belief

that one is a valuable person. This type of sensation stems from one's life's ideas, emotions,

sentiments, and experiences (Ibrahim Ayankola, 2020).

According to Mozumdar, A (2012), self-esteem is highly positively connected with work

satisfaction. Individuals that have a high sense of self-esteem are primarily engaged in

collaborating with others. Later, Cherabin et al. (2012) discovered a link between self-esteem

and job satisfaction.

The self-esteem of health information management personnel is delineated as the overall sense of

their self-worth or personal worth that is typically seen as a personality trait which tends to be

stable and enduring. This study has considered Hackman and Oldham’s model (1976) as a base

to predict job satisfaction. The study's goal is to predict job happiness by measuring work

engagement and self-esteem. This study's findings clearly demonstrated a link between self-

esteem, work engagement, and job happiness (Avinash P etal, 2019).

This just establishes the reality of theory. Abraham Maslow's Hierarchy of Needs aims to explain

employee happiness and motivation in the healthcare sector. According to this view, contentment

and dissatisfaction are caused by diverse things. Abraham Maslow's (1943, 1970) need-based

theory of motivation is the most generally recognized theory of motivation and possibly the most

mentioned of the content theories. A human has five basic wants, according to this theory:

physiological, security, affiliation, es-teem, and self-actualization. Pay, food, housing, and

20
clothes, as well as adequate and comfortable working circumstances, are examples of

physiological requirements.

2.4 job characteristics among health workers.

2.4.1 Job cadre

The human resources issue has had a significant influence on the health systems of many African

nations, resulting in high vacancy rates across practically all health professional cadres. Malawi

has been particularly hard hit, with vacancy rates of 77 percent for specialized physicians, 45

percent for medical officers, 80 percent for nursing officers, and 44 percent for nursing sisters,

according to the most recent numbers. Malawi, on the other hand, has a history of employing

cadres of health professionals with shorter periods of training, such as registered nurse-

midwives, clinical officers, and medical assistants, who have constituted the backbone of the

health-care system. District staffing records, for example, reveal that while there were 872

enrolled nurse-midwives working in 2006, only 127 registered nurses were on the job. There

were also 232 clinical officers and clinical officers and 300 medical assistants but only 16

medical officers. In the process, much of the obstetric work traditionally carried out by doctors

has been shifted to clinical officers, who perform as much as 93% of major emergency obstetric

operations in government hospitals and 78% in mission facilities, with comparable post-

operative outcomes.(Elisha McAuliffe, et al.,2009)

There have been few studies that examine the perspectives of these mid-level cadres and the

factors that impact their motivation, performance, and retention within health care systems.

Recent study, however, reveals that these cadres are becoming demotivated as a result of

inadequate career growth and advancement chances, as well as a lack of constructive

supervision, feedback, and recognition, which leaves them feeling unsupported and

21
underappreciated. There is fear that if they are not appropriately supported and motivated, the

quality of treatment would decline (Bradley S, McAuliffe E, 2009).

2.4.2 Job security

Because job security is a fundamental component of employee happiness, it is difficult to

forecast how different components will influence total work satisfaction. Job security is

particularly crucial in today's atmosphere, when jobs are being reduced and recruiting has slowed

owing to the terrible economy, or recession. Workers were all that more drawn towards constant

change of employment in the regular course of time since there were the highest number of job

options at that period. A plethora of options present themselves at that time, allowing them to do

so. As a result, employees are searching for job security because most firms are more concerned

with layoffs than with employing new personnel (Subhasish Ch, 2015).This is similar to the

study done in Nigeria by Olusegun Emmanuel Akinwale and Olusoji James George (2020) on

Job security and job happiness among health employees at Nigeria's government tertiary

institutions on Job happiness is essential in the everyday life of the workforce, and the

mechanism that promotes job satisfaction necessitates the attention of corporate management.

The above findings are inconclusive, necessitating more investigation, which is the goal of this

study.

This just highlights the truth of Herzberg's two-factor theory's attempts to explain happiness and

motivation in healthcare professionals' workplaces. According to this hypothesis, contentment

and discontent are influenced by various causes, namely motivation and cleanliness. This

suggests that a health worker's incentive to work is inextricably linked to a subordinate's job

happiness. Another study conducted by Abdullah and Ramay (2012) found that workplace safety

and security had a significant impact on health professionals' devotion and performance.

22
Abdullah and Ramay (2012) discovered a positive relationship between employment stability

and employee health services.

2.4.3 Work load

Workload can be defined as the types of work that employees must perform, which include job

duties, job responsibilities, and job scope. Typically, each employee has their own job

responsibilities that they must complete, and according to BMJ Quality and Safety workload can

be divided at least into three types of workload, which include task-level workload, unit-level

workload, and job level workload.

Latip, Tak, Rahaman, and Abdul Kohar (2018) Work overload occurs when people are given

workloads that exceed their capacities as a result of increased productivity and performance

expectations. Shittu, Hassan, and Nawaz (2018) discovered that in large organizations,

employees are always given several tasks that must be finished in a short amount of time, while

Lin, Wong, and Ho (2015) stated that the combination of a deadline and work overload would

make the job more stressful.

According to Aruasa, Chirchir, and Chebon (2019) mention that there are various aspects that

may impact employee job happiness, ranging from the amount of compensation, the number of

workloads, and the depth of coworker relationships. According to El Rahaman (2017), the

burdens that employees confront on the workplace may also impact their degree of job

satisfaction. Workload, in particular, is a negative danger to companies, resulting in poor

performance and an inability to meet the criteria of their job duties. As a result of the increasing

employment demand, performance will suffer (Goh, Ilies, & Wilson, 2015).

23
2.4.4 Medical Equipment and supplies

Medical equipment management is defined as the organization and coordination of activities that

ensure the successful management of equipment related to patient care in a health facility. A lack

of proper medical equipment management has limited health facilities' capacity to deliver

adequate quality dental healthcare services. Many pieces of dental healthcare equipment in

hospitals are non-functional, unusable, or poorly maintained. As a result, the majority of the

time, the country's limited resources are ted, and people's health care is jeopardized. The

fundamental cause of these pitiful conditions is the lack of a robust governance framework with

sufficient checks and balances, which has resulted in low quality oral healthcare services. (Perry,

2011).

The healthcare technology management always guarantees that medical equipment and other

systems used in dental healthcare are safe and in excellent working order, and in order to do so,

effective equipment management is required to achieve the healthcare's goal and vision (WHO,

2011).

Essential medicinal items must be available at the appropriate level of the health-care system at

all times. A well-functioning health-care system offers fair access to key dental goods and

technology of guaranteed quality, safety, efficacy, and cost-effectiveness, as well as their

scientifically sound and cost-effective use.

Maintenance management systems, for example, are crucial to improving the dependability of

dental equipment and greatly improving safety and cost-efficiency; regular maintenance may

extend the life of equipment. This procedure also guarantees that we are offering acceptable

quality oral healthcare services while conserving restricted resources. However, many hospitals

and health care institutions do not benefit from high-quality upkeep (Wang, 2014).

24
Several researchers discovered that medical or health equipment is an essential component that is

linked to patient happiness. Furthermore, the state of medical equipment in all sections of health

institutions reveals efficiency, standards, and genuine attempts to provide quality health care

services.

2.4.5 Performance appraisals

The performance of health professionals is the backbone of excellent service delivery in the

healthcare industry (Chegenyea, et al., 2015). The fundamental goal of performance evaluation is

to maximize job quality and increase the quality of health professionals' services (Choudhary and

Puranik, 2014). Healthcare institutions must design a strategy for measuring the skills,

knowledge, and attitudes required of healthcare service professionals. This criteria is used to

judge how effectively health staff perform and to identify areas for improvement. As a result,

creating a performance assessment program in a health facility allows management to monitor

employees' performance while also motivating employees by enhancing morale, which leads to

increased quality of health workers' practice(Choudhary and Puranik, 2014; Musyoka, 2015).

The degree to which individuals love and believe in what they do for a living, as well as their

belief that their employer appreciates what they bring to the table, the more an employee's

engagement, the more likely he or she is to "go the additional mile" and offer good on-the-job

performance. Furthermore, engaged employees are more likely to commit to keeping with their

present health care providers.

Health care employees are more motivated when they have difficult possibilities at work, such as

participation in intriguing initiatives, employment with a satisfactory level of challenge, and the

potential to assume greater responsibility. It is also known as progression, and health workers

prefer to feel that they are making progress in their careers (Nikpeyma Et al., 2014).

25
2.4.6 Skills training

Human health is maintained by health professionals through the use of evidence-based medicine.

According to the International Standard Classification of Occupations, health professionals

include medical doctors, nurses, midwives, dentists, medical labs, and pharmacists (ISO).

Various programs for continuing professional development can be used to improve the

competence of health care workers (WHO, 2013). Health staff are a hospital's most valuable

asset. We cannot overestimate their importance in guaranteeing the success of our hospitals. This

means that educating these one-of-a-kind assets is critical to improving healthcare services.

These factors were chosen because they allow health workers to grow in numerous areas and

broaden their knowledge and talents for optimal health worker development (Kabir, 2011).

When compared to unskilled individuals, trained health workers are more happy with their

occupations (Abdullah &Djebavni, 2011). Training programs favorably influence the growth of

health personnel, which is beneficial to their competence (hunjira et al 2010). Health workers

who engage in training programs are more confident and have a positive attitude about their

health institution (Kabir, 2011). Monitoring and analyzing healthcare employees' performance,

identifying training needs, and revealing hidden skills are all part of the training process, which

assists health facilities in increasing health care workers' abilities and job satisfaction. Choudhary

and Puranik (2014) The above findings are inconclusive, necessitating more investigation, which

is the goal of this study.

This topic has been studied since hospitals often use training and development to close the gap

between current and expected future performance, as well as to increase health professionals' job

satisfaction. The duty for training and development in a human resources department has long

been seen as critical. Its responsibilities include determining training and development

26
requirements, designing methodologies and programs to suit those goals, organizing their

execution, and evaluating the results (Van Eaton &Pellegrini, 2011).

2.4.7 Job Recognition

The healthcare sectors of countries have a direct influence on the economy and global health.

The relevance of health professionals' well-being at work and its effects on productivity,

effectiveness, and job satisfaction is becoming more widely recognized. The lack of knowledge

has significant consequences for aspects like as burnout, sales, and a bad sense of well-being

(Amutio etal., 2009). According to Siegrist's research, a lack of proportionality between efforts

and benefits may result in unpleasant sensations that, in turn, stimulate good emotions and well-

being with sufficient remuneration (e.g. recognition). This is intriguingly comparable to Vera

Akafo's study in Ghana. According to Peter Agyekum Boateng (2015), the Impact of Reward

and Recognition on Job Satisfaction and Motivation, incentives and recognition play a critical

role in motivating health professionals and increasing performance (Lawler,2013). A well-

structured incentive system may significantly increase a hospital's efficacy and productivity. A

more diverse workforce demands more complex compensation systems, and hospitals are

increasingly realizing that they must consider the whole remuneration package for health

employees. Employers are increasingly implementing sophisticated employee recognition

programs that emphasize non-monetary incentives, such as the "best health worker" award for

employees. Workshops and lunches with the CEO for a month. Similarly, Robbins (2009) found

that cognitively demanding work, equitable compensation, supportive working environment, and

helpful coworkers are the most significant characteristics that contribute to job satisfaction.

Furthermore, Coughlin (2010) found that in a survey of staff nurses, health professionals rated

peer recognition as very important. Providing timely recognition and appreciation for good

27
performance has been identified as a habit that has a direct influence on the workplace

satisfaction of health workers, particularly nurses. These contribute to the study's goal.

2.5 Summary of Literature Review

The literature examined showed the theoretical impacts on job satisfaction, focusing on two

factor theories by Herzberg, which address variables that lead to job satisfaction and

dissatisfaction. The reasons and hygienic aspects are included Salary, conditions of employment,

hospital rules and administrative management cover hygiene aspects. Other theories, such as job-

characteristic models, also address employer discontent and work satisfaction, which have a

range of elements, including Job cadre. Job security, Work load, Equipment and supplies,

Performance appraisals, Skills training, Job recognition and others. They also agree that

happiness at work is affected by various variables in their definitions by agreeing that

circumstances of work and employment.

According to the research, health care employees are more motivated and advance if they have

opportunities at work, such as participating in an engaging assignment. Effective health care

services are crucial to the happiness of health care personnel in public hospitals. This is critical

in order to maintain and improve the quality of care. Managers must explore compensation

structures that take into account the organization's importance for each position; performance

pay, personal or special allowances, peripheral allowances, pensions, and so on. In many

countries, the salaries of health professionals are below the minimum wage, and the payment of

employees in the public sector is frequently unfair in comparison to others in equivalent

employment, which has an influence on the supply of healthcare services.

28
 CHAPTER THREE: METHODOLOGY

3.0 Introduction
This chapter contains study area, scope of the study, research design, study population, inclusion
and exclusion criteria, sample size, sampling techniques, study variables, data sources, data
collection tools, validity of the study, reliability of the study, data processing, data analysis,
ethical considerations and limitations of the study.

3.1 Study Area

The study conducted in the district of Hargeisa. Hargeisa (the capital city of Somaliland) is
located between 9,562,389 latitudes and 44,077,013 longitudinal peoples at an altitude of 1334 m
from sea level. (Hargeisa Local Government, 2016). Hargeisa has south-western borders with
Ethiopia, Gabiley to north-west and Berbera town to east. Hargeisa is favored because Hargeisa
is the capital city and has more hospitals in the country than any other city.

29
3.2 Scope of the Study
3.2.1 Geographical Scope

The study conducted from Hargeisa group hospital, Hargeisa-Somaliland. Hargeisa Group
Hospital Hargeisa Group Hospital is the national referral hospital in Somaliland, with a
department of education and quality improvement. Hospital Hargeisa Group established in
1953. It is a 400-bed hospital, located in Hargeisa is the largest public hospital in the region of
Somaliland state, and offers healthcare facilities to patients of the city. The location of the
hospital is near Hargeisa Presidency Road, 26 June District, Hargeisa, Somalia.
3.2.2 Content Scope

The study focused on the Level of job satisfaction influencing health workers job satisfaction in

Hargeisa group hospital, Hargeisa-Somalia, individual characteristics influencing health workers

job satisfaction in Hargeisa group hospital, Hargeisa-Somalia, and the job characteristics

influencing health workers job satisfaction in Hargeisa group hospital, Hargeisa- Somalia.

According to the records from Hargeisa Group hospital, there were 390 health Workers who

include; doctors (132), surgeons (13), pharmacists, (17), Therapist (3) professional nurses (71)

associate professional nurses (130) and professional midwives (21)

3.2.3 Time Scope

This study covered information from the collected over four-week period study participants

have worked at hospital for no less than 6months 'because this a cross-sectional study design

Information period provides sufficient time to consider generally established organizational

Culture including work environment and yet poses lower risk of recall bias. The researcher

Conducted the study within starting from July 2021 because the process includes data searching,

Gathering and editing.

3.3 Research Design

The study design used is cross-sectional research design. The researcher used this design because

it is considered to be most appropriate to achieve or address the research question and objectives

30
under study which ensured high quality research. The researcher gathered data from the

Population at one time and then applied that information to examine evaluation of job

satisfaction and associated factors among health workers at Hargeisa group hospital in

Somaliland.

3.4 Study Population

This study comprised the health workers in all departments of the health facility in Hargeisa

group hospital. According to the records from Hargeisa Group hospital, there were 390 health

Workers in the different management levels of the health workers. Hargeisa Group Hospital has

a three groups of employees namely,20 top level management who comprise the heads of the

Departments, 320 middle level management are the technical staff who include medical officers,

Nurses, occupational therapists, nutritionists, laboratory technologists, dentists, radiographers

Ophthalmologist, social workers and public health officers and 50 lower level management or

Support that include (clerical officers, subordinate staffs, drivers, cooks, tailors and secretaries).

3.5 Inclusion and Exclusion Criteria

Inclusion Criteria

All health workers (permanents, contractors, internship doctors) in the selected Hargeisa Group

Hospital (HGH) who presented at the time of carried the study and those who willing to provided

information included from the study.

Exclusion Criteria

All health workers in the selected facility Hargeisa Group Hospital (HGH) who not present at

the time of carrying the study, those who sick and those who were not willing to provide

information excluded from the study.

31
3.6 Sample Size
The study used Sloven’s formula to determine the sample size of the actual respondents.

Sloven’s formula states: This formula used because the study population is known. According to

the hospital records in Hargeisa group hospital, there were 390 health workers in the departments

of health facility in public. Due to time limitations of the study the entire population not is

studied.

Where;

n = 390/1+390(0.05)2

n = 390/1+390 (0.0025)

n = 197 respondents

Table 1sample size

Category Study population Sample size

Hospital team management 20 11

Technical staff 320 160

Supportive staff 50 28

Total 390 197

32
3.7 Sample Technique

3.7.1 Simple random sample

The study involved the use of simple random sampling. A simple random sample is a subset of a

statistical population in which each member of the subset has an equal probability of being

chosen. The researcher used simple random sampling in selecting; hospital management and

other support staff. The researcher used this type of sampling technique because of lack of bias.

Several papers (written on yes or no) put in a box and shuffled, health workers in all

departments of hospital will be required to pick a paper and those who pick yes selected for the

study.

3.8 Study Variables

3.8.1 Dependent variable

The dependent variable is indicated by Job satisfaction (Achievement, Advancement,

Autonomy, (Espirit de corps means the common spirit existing in the members of a group and

inspiring enthusiasm, devotion and strong regards for the honor of the group. Job satisfaction

measured using a 5 point Likert scale and it’s evidenced by the following associated outcomes

burn out, absenteeism and employee attrition. All items measured using a 5-point Likert Scale.

(1-StronglyAgree, 2-Agree, 3-Nuetral, 4-disagree and 5-Strongly disagree). The choice of this

measurement is because this study relied on the ordinal nature of data and each point on the scale

carried a numerical score used to measure the participants’ response as recommended by Joshi et

al., (2015).

3.8.2 Independent Variable

The independent variables are individual factors (Socio demographic, Level of salary/incentives,

Length of tenure at Hospital. Years of work experience, Sense of vocational calling, Self-

33
confidence.) And job characteristics (job cadre, job security, Work load, equipment and supplies,

performance appraisals, skills training, job recognition.).

3.9 Data Source

3.9.1 Primary Data

The study involved the use of primary data. Primary data is data that is collected by a researcher

from first-hand sources. The researcher obtained primary data from questionnaires and Key

Informant Interview guide. The researcher used primary data because it is reliable as the

researcher can replicate the procedure to check the results, as they know the procedure and how

the data collected and analysed.

3.9.2 Secondary Data

The secondary sources were constituted scholarly books and articles, already written literature in

journals, e-books, published articles, and periodicals. The documentary resources facilitated the

data collection and provided contextual analysis.

3.10 Data Collection Tools/ Instruments

3.10.1 Self-Administered Questionnaire

The researcher used a self-administered questionnaire. A self-administered questionnaire (SAQ)

refers to a questionnaire that has been designed specifically to be completed by a respondent

without intervention of the researchers (e.g. an interviewer) collecting the data. The researcher

distributed questionnaires to all health workers in all departments of the selected health facility in

Hargeisa district. The researcher used a self-administered questionnaire for respondents to

answer at their convenience and the choice of the SAQ is that all the healthcare workers in all

departments are able to read and write.

3.10.2 Key informant interview Guide

The researcher also used a key informant interview guide (KIG). A key informant interview

guide, or aide memoire, is a list of topics, themes, or areas to be covered in a semi-structured

34
interview. The researcher used an interview guide when interviewing the in charge of hospital

management team departments in the selected health facility in Hargeisa group hospital. The

researcher used an interview guide because it helped collect fresh, new and primary information

as needed. The KIG offered in-depth qualitative data in terms of the health workers' job

satisfaction in the hospital.

3.11 Quality Control Measures

3.11.1 Validity of the Instrument

Validity refers to the degree to which results obtained from analysis of the data actually

represents the phenomenon under study (Mugeda, 2009). In calculating validity, the researcher

ensured that questions are relevant so that it gives meaningful and reliable results represented by

variables in the study. The researcher used the following formula to establish validity of the

research instrument as seen below. (0.70)

Content Validity Index (CVI)

CVI =

CVI= = 0.86 Therefore the instrument is valid since the CVI is above 0.70

CVI>0.70 – Instrument is valid

CVI<0.70 – Instrument is not valid

If the overall Content Validity Index (CVI) of the instrument is equal to the average acceptable

Index of 0.7 or above, then the instrument accepted as valid (Amin, 2005).

3.11.2 Reliability of the Instrument

To ensure the reliability of the instrument, the researcher used the test-retest method. The

questionnaire given to 10 people and after two weeks, the same questionnaire given to the same

35
people at the different departments and the Cronbatch Alpha computed using SPSS. The

minimum Cronbatch Alpha coefficient of 0.75 used to declare an instrument reliable (>0.75).

Reliability Statistics

Cronbach's Alpha N of Items

0.86 36

Cronbatchs Alpha >0.75- Instrument is reliable

Cronbatchs Alpha <0.75 – Instrument is not reliable

3.12 Data Collection Procedures

A permission letter / introductory letter were obtained from Clarke International University

(CIU). When it is approved, the researcher ma a list of qualified respondents from health workers

Hargeisa group hospital in Hargeisa district. The researcher then explained the purpose of study

to the respondents and request from them to sign the informed consent form. The researcher

recruited and trained research assistants to collect accurate data timely. The respondent

requested to answer in full and not to leave any part of the questionnaires unanswered. The

researcher and assistants collect the questionnaires within two weeks from the date of

distribution. All return questionnaires were checked for completeness of all answers.

3.13 Data Presentation

Quantitative: Data cleaned, coded and entered using Epi-Info Software Version 7 and analyzed

using SPSS Version 26. Mean, mode, and median used for continuous variables whereas;

percentage used for categorical variables. Descriptive results were presented using tables and

figures.

36
Qualitative data: Raw data transcribed and read through repeatedly to see whether the content

okay and then exported to Atlas 7.1 software for coding and analysis.

3.14 Data Analysis Plan

Data was single-entered and analyzed using Statistical Package for Social Sciences Research

(SPSS) statistical software version 26 for analysis.

Univariate Analysis

Descriptive statistics analysis was conducted to characterize the study participants across their

missed opportunity for immunization. Further, different proportions according to participants'

health workers and job satisfaction were established. This data was presented using tables,

charts and graphs.

Bivariate Analysis

To determine whether there were differences in participant individual and job characteristic

factors associated with health workers job satisfaction, the Chi-squared Fishers exact test was

used for categorical variables. The level of statistically significant was set at 0.05 to avoid

dropping important variables that were associated with job satisfaction among health workers.

Multivariate Analysis
At multivariate analysis, the level of statistical significance was 5%. First, for all statistically

significant variables at bivariate level of analysis were subjected to binary logistic regression

analysis model to determine the strength of association and the results were reported as crude

odds ratio (COR) with corresponding 95% confidence intervals and p- values. Second, a multi-

nominal logistic regression analysis considered all variables at unadjusted analysis that were

37
statistically significant in establishing those independently associated with the outcome. This

expressed as adjusted odds ratio (AOR), with 95% CI and p-values.

3.14.2 Qualitative Data Analysis

Qualitative data also collected from key informant interview discussions with health workers in

Hargeisa group hospital. Qualitative data analysis involves 5 steps, including preparing and

organizing data, reviewing, creating initial codes, revising codes and combining them into

themes, and presenting themes in a cohesive manner. Following responses from the KII,

key/common themes or model responses generated based on the objectives. Audios from KII

were transcribed and the transcripts were coded. Emerging themes from the transcripts entered

into a code book and used for writing the report.

3.15 Plan for dissemination

The results of this study were submitted as a dissertation to Clarke international University. The

researcher also writes and submitted a manuscript for publication in a credible peer-reviewed

journal, preferably an open-access journal. The researcher also disseminated the study findings

through local conferences, short health facility reports, and patient brochures.

3.16 Ethical Considerations

Permission and approval to conduct the study also obtained from the institute of public health

and management at Clarke International University (CIU) and Clarke International University

research ethics committee (CIUREC). An introductory letter addressed to Hargeisa group

hospital where an approval letter expected to be issued to the researcher granting him

permission to carry out the study at the stated hospital. Informed consent obtained from

respondents after explaining adequately the aim, procedures and anticipated benefits of the study.

Respect for anonymity observed by using serial numbers as opposed to the use of participants’

38
names. Privacy is ensured by requesting respondents to suggest an appropriate time for

responding to the research items in order to maintain their privacy. In addition to that,

confidentiality is ensured by respecting and not revealing information provided in confidence.

Last but not least, respect for intellectual property observed through acknowledging

contributions of different scholars by providing citations as recommended by Resnick (2015).

3.17 Limitations of the Study

Some respondents might be too busy with their daily schedules and might fail to spare time to fill

the questionnaires in time. In such circumstances, the researcher gave sample time to those

respondents.

Inability to use census because the sample size may not represent the whole study population and

the researcher might miss some information that important in the research.

The findings of the study may not be generalized to healthcare professionals in other hospitals, as

the different environment and circumstances prevailing in other hospitals may impact on job

satisfaction.

The researcher have to battle with the limited time available to him in combining traveling to

the place of case study due to COVID 19 and also the participants are some of them don’t have

enough space.

39
 CHAPTER FOUR: PRESENTATION OF RESULTS
4.0 Introduction
This chapter presents results got from a study that evaluated job satisfaction and associated

factors among health workers at Hargeisa group hospital in Somaliland.

Respondent rate

Out of one hundred ninety-seven respondents expected to participate in this study, one hundred

eighty-eight were voluntarily enrolled with a 95.4% response rate.

4.1 Univariate Analysis of Level of Job Satisfaction among Health Care Workers

Table 2: assessment of job satisfaction among respondents

Variables Category Frequency Percentage (100%)

Ability to see the result of work I do Strongly Agree 93 49.5
Agree 38 20.2
Neutral 19 10.1
Disagree 19 10.1
Strongly Disagree 19 10.1
I take pride in a job well done Strongly Agree 97 51.6
Agree 72 38.3
Disagree 19 10.1
I am given opportunities for advancement Strongly Agree 73 38.8
Agree 58 30.9
Neutral 38 20.2
Disagree 19 10.1
I get chances of ahead on job Promotions Strongly Agree 131 69.7
Agree 38 20.2
Neutral 19 10.1
I can do something worthwhile. Strongly Agree 19 10.1
Agree 131 69.7
Neutral 19 10.1
Strongly Disagree 19 10.1
Satisfied with the spirit of cooperation Strongly Agree 150 79.8
with workers
Neutral 19 10.1
Strongly Agree 19 10.1
I get a chance to try out my ideas Strongly Agree 78 41.5
Agree 72 38.3
Neutral 19 10.1
Disagree 19 10.1

40
 Total 188 100.0
Source primary field data

According to the results presented in table 1, 93(49.5%) of the respondents strongly agreed that

they were able to see the result of the work they did while 19(10.1%) of them strongly disagreed.

In addition, our study finding revealed that half 97(51.6%) of the respondents strongly agreed

that they take pride in a job well done as compared to the 19(10.1%) that disagreed. Meanwhile,

73(38.8%) of the respondents strongly agreed that they were given opportunities for

advancement in their job unlike19 (10.1%) that never had opportunities for advancement.

Similarly, our study established that 131(69.7%) of the respondents strongly agreed they got

chances a head-on job promotion as compared to those who were neutral 19(10.1%).

Furthermore, only 19(10.1%) of the respondents strongly agreed they were able to do something

worthwhile while 19(10.1%) of the respondents strongly disagreed. More so, the majority

150(79.8%) of the respondents strongly agreed they were satisfied with the spirit of cooperation

with workers while 19(10.1%) strongly disagreed.

41
Source primary field data 2022 Figure 1; the overall level of job satisfaction among health
workers

The results in figure 1 showed that most 150(79.79%) of the respondents were satisfied with

their job while the remaining 38(20.21%) of them were dissatisfied. This finding corresponds

with the result got from key informant interviews in which health workers were satisfied with the

job due to the provision of incentives mostly during overtime work.

As the respondent was quoted saying" As management, we understand that our

staffs are overworked due to understaffing, however, we offer them incentives and
bonus such as allowances for working an extra hour, and I think this is one of the
major reasons why they enjoy working for the organization”.

4.2 Univariate Analysis of Demographic Characteristics of the Respondents

Table 3: univariate analysis of demographic characteristics of respondents

Variables Category Frequency Percentage (100%)

Gender Male 104 55.3
Female 84 44.7
Age 20-25 86 45.7
26-30 51 27.1
31-35 17 9.0
36-40 17 9.0
41 years and above 17 9.0
Marital status Single 76 40.4
Married 55 29.3
Widow 19 10.1
Divorced 19 10.1
Others 19 10.1
Number of children One 53 28.2
Two 94 50.0
Three 41 21.8
Number of dependents One 120 63.8
Two 60 31.9
Three 8 4.3
Level of Education Certificate 19 10.1
Diploma 38 20.2
Degree 93 49.5

42
 Post-graduate Diploma 19 10.1
Masters 19 10.1
Employment Status Permanent 89 47.3
Temporary 13 6.9
Part-Time 61 32.4
Other 25 13.3
Job Title Doctor 18 9.6
Midwife 38 20.2
Nurse 75 39.9
Pharmacist 19 10.1
Lab Technicians 19 10.1
Other staffs 19 10.1
Duration of work 1-4yrs 37 19.7
5-10yrs 114 60.6
More than 10yrs 37 19.7
Years of experience 6month - 1 year 37 19.7
1-5 years 114 60.6
More than 5 years 37 19.7
Total 188 100.0
Source primary field data 2022

The distribution of the respondents according to demographic characteristics revealed that

slightly more than half 104(55.3%) of them were male while the female constituted 84(44.7%).

in addition, the majority 86(45.7%) of the respondents were aged 20 to 25 years while the least

proportion was constituted by those aged 31 to 35 years, 36 to 40 years, and 41 years beyond

17(9.0%) respectively.

The distribution of the respondents according to marital status revealed that 76(40.4%) of them

were single, followed by 55(29.3%) married while those who were widowed, divorced and

others constituted the same proportion 19(10.1%). Moreso, the study assessed the respondent's

number of children and the result indicated that half 94(50.0%) of them had two children as

compared to 53(28.2%) that had one child and 41(21.8%) with three children. Similarly, our

study established that most 120(63.8%) of the respondents had one household member unlike

60(31.9%) with two members and 8(4.3%) of them had three household members.

43
 Furthermore, our study found out that 19(10.1%) of the respondents were certificate holders,

post-graduate diplomas, and masters respectively while 93(49.5%) of them had degrees and

38(20.2%) had a diploma. Moreso, our study finding indicated that 89(47.3%) of the respondents

were permanently employed followed by 61(32.4%) of those with part-time jobs and 13(6.9%)

who had temporary employment.

4.3 Bivariate Analysis of Demographic Characteristics of the Respondents

Table 4: Bivariate analysis of demographic characteristics of respondents

The overall level of job satisfaction

Variables Category Satisfied Dissatisfied Total ᵡ2 P-value
Gender Male 83(55.3%) 21(55.3%) 104(55.3%) 0 1
Female 67(44.7%) 17(44.7%) 84(44.7%)
Age 20-25 71(47.3%) 15(39.5%) 86(45.7%) 0.815 0.945
26-30 40(26.7%) 11(28.9) 51(27.1%)
31-35 13(8.7%) 4(10.5%) 17(9.0%)
34-40 13(8.7%) 4(10.5%) 17(9.0%)
41 years beyond 13(8.7%) 4(10.5%) 17(9.0%)
Marital status Single 65(43.3%) 11(28.9%) 76(40.4%) 11.109 0.024*
Married 40(26.7%) 15(39.5%) 55(29.3%)
Widow 13(8.7%) 6(15.8%) 19(10.1%)
Divorced 13(8.7%) 6(15.8%) 19(10.1%)
Others 19(12.7%) 0(0.0%) 19(10.1%)
Number of children One 41(27.3%) 12(31.6%) 53(28.2%) 1.051 0.624
Two 74(49.3%) 20(52.6%) 94(50.0%)
Three 35(23.3%) 6(15.8%) 41(21.8%)
Number of household members
One 97(64.7%) 23(60.5%) 120(63.8%) 0.274 0.953
Two 47(31.3%) 13(34.2%) 60(31.9%)
Three 6(4.0%) 2(5.3%) 8(4.3%)
Level of Education Certificate 18(12.0%) 1(2.6%) 19(10.1%) 19.088 <0.001
Diploma 28(18.7%) 10(26.3%) 38(20.2%)
Degree 66(44.0%) 27(71.1%) 93(49.5%)
Post-graduate Diploma 19(12.7%) 0(0.0%) 19(10.1%)
Masters 19(12.7%) 0(0.0%) 19(10.1%)
Employment Status Permanent 69(46.0%) 20(52.6%) 89(47.3%) 0.756 0.852
Temporary 11(7.3%) 2(5.3%) 13(6.9%)
Part-Time 49(32.7%) 12(31.6%) 61(32.4%)
Other 21(14.0%) 4(10.5%) 25(13.3%)
Job Title Doctor 12(8.0%) 6(15.8%) 18(9.6%) 18.464 0.001*
Midwife 26(17.3%) 12(31.6%) 38(20.2%)
44
 Nurse 67(44.7%) 8(21.1%) 75(39.9%)
Pharmacist 13(8.7%) 6(15.8%) 19(10.1%)
Lab Technicians 13(8.7%) 6(15.8%) 19(10.1%)
Other staffs 19(12.7%) 0(0.0%) 19(10.1%)
Duration at work 1-4yrs 25(16.7%) 12(31.6%) 37(19.7%) 6.769 0.039*
5-10yrs 91(60.7%) 23(60.5%) 114(60.6%)
More than 10yrs 34(22.7%) 3(7.9%) 37(19.7%)
Years of experience 6month - 1 year 31(20.7%) 6(15.8%) 37(19.7%) 5.637 0.063
1-5 years 85(56.7%) 29(76.3%) 114(60.6%)
More than 5 years 34(22.7%) 3(7.9%) 37(19.7%)
Total 150(100%) 38(100%) 188(100%)
Source primary field data 2022 * statistically significant at P<0.05

The association result presented in Table 3 revealed that job satisfaction among health care

workers in this study was influenced by marital status (p=0.024), level of education (p<0.001),

job title (p=0.001), and duration at work (p=0.039).

4.3 Univariate Analysis of Individual Characteristics Associated With Job Satisfaction

among Health Workers

Table 5: univariate analysis of individual factors associated with job satisfaction

Variables Category Frequency Percentage (100%)

Role matches my experience Strongly Agree 57 30.3
Agree 92 48.9
Neutral 39 20.7
My experience has prepared me for this job
Strongly Agree 72 38.3
Agree 58 30.9
Neutral 39 20.7
Disagree 19 10.1
I am satisfied with the pay and amount of work
Strongly Agree 54 28.7
Agree 115 61.2
Strongly Disagree 19 10.1
Satisfied with incentives provided at my workplace
Strongly Agree 14 7.4
Agree 134 71.3
Neutral 40 21.3
I am confident this job aligns with my vocational calling
Strongly Agree 93 49.5

45
 Agree 38 20.2
Neutral 19 10.1
Disagree 19 10.1
Strongly Disagree 19 10.1
I believe I have been called to do the job
Strongly Agree 36 19.1
Agree 57 30.3
Neutral 54 28.7
Disagree 23 12.2
Strongly Disagree 18 9.6
I get the chance to try my methods of doing the job
Strongly Agree 41 21.8
Agree 72 38.3
Neutral 75 39.9
I am confident in my ability to perform my job very well
Strongly Agree 75 39.9
Agree 54 28.7
Neutral 36 19.1
Strongly Disagree 23 12.2
I am well equipped to handle my work responsibilities
Strongly Agree 55 29.3
Agree 56 29.8
Neutral 36 19.1
Disagree 41 21.8
Total 188 100.0
Source primary field data 2022

Our study assessed the individual factors of the respondents in regards to job satisfaction and the

result showed that 92(48.9%) of the respondents agreed that their roles match the experience

while 39(20.7%) of them did not know. In addition, 72(38.3%) of the respondents strongly

agreed that their experience had prepared them for the current job as compared to 19(10.1%) that

disagreed. Similarly, our study found out that 115(61.2%) of the respondents were satisfied with

the payment and amount of work while 19(10.1%) of them expressed dissatisfaction.

Relatedly, our study finding revealed that the majority 134(71.3%) of the respondents agreed that

they were satisfied with incentives given at the place of work unlike 40(21.3%) that were neutral.

46
On the contrary, the result got from the key informant interview showed health workers were

dissatisfied with the incentives as stated below.

"Some health workers particularly in our public hospitals realized that their
communication skills are not linked to their income level. Thus, they may not change
their attitude and behavior and this shows that there is no promotion and recognition of
the health workers.”

However, 93(49.5%) of the respondents were confident that the current job aligns with their

vocational calling while 19(10.1%) of them disagreed. Moreso, our study finding indicated that

57(30.3%) of the respondents agreed that they believed they were called to do the job while

18(9.6%) of the respondents disagreed. However, only 41(21.8%) of the respondents agreed that

they get chances to try their method of doing the job unlike 75(39.9%) that were neutral.

In addition, 75(39.9%) of the respondents had confidence in the ability to perform their job very

well while 23(12.2%) were not confident. On the contrary, only 55(29.2%) of the respondents

strongly agreed that they were well equipped to handle work responsibility while 41(21.8%).

Similar findings were got from key informant interviews which revealed that health care workers

built a good relationship with patients to make them trust.

A respondent stated that ―Motivation of Health worker is important. Some health

workers built a good relationship with patients. It helps the patient to trust the doctor and
cooperate in the treatment process however there is a shortage of equipment to do my job
and this makes me sad.”

4.4 Bivariate analysis of individual factors associated with job satisfaction

Table 6: bivariate analysis of individual factors associated with job satisfaction

The overall level of job satisfaction

Variables Category Satisfied Dissatisfied Total ᵡ2 P-value

47
 I am in a role that matches the needs of the experience
Strongly Agree 19(12.7%) 38(100.0%) 57(30.3%) 108.807 <0.001*
Agree 92(61.3%) 0(0.0%) 92(48.9%)
Neutral 39(26.0%) 0(0.0%) 39(20.7%)
My experience has prepared me for this job
Strongly Agree 72(48.0%) 0(0.0%) 72(38.3%) 55.371 <0.001*
Agree 39(26.0%) 19(50.0%) 58(30.9%)
Neutral 20(13.3%) 19(50.0%) 39(20.7%)
Disagree 19(12.7%) 0(0.0%) 19(10.1%)
I am satisfied with the pay and amount of work I do
Strongly Agree 54(36.0%) 0(0.0%) 54(28.7%) <0.001*
Agree 96(64.0%) 19(50.0%) 115(61.2%)
Strongly Disagree 0(0.0%) 19(50.0%) 19(10.1%)
I am satisfied with the incentives provided at my workplace
Strongly Agree 14(9.3%) 0(0.0%) 14(7.4%) 23.322 <0.001*
Agree 96(64.0%) 38(100.0%) 134(71.3%)
Neutral 40(26.7%) 0(0.0%) 40(21.3%)
I am confident this job aligns with my vocational calling
Strongly Agree 84(56.0%) 9(23.7%) 93(49.5%) 16.923 0.025*
Agree 26(17.3%) 12(31.6%) 38(20.2%)
Neutral 11(7.3%) 8(21.1%) 19(10.1%)
Disagree 13(8.7%) 6(15.8%) 19(10.1%)
Strongly Disagree 16(10.7%) 3(7.9%) 19(10.1%)
I believe I have been called to do the job
Strongly Agree 28(18.7%) 8(21.1%) 36(19.1%) 5.822 0.215
Agree 50(33.3%) 7(18.4%) 57(30.3%)
Neutral 44(29.3%) 10(26.3%) 54(28.7%)
Disagree 16(10.7%) 7(18.4%) 23(12.2%)
Strongly Disagree 12(8.0%) 6(15.8%) 18(9.6%)
I get the chance to try my methods of doing the job
Strongly Agree 28(18.7%) 13(34.2%) 41(21.8%) 6.676 0.035*
Agree 56(37.3%) 16(42.1%) 72(38.3%)
Neutral 66(44.0%) 9(23.7%) 75(39.9%)
I am confident in my ability to perform my job very well
Strongly Agree 66(44.0%) 9(23.7%) 75(39.9%) 6.04 0.112
Agree 42(28.0%) 12(31.6%) 54(28.7%)
Neutral 26(17.3%) 10(26.3%) 36(19.1%)
Strongly Disagree 16(10.7%) 7(18.4%) 23(12.2%)
I am well equipped to handle my work responsibilities
Strongly Agree 45(30.0%) 10(26.35) 55(29.3%) 5.655 0.132
Agree 49(32.7%) 7(18.4%) 56(29.8%)
Neutral 28(18.7%) 8(21.1%) 36(19.1%)
Disagree 28(18.7%) 13(34.2%) 41(21.8%)
Total 150(100%) 38(100%) 188(100%)
Source primary field data 2022 * statistically significant at P<0.05

48
The result presented in Table 5 revealed the following factors were found associated with having

roles that match with experience (p<0.001), having experience prepared for a job (p<0.001),

satisfaction with pay, and amount of work (p<0.001), satisfaction with incentives at workplace

(p<0.001), having confidence with job alignment with vocational calling (p=0.025) and having

tried own methods (p=0.035).

4.5 Univariate Analysis of Jobs Characteristic Associated With Job Satisfaction among

Health Workers

Table 7: univariate analysis of job characteristics Associated With Job Satisfaction among

Health Workers

Variables Category Frequency Percentage (100%)

I am noticed when I do a good job
Strongly Agree 95 50.5
Agree 55 29.3
Neutral 38 20.2
I get full credit for the work I do
Strongly Agree 36 19.1
Agree 95 50.5
Neutral 38 20.2
Disagree 19 10.1
I am content with the way layoffs and transfers are avoided in my job
Strongly Agree 57 30.3
Agree 38 20.2
Neutral 76 40.4
Strongly Disagree 17 9.0
I am certain my job provides for steady employment
Strongly Agree 93 49.5
Agree 76 40.4
Neutral 19 10.1
I feel great pressure from work
Strongly Agree 95 50.5
Agree 38 20.2
Neutral 19 10.1
Disagree 19 10.1
Strongly Disagree 17 9.0

49
 I am satisfied with the staff appraisal process
Strongly Agree 38 20.2
Agree 74 39.4
Neutral 76 40.4
I am given adequate feedback on my performance
Strongly Agree 57 30.3
Agree 93 49.5
Neutral 38 20.2
I am satisfied with the equipment’s at my job
Strongly Agree 57 30.3
Agree 57 30.3
Neutral 55 29.3
Disagree 19 10.1
I am cooperative with my co-workers
Strongly Agree 57 30.3
Agree 57 30.3
Neutral 37 19.7
Disagree 37 19.7
I am friendly to my co-workers
Strongly Agree 37 19.7
Agree 57 30.3
Neutral 94 50.0
I make use of my abilities and skills
Strongly Agree 76 40.4
Agree 56 29.8
Neutral 37 19.7
Disagree 19 10.1
I do work that is well suited to my abilities
Strongly Agree 57 30.3
Agree 113 60.1
Strongly Disagree 18 9.6
I am satisfied with the way my boss trains me
Strongly Agree 19 10.1
Agree 131 69.7
Neutral 38 20.2
Total 188 100.0
Source primary field data 2022

The job characteristics assessed in this study showed that 95(50.5%) of the respondents strongly

agreed that they noticed when they do a good job while 38(20.2%) of them strongly disagreed. In

addition, 36(19.1%) of the respondents strongly agreed that they got full credit for the work they

50
do while 19(10.1%) never got credits for the work done. Moreso, 57(30.3%) of the respondents

were contented with way layoffs and transfers while 17(9.0%) of them were not.

Furthermore, our study established that 93(49.5%) of the respondents provided steady

employment while 19(10.1%) of them were neutral. In addition, half 95(50.5%) of the

respondents strongly agreed that they felt great pressure from work while 17(9.0%) of them

never felt pressure from work. Moreso, our study finding indicated that only 38(20.2%) of the

respondents strongly agreed that they were satisfied with the staff appraisal process while

76(40.4%) were neutral to the appraisal. However, only 57(30.3%) of the respondents were

given adequate performance at their job while 19(10.1%) did not get any feed. Interestingly, only

57(30.3%) of the respondents were satisfied with the equipment at work while 19(10.1%) of

them disagreed. Similarly, our study finding established that 57(30.3%) of the respondents were

cooperative with co-workers unlike 37(19.7%) that were dissatisfied with cooperation with co-

workers. However, only 37(19.7%) of the respondents were found friendly to their co-workers as

compared to the 94(50.0%) that were not friendly.

Similarly, our study finding indicated that 76(40.4%) of the respondents made use of their

abilities and skills while 19(10.1%) of them strongly disagreed. In addition, 113(60.1%) of the

respondents strongly agreed that their work well suited their abilities as compared to 18(9.6%)

whose work never suited their abilities. Meanwhile, the study finding revealed that 131(69.7%)

of the respondents were satisfied with the way their bosses trained them while 38(20.2%) were

neutral. Similarly, the key informant stated that health workers take pride in the work they do in

a team. This is what a respond was quoted saying

―My team takes pride in what they do and this makes me satisfied with my role as
a manager. As a manager, I have advocated for career growth to be facilitated by

51
 management, and this has been done. Currently, we have 8 nurses and midwives
pursuing their degree and these are all being catered for by the hospital this has made
them satisfied with their job because there is room for growth, supported by
management”

4.6 Bivariate Analysis of Job Characteristics Associated With Job Satisfaction

Table 8: bivariate analysis of job characteristics associated with job satisfaction

The overall level of job satisfaction

Variables Category Satisfied Dissatisfied Total ᵡ2 P-value
I am noticed when I do a good job
Strongly Agree 88(58.7%) 7(18.4%) 95(50.5%) 27.494 <0.001*
Agree 42(28.0%) 13(34.2%) 55(29.3%)
Neutral 20(13.3%) 18(47.4%) 38(20.2%)
I get full credit for the work I do
Strongly Agree 27(18.0%) 9(23.7%) 36(19.1%) 15.604 0.001*
Agree 85(56.7%) 10(26.3%) 95(50.5%)
Neutral 28(18.7%) 10(26.3%) 38(20.2%)
Disagree 10(6.7%) 9(23.7%) 19(10.1%)
I am content with the way layoffs and transfers are avoided in my job
Strongly Agree 38(25.3%) 19(50.0%) 57(30.3%) 31.723 <0.001*
Agree 23(15.3%) 15(39.5%) 38(20.2%)
Neutral 75(50.0%) 1(2.6%) 76(40.4%)
Strongly Disagree 14(9.3%) 3(7.9%) 17(9.0%)
I am certain my job provides for steady employment
Strongly Agree 69(46.0%) 24(63.2%) 93(49.5%) 19.252 <0.001*
Agree 71(47.3%) 5(13.2%) 76(40.4%)
Neutral 10(6.7%) 9(23.7%) 19(10.1%)
I feel great pressure from work
Strongly Agree 85(56.7%) 10(26.3%) 95(50.5%) 16.684 0.002*
Agree 28(18.7%) 10(26.3%) 38(20.2%)
Neutral 13(8.7%) 6(15.8%) 19(10.1%)
Disagree 10(6.7%) 9(23.7%) 19(10.1%)
Strongly Disagree 14(9.3%) 3(7.9%) 17(9.0%)
I am satisfied with the staff appraisal process
Strongly Agree 23(15.3%) 15(39.5%) 38(20.2%) 29.726 <0.001*
Agree 52(34.7%) 22(57.9%) 74(39.4%)
Neutral 75(50.0%) 1(2.6%) 76(40.4%)
I am given adequate feedback on my performance
Strongly Agree 36(24.0%) 21(55.3%) 57(30.3%) 14.028 0.001*

52
 Agree 81(54.0%) 12(31.6%) 93(49.5%)
Neutral 33(22.0%) 5(13.2%) 38(20.2%)
I am satisfied with the equipment’s at my job
Strongly Agree 56(37.3%) 1(2.6%) 57(30.3%) 17.446 0.001*
Agree 41(27.3%) 16(42.1%) 57(30.3%)
Neutral 40(26.7%) 15(39.5%) 55(29.3%)
Disagree 13(8.7%) 6(15.8%) 19(10.1%)
I do work that is well suited to my abilities
Strongly Agree 56(37.3%) 1(2.6%) 57(30.3%) 19.016 <0.001*
Agree 79(52.7%) 34(89.5%) 113(60.1%)
Strongly Disagree 15(10.0%) 3(7.9%) 18(9.6%)
I am satisfied with the way my boss trains me
Strongly Agree 19(12.7%) 0(0.0%) 19(10.1%) 7.999 0.017*
Agree 98(65.3%) 33(86.8%) 131(69.7%)
Neutral 33(22.0%) 5(13.2%) 38(20.2%)
Total 150(100%) 38(100%) 188(100%)
Source primary field data 2022 * statistically significant at P<0.05

The results presented in Table 7 showed that the following variables were found associated with

job satisfaction among health care workers in this study. For example, ability to notice a good

job done (p<0.001), getting full credit for the work done (p=0.001), being contented with the

way layoffs and transfer are avoided in the job (p<0.001), provision of steady employment

(p<0.001), and have felt pressure from work (p=0.002). In addition, being satisfied with the staff

appraisal process (p<0.001), getting adequate feedback about performance (p=0.001),

satisfaction with equipment at the job (p=0.001), being having work well suited to the abilities

(p<0.001), and being satisfied with the way bosses trained them (p=0.017).

4.6 Determinants of Job Satisfaction among Health Care Workers

In this section, we fitted variables that showed statistical significance with job satisfaction at

bivariate analysis using binary logistic regression model and the results are presented using

adjusted odds ratio at 95% level of confidence.

Table 9 .model summary of factors associated with job satisfaction

53
 Variables P-value COR(95%CI) P-value aOR;(95%CI)
Demographic characteristics
Duration of work at the hospital 0.045
1-4years 0.015* 5.440(1.387-21.333) 0.015 5.440(1.387-21.33)
5-10 years 0.103 2.864(0.808-10.159) 0.103 2.864(0.808-10.159)
>10 years Reference 1
Individual characteristics
I am confident to perform my job
Strongly agree 0.893 0.844(0.071-9.965) 0.437 0.571(0.139-2.345)
Not sure 0.677 1.500(0.223-10.077) 0.211 2.462(0.601-10.084)
Strongly disagree Reference 1
I get a chance to try my methods 0.677
Strongly agree 0.677 1.500(0.223-10.077) 0.012* 3.405(1.306-8.874)
Strongly disagree Reference 1
Job characteristics factors
I am noticed when I do a good job 0.003
Strongly agree 0.001 0.019(0.002-0.204) <0.001 0.088(0.033-0.24)
Agree 0.001 0.009(0.001-0.153) 0.019 0.344(0.141-0.838)
Strongly disagree Reference 1
I get full credit for the work I do 0.021
Strongly agree 0.096 18.397(0.595-568.45) 0.097 0.37(0.114-1.199)
Agree 0.700 0.692(0.106-4.5) <0.001 0.131(0.043-0.398)
Not sure 0.036 36.573(1.259-1062.3) 0.117 0.397(0.125-1.259)
Strongly disagree Reference 1
I am certain to provide employment 0.599
Strongly agree 0.599 1.446(0.366-5.719%) 0.066 0.386(0.14-1.065)
Agree <0.001 0.078(0.022-0.281) <0.001 0.078(0.022-0.281)
Strongly disagree Reference 1
Satisfied with the staff appraisal 0.002
Strongly agree 0.001 101.202(7.433-1377) <0.001 48.913(6.12-390.52)
Agree 0.002 27.602(3.287-231) 0.001 31.731(4.147-242.8)
Strongly disagree Reference
Adequate feedback on performance 0.148
Strongly agree 0.056 4.088(0.964-17.336) 0.015* 385(1.303-11.379)
Agree 0.219 3.043(0.515-17.974) 0.969 0.978(0.319-2.994)
Strongly disagree Reference 1
Satisfied with the equipment’s at the 0.116
job
Strongly agree 0.022 0.067(0.007-0.681) 0.004* 0.039(0.004-0.35)
Strongly disagree 0.999 Reference 1
Source primary field data 2022 * significant variables at p<0.05

54
The multivariate analysis result presented in table9 indicated that respondents that had worked

for one to four years in the hospital had five times increased chances of job satisfaction as

compared to those who worked more than ten years (aOR=5.44;95%CI:1.387 to 21.33,p=0.015).

However, among the individual factors assessed, the study established that respondents that had

chances to try their methods on the job were three times likely to be satisfied with the job as

compared to those who were unable (aOR=3.405;95%CI:1.306 to 8.874,p=0.012).

On the contrary, the study revealed that respondents who got full credit for the work they do

were less likely to get job satisfaction unlike those who strongly disagreed (aOR=0.131; 95%CI:

0.043 to 0.398;p<0.001). Similarly, fewer chances of job satisfaction were observed among

respondents that felt certain to provide steady employment as compared to those who disagreed

(aOR=0.078; 95%CI: 0.022 to 0.281; p<0.001). Meanwhile, significantly higher chances of job

satisfaction were observed among respondents that strongly agreed with the satisfaction of the

staff appraisal process unlike those who were dissatisfied (aOR=48.913; 95%CI: 6.12 to 390,

p<0.001). similarly, the study finding indicated that respondents that had adequate feedback on

work performance were most likely to be satisfied as compared to those who never got adequate

feedback (aOR=385;95%CI:1.303 to 11.379;p=0.015). On the other hand, our study finding

indicated that respondents that we're satisfied with equipment at the job had fewer chances of job

satisfaction, unlike their counterparts that disagreed (aOR=0.039; 95%CI: 0.004 to

0.35,p=0.004).

55
 CHAPTER FIVE: DISCUSSION OF RESULTS

5.0 Introduction
This chapter presents a discussion of the study findings presented in chapter four and compares it

with results got from other studies that assessed factors associated with job satisfaction.

However, the major focus of the discussion will rely on factors that showed statistical

significance with job satisfaction.

5.1 Overall level of job satisfaction

Our study finding revealed that 79.79% of the respondents were found satisfied with their job

while 21.1% were dissatisfied. Our study finding on the level of job satisfaction was higher than

41.17% got from a study conducted in a systematic review in Ethiopia (Hailemichael Kindie

Abate, Chilot Kassa Mekonnen, 2021). Similarly, another study conducted in Ethiopia revealed

that the overall level of job satisfaction was found 41.46% including compensation, recognition

by management, and opportunities for development (Deriba et al. H, 2017). However, a

comparative cross-sectional study conducted in Northwest Ethiopia revealed a 55.2% overall

level of job satisfaction among health workers (Amare Geta, 2021). This was measured from

provider's satisfaction, working in a private hospital, pleasant nature of work, autonomy,

adequate supportive supervision, reward, and recognition as well as high normative commitment.

Therefore, our study obtained a high prevalence of job satisfaction because the respondents were

had opportunities for advancement in their jobs, the spirit of cooperation with co-workers as well

as having friendly co-workers. In addition, the health care workers had chances to try their

method of work, and they had an experience that matches the roles they perform.

56
This implies that to achieve a 100% level of job satisfaction, the health management team at

Hargeisa hospital should continue offering job advancement opportunities to those who never

had the chance, encourage others to work in a team.

5.2 Demographic characteristics of the respondents associated with job satisfaction

The study finding revealed that the marital status of the respondents was found significantly

associated with job satisfaction (p=0.024). Similarly, a study by West Et al., (2011) showed that

personal relationships of health workers are frequently seen to deteriorate as a result of the

demanding and time-consuming nature of their employment. Despite these perceptions, there is

no evidence that health practitioners have worse relationships or are more likely to divorce. On

the other hand, a study done by Yan-Qiong et al. (2019) studied the association between marital

status and job satisfaction found that unmarried health employees were dissatisfied with their

employment more than married health workers and that marriage substantially and positively

connected with job happiness (Yan-Qiong Etal., 2019). Thus, our study finding attributed to

adequate payment of incentives, the salary that matches with the work assigned for the

respondents, and provision of incentives for work overtime. Thus, job satisfaction is easily

achieved when all the respondents have access to work overtime stipends, incentives that match

with work assigned for them.

Furthermore, our study result indicated that the job satisfaction of the respondents was

influenced by job cadre (p=0.001). The human resources issue has had a significant influence on

the health systems of many African nations, resulting in high vacancy rates across practically all

health professional cadres. Malawi, on the other hand, has a history of employing cadres of

health professionals with shorter periods of training, such as registered nurse-midwives, clinical

officers, and medical assistants, who have constituted the backbone of the healthcare system.

57
In the process, much of the obstetric work traditionally carried out by doctors has been shifted to

clinical officers, who perform as much as 93% of major emergency obstetric operations in

government hospitals and 78% in mission facilities, with comparable postoperative outcomes.

(Elisha McAuliffe, et al., 2009). Thus, hospital administrators should employ health workers

according to their cadres and respective qualification to avoid assigning work meant for doctors

to nurses and midwives.

Similarly, the study finding revealed that duration of work at the hospital influenced health

workers' satisfaction with the job (aOR=5.44; 95%CI:1.387 to 21.33,p=0.015). Moreso,

respondents that had worked for one to four years in the hospital had five times increased

chances of job satisfaction as compared to those who worked more than ten years. Similarly,

Hossein Shahnaz et al (2014) discovered a substantial and unfavorable relationship between job

satisfaction from supervision and working experience. This finding was consistent with the result

got by Tazhibi’s study. Moreso, the greater the working experience, the greater the job

discontent (M. Tazhibi, 2011). It appears that as supervisors' working experience grows, they

want their ideas to be used in decisions and their work to be praised; nevertheless, the

administrative hierarchy will not always allow these expectations to be satisfied. Thus our study

suggests that as health workers take long in the services should be introduced to the management

of emerging and re-emerging diseases to improve on their level of knowledge to stick to the

required guidelines for treatment.

58
5.3 Individual factors associated with job satisfaction

The study established that respondents that had chances to try their methods on the job were

three times likely to be satisfied with the job as compared to those who were unable

(aOR=3.405;95%CI:1.306 to 8.874,p=0.012). Similarly, it was revealed in a study that

recognizing employees' autonomy when on duty motivates them to work with morals. Work

autonomy enables health workers, following their competence and experience, to make choices

coupled with the complexity of their work and to the varying job demands, job independence

allows them to make full use of their increased knowledge, handle problems efficiently and

enhance the responsibility for work outcomes parties (Oldham, G. R., Hackman, J. R., 2010).

Our study finding is attributed to training opportunities given to the health care workers to

advance in their area of specialty as well as giving them work that aligns with the vocational

roles and responsibilities. Thus, there is the need for health care workers to encourage their

colleagues to engage in training activities to improve health services delivery their methods but

sticking to the recommended guidelines by the ministry of health Somaliland.

In addition, our study finding indicated that respondents that had roles that match with their

experience were found satisfied with their job (p<0.001). Similarly, (Rukhmani, et al, 2010)

stated in their study that management should evaluate the importance of each position,

performance-based remuneration, personal or special allowances, fringe perks, and pensions

when creating wage structures, etc. Most health professionals in many countries make less than

the minimum living wage, and public sector workers' earnings are sometimes unjustly low when

compared to others in similar jobs, affecting the quality of care offered in hospitals.

This is because equal pay will be difficult to achieve in many countries, health professionals

may search for ways to supplement their low salaries by working part-time. Therefore, the

59
hospital management team should stick to giving work assignments according to their area of

qualification to achieve job satisfaction and in case someone is crossing to work in another

department, there should be refresher training organized to introduce the workers to guidelines

required to work in that particular department.

In addition, our study finding revealed that having had an experience that prepared respondents

for the current job influenced their job satisfaction unlike those who never had experience

(p<0.001). Our study finding is attributed to the availability of training opportunities, adequate

feedback of performance, staff appraisals which influenced them to improve on their work

performance.

Moreso, the study finding revealed that being satisfied with pay and the amount of work assigned

to the respondents influenced them to be satisfied with the job (p<0.001). Similarly, our study

also established that job satisfaction among the health care workers was found associated with

incentives at the workplace. Related to our study finding, salary and income inequality have an

impact on health professionals as evidence showed that relatively low income may lead to

dissatisfaction and motivation loss, as well as migration to higher-paying jobs. Low wages and

income, along with a lack of pension and insurance programs, have been connected to low work

satisfaction and insufficient oral health services, according to studies by Shemdoe and colleagues

(2016). In addition, a study revealed that essential rewards, such as income and compensation,

motivate health professionals, which have a direct influence on the employee's performance in

health services (Kalimullah, et al., 2010).

Thus, it is recommended that healthcare personnel should be helped to be more effective since

rewards are management tools that influence individual or group behavior. Health institutions

60
utilize pay, promotion, incentives, and other types of compensation to inspire and motivate

employees to perform at high-level intrinsic rewards.

Moreover, our study result showed that respondents that had confidence with job alignment with

their vocational calling had an association with job satisfaction (p=0.025). Our study finding

corresponds with the result got by Mozumdar, A (2012), who stated that self-esteem is highly

positively connected with work satisfaction. Individuals that have a high sense of self-esteem are

primarily engaged in collaborating with others. Later, Cherabin et al. (2012) discovered a link

between self-esteem and job satisfaction. The self-esteem of health information management

personnel is delineated as the overall sense of their self-worth or personal worth that is typically

seen as a personality trait that tends to be stable and enduring. This study has considered

Hackman and Oldham's model (1976) as a base to predict job satisfaction. Therefore, our study

suggests that health administrators should ensure that health care workers are consistently

assigned duties that align with vocational training to achieve 100% job satisfaction.

5.4 Job Characteristics Factors associated with job satisfaction

The study revealed that respondents that got full credit for the work they do were less likely to

get job satisfaction unlike those who strongly disagreed (aOR=0.131; 95%CI: 0.043 to

0.398;p<0.001). Similarly, our study established fewer chances of job satisfaction among

respondents that felt certain to provide steady employment as compared to those who disagreed.

Our study finding corresponds with the result which showed that a lack of proportionality

between efforts and benefits may result in unpleasant sensations that, in turn, stimulate good

emotions and well-being with sufficient remuneration (e.g. recognition). This is intriguingly

comparable to Vera Akafo's study in Ghana. According to Peter Agyekum Boateng (2015), the

Impact of Reward and Recognition on Job Satisfaction and Motivation, incentives and

61
recognition play a critical role in motivating health professionals and increasing performance

(Lawler,2013). A well-structured incentive system may significantly increase a hospital's

efficacy and productivity. Our study finding is attributed to the fact very few respondents were

credited for the work done as compared to the majority which never got credit for the work they

did. Thus, it's important to treat all employees equally in terms of giving overtime offers,

incentives as well as giving credit for the work and recommending for areas of corrections in

case there is a mistake in the tasks accomplished.

Meanwhile, our study finding indicated significantly higher chances of job satisfaction among

respondents that strongly agreed with the satisfaction of the staff appraisal process unlike those

who were dissatisfied (aOR=48.913; 95%CI: 6.12 to 390, p<0.001). The performance of health

professionals is the backbone of excellent service delivery in the healthcare industry (Chegenyea,

et al., 2015). The fundamental goal of performance evaluation is to maximize job quality and

increase the quality of health professionals' services (Choudhary and Puranik, 2014). Thus,

healthcare institutions must design a strategy for measuring the skills, knowledge, and attitudes

required of healthcare service professionals. This criterion is used to judge how effectively health

staff performs and to identify areas for improvement. In addition, creating a performance

assessment program in a health facility allows management to monitor employees' performance

while also motivating employees by enhancing morale, which leads to increased quality of health

workers' practice.

Furthermore, the study finding indicated that respondents that had adequate feedback on work

performance were most likely to be satisfied as compared to those who never got adequate

feedback (aOR=385;95%CI:1.303 to 11.379;p=0.015). Relatedly, Coughlin (2010) found that in

62
a survey of staff nurses, health professionals rated peer recognition as very important. Providing

timely recognition and appreciation for good performance has been identified as a habit that has

a direct influence on the workplace satisfaction of health workers, particularly nurses. In

addition, Robbins (2009) found that cognitively demanding work, equitable compensation, a

supportive working environment, and helpful coworkers are the most significant characteristics

that contribute to job satisfaction. These contribute to the study's goal. Thus, when supervisors

continue to appreciate roles by employees, all of them will be satisfied due to the little

recognition that they have contributed to the success of the goal.

On the other hand, our study finding indicated that respondents that we're satisfied with

equipment at the job had fewer chances of job satisfaction, unlike their counterparts that

disagreed. This is in line with the result got from a study that revealed that lack of proper

medical equipment management has limited health facilities' capacity to deliver adequate quality

dental healthcare services. Many pieces of dental healthcare equipment in hospitals are non-

functional, unusable, or poorly maintained. As a result, the majority of the time, the country's

limited resources are ted, and people's health care is jeopardized(Perry, 2011). Our study

finding is attributed to the fact very few respondents agreed that they had equipment at the job

while the majority never had any medical equipment which led to dissatisfaction. Thus,

healthcare technology management must always guarantee that medical equipment and other

systems used in dental healthcare are safe and in excellent working order, and to do so, effective

equipment management.

63
 CHAPTER SIX CONCLUSION AND RECOMMENDATIONS

6.0 Introduction

Chapter six presents a summary of study findings focusing on conclusions and

recommendations.

6.1 Conclusions

Our study finding revealed that the overall level of job satisfaction among health care workers

was significantly higher as compared to findings in other studies. This was attributed to the

availability of training opportunities, incentives, and overtime payment. However, factors that

influenced job satisfaction are presented according to the specific objectives below.

Demographic characteristics associated with job satisfaction were marital status, job title, and

duration at work.

Individual factors associated with job satisfaction included having had an experience that

prepared them for the current job, satisfaction with pay and amount of work, satisfaction with

incentives at the workplace, having confidence in job alignment with vocational calling, and

having had opportunities to try own method of work.

Job characteristics factors associated with job satisfaction were the ability to notice good job

done, getting full credit for the work done, being contented with the way layoffs and transfer are

avoided in the job, provision of steady employment, and having felt pressure from work. In

addition, being satisfied with the staff appraisal process, getting adequate feedback about

performance, satisfaction with equipment at the job, is having work well suited to the abilities,

and being satisfied with the way bosses trained them.

64
6.2 Recommendations

To achieve job satisfaction, all health care workers should have equal access to work

overtime stipends, incentives that match with work assigned for them.

Our recommends that as health workers take long in the services, they should be

introduced to the management of emerging and re-emerging diseases to improve on their

level of knowledge to stick to the required guidelines for treatment.

The hospital management should create a performance assessment program to allow

management to monitor employees' performance while motivating them by enhancing

morale that leads to increased quality of health workers' practice.

There is the need for health care workers to encourage their colleagues to engage in

training activities to improve health services delivery in their methods but sticking to the

recommended guidelines by the ministry of health Somaliland.

For successful and well performing institution, the management of HGH should ensure

that the health workers are well equipped with information and required skills for the job.

Healthcare technology management must constantly ensure that medical equipment and

other systems used in medical healthcare are safe and in good operating condition, and

effective equipment management is required to achieve so.

The management of Hargeisa group hospital should look for ways of improving Level of

salary/incentives or remuneration for the different level health workers better so as to

increase their job satisfaction.

The research recommends that future studies compare public and private institutions,

demonstrating that health workers in private facilities are more satisfied than those in

public facilities (Amare Geta, etal., 2021) .

65
The study suggests that long-term staff should protect and respected at the hospital as
they have significant levels of experience that should not be lost through attrition. It is
also important to avoid any factor that could result in burn out to hospital staff.

66
 REFERENCES
AVINASH PATHARDIKAR, SANGEETA SAHU, ABHINAV SRIVASTAVA (2019) Self-

esteem and Work Engagement influencing Job Satisfaction.

AMARE GETA, GASHAW ANDARGIE BIKS, ENDALKACHEW DELLIE, AND LAKE

YAZACHEW.(2021) Job Satisfaction and Associated Factors among Health Professionals

Working at Public and Private Hospitals in Bahir Dar City, Northwest Ethiopia: A Comparative

Cross-Sectional Study.

BAAH, K., & AMOAKO, G. K. (2011). Application of Frederick Herzberg’s Two-Factor

Theory in Assessing and Understanding Employee Motivation at Work: a Ghanaian Perspective.

European Journal of Business and Management, 3(9), 1-8.

BEKRU ET, CHERIE A, ANJULO AA. (2017) Job satisfaction and determinant factors among

midwives working at health facilities in Addis Ababa city, Ethiopia. PLoS One.;

BLAAUW D, DITLOPO P, MASEKO F, CHIRWA M, BIDWELL P, THOMAS S, ET AL.

(2013) Comparing the job satisfaction and intention to leave of different categories of health

workers in Tanzania, Malawi, and South Africa. Glob Health Action.

CARUSO CC. (2014). Negative impacts of shift work and long working hours. Journal of

rehabilitation nurses. 39(1):16‒25.

DERIBA BK, SINKE SO, ERESO BM, BADACHO AS. (2017) Health professionals’ job

satisfaction and associated factors at public health centers in West Ethiopia. Hum resource Health.

67
GELETO A, BARAKI N, ATOMSA GE, DESSIE Y. (2015) Job satisfaction and associated factors

among health care providers at public health institutions in Harari region, eastern Ethiopia : a cross

- sectional study. BMC Resource Notes.

HERZBERG, F (1966). Work and the Nature of Man. World Publishing Company

HUNJRA AI, CHANI MI, SHER A, AZAM M, KASHIF-UR-REHMAN (2010). Factors

effecting job satisfaction of employees in Pakistani banking sector. Afr. J. Bus. Manag, 4(10):

2157-2163.

KUMAR R, AHMED J, SHAIKH BT, HAFEEZ R, HAFEEZ A, KUMAR R, AHMED J,

SHAIKH B, HAFEEZ R, HAFEEZ A. (2013) Job satisfaction among public health

professionals working in public sector: a cross sectional study from Pakistan. Hum resource

Health.

LAI, H-H (2011), 'The influence of compensation system design on employee satisfaction',

African Journal of Business Management, vol 5, no. 26, pp. 1078-10723.

MASLOW, A. H. (1943). A theory of human motivation. Psychological Review, 50(4), 370-

396. https://doi.org/10.1037/h0054346

NIKPEYMA, N., SAEEDI, Z. AZARGASHB, E. MAJD, H. (2014). Problems of clinical Nurse

Performance Appraisal System: A Qualitative Study. Asian Nursing Research, Vol. 8, pp.: 15-22

OLDHAM, G.R. AND HACKMAN, J.R. (2010), “Not what it and not what it will be: the

future of job design research”, Journal of Organizational Behavior, Vol. 31.

68
PILLAY, R. (2009). Work satisfaction of professional nurses in South Africa: a comparative

analysis of the public and private sectors. Hum Resource Health. 2009, 7: 15-10.1186/1478-

4491-7-15.

RAFIQ, M., JAVED, M., KHAN, M., & AHMED, M. (2012). Effect of Rewards on Job

Satisfaction Evidence From Pakistan. Interdisciplinary Journal of Contemporary Research in

Business.4 (1).

SARAH NYAMBURA WAMUNYU (2016). Factors Influencing Health Workers’ Job

Satisfaction In Public Hospitals: A Case Of Kiambu Level Four Hospital In Kiambu County,

Kenya.

TEMESGEN K, AYCHEH MW, LESHARGIE CT. (2018) Job satisfaction and associated

factors among health professionals working at Western Amhara region, Ethiopia. Health Qual

Life Outcomes.;16:1–7.

TIMALSINA R, RAI L, GAUTAM S, PANTA P.(2015) Factors Associated With

Organizational Commitment among Nurses. J Stud Manag Plan.

WORLD HEALTH ORGANIZATION (2013). The World Health Report: Working Together for

Health. Geneva:

EILISH MCAULIFFE,A OGENNA MANAFA,B FRESIER MASEKO,C CAMERON

BOWIE,D EMMA WHITEE (2009) Understanding job satisfaction amongst mid-level cadres in

Malawi: the contribution of organizational justice. Reproductive Health Matters

2009;17(33):80–90.

LATIP, H., TAK, A., RAHAMAN, M., & ABDUL KOHAR, U. (2018). Managing Work-Life-

Family Demands towards Job Satisfaction among Family Business Entrepreneurs.

EL RAHMAN, R. (2017). The relationship between intent to leave. Academia. Edu.

69
 APPENDECIS

APPENDIX I: CONSENT FORMS AND QUESTIONNAIRE

Dear respondent

Iam Adnan Abdilahi Matan, a postgraduate student of Clarke International University in the

School of Public Health and Management. As a partial fulfillment to the qualification of Master

of Public Health. I am currently carrying out a study about ―Factors Influencing Health Workers

Job Satisfaction in Hargeisa Group Hospital, Hargeisa-Somalia‖ I humbly request you to be one

of the participants in this study and your cooperation will be of great importance to this study.

The research is purely for academic purposes. The responses that you willingly give will

facilitate the completion of the study and will enable us gain an in-depth understanding on the

above issues. The information you provide will be kept confidential and will not be shared with

third party. The researcher; assure you of strict confidentiality that is why your name is not

required. Thanks for your anticipated valuable time and assistance.

SECTION A: SOCIO-DEMOGRAPHIC CHARACTERISTICS

Please take time to read and answer each question carefully by making (✓) or tick the best
alternative that represents your response. Please do not write your name.
1. Gender
a).Male b). Female
2. Age
a).20-25 b). 26-30
c).31-35 d). 34-40
e).41 years and above
3. Marital Status

a). Single b). Married c). Widow d).Divorced

Others specify…………………………………………………………….
4. How many children do you have?...........................................................................

70
5. How many dependents do you have to take care of including your biological children?
............................................................................................................................................................
6. Level of Education
a). Certificate b). Diploma
c).Degree d).Post-graduate Diploma
e) Master
5. Employment Status
a).Permanent b).Temporary
c).Part Time e).Other ………………..
7. Job Title

a). Doctor b). Midwife c).Nurse

d) Pharmacist f) Lab Technicians g) other staffs

8. How long have you been working at Hargeisa group hospital

a). 1-4yrs b). 5-10yrs c). More than 10yrs
9. Years of experience

a) 6month - 1 year b) 1-5 years

c) More than 5 years

SECTION B

Instructions: please write your rating on the space before each option which corresponds to your

best choice in terms of level of motivation. Kindly use the scoring system below:

Score Response Mode Description

1 Strongly Agree You agree with no doubt at all Very satisfactory

2 Agree You agree with some doubt Satisfactory

3 Neutral You are not sure about None

4 Disagree You disagree with some doubt Fair

5 Strongly Disagree You disagree with no doubt at all Poor

71
 Part I: Job Satisfaction among Health Workers
No Statement 1 2 3 4 5

1 I am able to see the results of the work I do

2 I take pride in a job well done

3 I am given opportunities for advancement on this job.

4 I get the chances of getting ahead on this job Promotions are given out on
this job
5 I am able to do something worthwhile.

6 I am satisfied with the spirit of cooperation among my co-workers.

7 I get the chance to try out some of my own ideas.

Part II: The individual characteristics associated with job satisfaction among health
workers

No Statement 1 2 3 4 5

1 I am in role that matches the needs of the experience

2 My experience has prepare me for this job

3 I am satisfied with the pay and amount of work I do

4 I am satisfied with the incentives provided at my workplace

5 I am confident this job aligns with my vocational calling.

6 I believe I have been called to do the job

7 I get the chance to try my own methods of doing the job

8 I am confident in my ability to perform my job very well

9 I am well equipped to handle on my work responsibilities

72
Part III: The job characteristic associated with job satisfaction among health workers

No Statement 1 2 3 4 5
1 I am noticed when I do a good job

2 I get full credit for the work I do

3 I am content with the way layoffs and transfers are avoided in my job

4 I am certain my job provides for steady employment

5 I feel great pressure from work.

6 I am satisfied with the staff appraisal process.

7 I am given adequate feedback on my performance.

8 I am satisfied with the equipment’s at my job

9 I am cooperative with my co-workers

10 I am friendly to my co-workers

11 I make use of my abilities and skills

12 I do work that is well suited to my abilities

13 I am satisfied with the way my boss trains me

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 APPENDIX II: KEY INFORMER INTERVIEW GUIDE
1. Kindly tell us the status of level of job satisfaction among health workers in your

facility?.………………………………………………………………………………

………………..........................................................................................................

2. Do think there could be some challenges that may contribute to dissatisfaction among

the staff? …………………………………………..……………………………………

…………………………..………………………………………………………………

3. How has the hospital used the factor of remuneration to satisfy health workers on

their jobs? ……………………………………………………………………………..

……………......................................................................................................................

4. How long they have been employed at Hargeisa group hospital?

………………………………………………………………………………………………

………………………............................................................................................................

5. How often they get staff appraisal and if the enjoy staff appraisal?

………………………………………………………………………………………………

………………………............................................................................................................

6. How has recognition and promotion motivated you to work hard to create effective

health service delivery by the hospital?

………………………………………………………………………………………

7. Do you have additional measure in place to increase your workers job satisfaction?

…………………………………………………………………………………………

……..................................................................................................................................

Thanks you

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 APPENDIX III: COVID 19 RISK MANAGEMENT PLAN

To foster an agile approach to Corona Virus Disease of 2019 (Covid-19) which is caused by the

novel corona virus and is the world’s new normal, we have considered a collaboration of risk

prevention functions and leveraged the use of new skills and tools. It has also been made clear

that we must have a plan to manage and monitor all serious risks, and be prepared for those risks

to escalate in the future regardless of how unlikely that may seem at the present time.

I am therefore sharing some of the recommendations and practices we have put together for our

data collection teams operating amidst Covid-19 to provide safety for both the team and the

participants. We want to remain transparent about the steps we are taking to mitigate risks to our

research team and the communities in which the study will be conducted.

The goal here is to protect our field research team and the study communities from Covid-

19 by emphasizing strong practices around risk reduction, including social distancing and

good hygiene. These practices are outlined below;

Education of research team and study communities about Covid-19

● Clearly communicate to the data collection team that the aim is to both protect them and

surrounding communities from Covid-19. We aim to help the team understand what

Covid-19 is, its cause, how it spreads, how they could get infected and infect others, its

symptoms and how long symptoms may take to manifest upon infection.

● Prepare research team to share information to the study participants about the

preventative practices they will be adopting. These conversations may increase interview

length so our per-day data collection goals may need to be adjusted.

● Ask the research team to keep an ear-to-the-ground and share any misinformation or

rumors about Covid-19 spreading, involving the team or otherwise. We will build this

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 into a debriefing and reporting to ensure we are maintaining the trust of the communities

we will work with.

Provision of sanitization supplies

● Research team will be provided with, face masks, soap, hand sanitizers and screen-

cleaning materials. Hand sanitizer must contain at least 60% alcohol.

● The research assistants and key researcher will carry with them these supplies to all study

sites visited everyday as needed.

● These supplies will also be provided to study participants where necessary (where the

participant does not already have their own supplies).

Interview procedures

The research team will employ precautions when interviewing the study participants. For

participants who may be elderly and/or sick (including cough and/or flu), extra precaution will

be taken. Phone interviews will be considered. These precautions are;

● Maintaining a social distance of greater than 2 meters.

● Where necessary, teams will opt out of interviews with the elderly and/or coughing

and/or immunocompromised, or consider doing phone interviews.

● Where possible, research team will call ahead to assess the situation at study site before

proceeding to visit the site to carry out the interviews.

Planning and executing trainings and debriefs

The training of the research assistants and the regular debriefs during data collection will be

carried out while strictly ensuring the Ministry of Health guidelines for prevention of spread of

Covid-19 are observed as strictly as possible.

Going digital

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Where deemed necessary and possible, in-person meetings will be converted to virtual meetings,

whether via online meeting platforms like zoom. This will be applied between the study

participants and/or the principal investigator and research assistants.

Practice social distancing during in-person meetings

● Where physical meetings cannot be avoided, meeting and greeting practices have to be

changed to observe Ministry of Health guidelines on Covid-19 prevention and spread.

This means that we have to ensure social distancing is observed at all times by

maintaining a physical distance of at least 1.5 meters when greeting each other and

during the entire meeting. The use of greeting gestures will be employed to discourage

hand shaking.

● When possible, shift data collection conversations out-of-doors or to more well-ventilated

spaces. Meetings will be conducted outdoors in comfortable and practical spaces while

still ensuring social distancing, hand hing/ sanitizing and mask wearing.

● Alternatively, meetings can be held within healthy indoor spaces: a space that is well-

ventilated and allows people to sit or stand at least 6ft/2m apart. This will be actively

encouraged, for example, by the arranging of chairs, to promote social distancing.

Mask wearing

All the study participants and research team members will be provided with recommended face

masks, which must be worn at all times in the duration of face-to-face meetings and/or

interviews.

Practice hygienic behavior

The practice of excellent hand hygiene will be encouraged to all study participants and strictly

practiced by the research team. Thorough hand hing with soap and water is always preferable to

77
the use of hand sanitizers and will be practiced whenever possible. Hand sanitizers will always

be at hand for use if hand hing is not feasible. Proper hand hygiene will be encouraged and

practiced at the following points throughout the day:

● After cough, sneeze or blow your nose

● Before and after touching eyes, nose or mouth

● After each interview or other social interaction

● After close physical contact with anyone who is unwell

● After traveling

● After exchanging money

● After using an Automatic Teller Machine

● Before and after eating

● After using the toilets

Proper hand hing guide:

● Wet your hands with running water, and then turn off the tap.

● Lather your hands by rubbing them together with the soap. Lather the backs of your

hands, between your fingers, and under your nails.

● Scrub your hands for at least 20 seconds.

● Rinse your hands well under clean, running water.

● Dry your hands using a clean towel or air dry them.

● If, given the context, you were not able to h your hands for a full 20 seconds, you can

always follow up with sanitizer once dry.

Proper hand sanitizing guide:

78
 ● Apply the hand sanitizer product to the palm of one hand (read the label to learn the

correct amount).

● Rub your hands together.

● Rub the product over all the surfaces of your hands and fingers until your hands are dry.

This should take around 20 seconds.

Other hygienic tips:

1. Sneeze and cough into your elbow, handkerchief or disposable tissue.

2. Don’t spit in the open.

3. Try to avoid touching your face and h and/or sanitize hands if you do.

79
 APPENDIX IV: TIME FRAMEWORK
Year 2021

Deliverable Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov

Identify research

area

Formulate

research strategy,

design and select

methods

Write research

proposal

Proposal

approval

Data collection

Data analysis

Dissertation

writing

80
APPENDIX V: RESEARCH BUDGET

Items Item Number of Price per unit Total

description Units

Transportation Care payment 1 30 30

Paper printing 1 30 30
Printing

Internet Bundles 1 50$ 50$

services

Travel 1 635$ 635$

Total cost 745$

81