Factors Influencing the Retention of Female Primary Healthcare Workforce at Primary Health Care Facilities in Bhutan: A Cross-sectional Study

Abstract

Retention of the female primary health care (PHC) workforce in PHC facilities is pivotal in achieving sustainable development goals, particularly concerning maternal and child health. Though the policy mandates at least one female Health Assistant (HA) in every PHC facility, Bhutan is yet to achieve the target. This study aimed to explore factors influencing the retention of the female PHC workforce at the PHC facilities in Bhutan.

A cross-sectional questionnaire survey was employed among all 165 female HAs working in PHC facilities across 20 districts in Bhutan. The questionnaires were developed based on the World Health Organization rural retention framework which comprised of six domains. Data were collected online using a structured close-ended self-administered questionnaire. Descriptive statistics including frequencies, percentages, means, standard deviations, maximum and minimum, bivariate analysis, and multivariate linear regression analysis were performed. The statistical significance was accepted at ρ-value <0.05.

The results showed that participants indicated a higher sense of retention in rural areas (3.52±0.92). The retention of female HAs was positively significantly associated with age (ρ=0.012, b=0.088), average monthly income (ρ=0.003, b=0.002), number of years in service (ρ=0.004, b=0.091), personal origin and values (ρ<0.001, b=0.251), family and community aspects (ρ<0.001, b=0.172), working and living conditions (ρ<0.001, b=0.181), career-relates (ρ<0.001, b=0.152), financial aspects (ρ<0.001, b=0.303), and bonding or mandatory service (ρ<0.001, b=0.254). The multiple regression analysis showed that financial incentives (ρ<0.001, b=0.215) and working & living conditions (ρ=0.012, b=0.100) were the predictors that influence the retention of female HAs in PHC facilities. The explanatory power (Adjusted R2) of the retention in PHC facilities was 20.3%.

The findings from this study indicated factors influencing the retention of the female HAs in Bhutan are multifactorial. Thus, addressing female PHC workforce shortages will require the development of a comprehensive approach. A particular focus should be given to creating a supportive working and living environment, and sustaining the provision of financial incentives as provided today

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