Original Research
Factors influencing workplace satisfaction and retention of Paediatric and Child Health Clinical Officers in Malawi's public health sector: a mixed-methods study
AUTHORS
Farzana Yasmin1 MD, Researcher
Peter Moons2 MD, Senior Lecturer *
Ajib Phiri3 MMED (Paed), Associate Professor
Sebastian Appelbaum4,5 DiplStat, Researcher
Laurine Nserebo-Banda6 BScN, Child Health Nurse
Carsten Krüger1 FRCPCH, Senior Lecturer and Reader 
#Ralf Weigel1 FRCPCH, Endowed Chair
#Yamikani FG Chimalizeni2 FCPAED, Head of Department of Paediatrics and Child Health
#Contributed equally
AFFILIATIONS
1 Friede Springer Endowed Professorship of Global Child Health, Witten/Herdecke University, Witten, Germany
2 Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Campus Blantyre, Malawi
3 Department of Paediatrics and Child Health, Kamuzu University of Health Sciences, Campus Lilongwe, Malawi
4 Centre for Clinical Trials, Witten/Herdecke University, Witten, Germany
5 Department of Psychology and Psychotherapy, Witten/Herdecke University, Witten, Germany
6 Paediatrics–Haematology–Oncology, National Cancer Centre, Lilongwe, Malawi
ACCEPTED: 21 May 2025
Early Abstract:
Introduction: Malawi’s paediatric and child health workforce faces a critical shortage. In response, the Kamuzu University of Health Sciences (KUHeS) has been training 29 Clinical Officers (COs) in a Bachelor of Science in Paediatric and Child Health (BSc PCH) program since 2012 to serve as paediatric and child health district leaders in mostly rural areas. However, little is known about their workplace reality, and how it affects their fulfilment professionally as such information may have policy implications. Therefore, we aimed to investigate Malawian BSc PCH COs’ workplace satisfaction, retention and its influencing factors.
Methods: In a mixed-methods, sequential explanatory design study, we used a quantitative workplace satisfaction survey (5-point Likert scale) covering 11 dimensions, and qualitative in-depth interviews. Analysis included paired t-tests applied to Herzberg’s two factor theory of individual needs’ dimensions contributing to workplace satisfaction. During data collection in 2022, 27 (93%) COs participated in the survey and 15 COs and 14 key informants in in-depth interviews.
Results: BSc PCH COs worked at public district hospitals (n=13), public central hospitals (n=8), and at non-governmental organizations (NGOs) (n=6). Moral satisfaction and workplace/team harmony dimensions scored highest with means (standard deviation (SD)) of 3.94 (0.50) and 3.85 (0.69), respectively. In contrast, career advancement and salary and benefits scored lowest with 2.01 (0.99) and 2.46 (0.80), respectively. Differences existed between COs at public district vs public central hospitals for the dimensions of task (e.g. variety, specific job description) (p=0.03), work environment (p=0.006), and salary and benefits (p=0.03). Similarly, COs at public district hospitals vs NGOs differed for the work environment (p=0.016), management style (p=0.003), and salary and benefits (p=0.002). Seventeen COs considered leaving their current position, with salary being a significant reason (p=0.048). Moreover, delayed recognition and promotion, non-specific job descriptions, limited professional development opportunities, a lack of supervision, and career advancement barriers obstructed workplace satisfaction, according to the in-depth interviews.
Conclusion: BSc PCH COs program graduates’ workplace satisfaction differs according to the workplace. Graduates working in public hospitals at district level, located mostly in rural areas, appear to be most critically affected and may leave government services. Changes in their specific work environment, career and professional development and remuneration may offer stakeholders opportunities to improve BSc PCH COs’ workplace satisfaction and retain them where they are needed most.
Keywords: child health, clinical officer, Malawi, mixed-methods study, retention in rural areas, workplace satisfaction.