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

Background: The impact of federalization on health workforce satisfaction remains inconclusive. There is paucity of literature on how decentralization affects health personnel’s motivation and performance. Nepal’s transition to federalism has been ongoing for a decade, yet only few studies have examined its impact on health workers. It is essential to understand factors that affect satisfaction of health workforce in order to ensure seamless delivery of health care. Therefore, this study aimed at assessing the level of job satisfaction among local-level health workers in Sudurpashchim (Far western) province of Nepal. Methods: A cross-sectional study was conducted among 444 health workers in Sudurpashchim Province. Job satisfaction was measured using a five-point Likert scale which has 31 items across three domains: working environment; employment adjustment process and policy; and local governance. The association between job satisfaction and independent variables were examined using Chi-squared test followed by multiple logistic regression. Results: The overall job satisfaction rate was 14.9%, with 34.7% satisfied with the working environment, 16.2% with local governance, and only 4.3% with the employee adjustment process and policy. The Gazetted Officers were less likely to be satisfied (adjusted odds ratio (AOR): 0.48; 95% confidence interval (CI): 0.27, 0.86) compared to their non-gazetted counterparts such as assistants and clerks. Similarly, those with a master's or higher degree (AOR: 0.38; 95% CI: 0.16, 0.89) were less likely to be satisfied with the working environment. Employees from the mountainous regions were less likely to be satisfied with local governance (AOR: 0.38; 95% CI: 0.15, 0.99) compared to their counterparts from hilly/Terai regions. Conversely, health workers serving in the health sections of municipalities were more satisfied than those working in peripheral health facilities (AOR: 2.03; 95% CI: 1.12, 3.65). Conclusion: Overall job satisfaction among the health workers was notably low, particularly in relation to the policies and procedures surrounding employee adjustment following Nepal’s federalization. This phenomenon necessitates rigorous inquiry into poor satisfaction and identifying their underlying causes. Concurrently, it is imperative that the state governments proactively engage with and address the discontent expressed by health workers regarding the adjustment mechanisms, while also prioritizing the strategic expansion of professional advancement opportunities, particularly in geographically marginalized, resource-constrained, and difficult regions such as the Himalayan areas.