Perceived workload of healthcare providers delivering free maternal services: An analytical cross-sectional etudy based on the National Aeronautics and Space Administration Task Load Index (NASA-TLX) in primary health care facilities in Kananga, Democratic Republic of the Congo

Background Since 2021, the Democratic Republic of the Congo has implemented a free maternity care policy. This policy is likely to increase the demand for maternal health services, potentially creating additional challenges in managing workload if it is not accompanied by an adequate health workforce. This study aimed to quantify the perceived workload of healthcare providers and identify associated factors within this specific policy context. Methods An analytical cross-sectional study was conducted among 129 healthcare professionals (midwives, birth attendants, and nurses) exhaustively recruited from 36 health facilities selected by convenience sampling. Workload was measured via the National Aeronautics and Space Administration Task Load Index (NASA-TLX) tool. Data were collected through face-to-face administration of a structured questionnaire at the end of participants’ work shifts. Descriptive and inferential statistical analyses were performed via STATA version 18. Measures of central tendency, including means and medians, were calculated. The Mann–Whitney and Kruskal–Wallis tests were applied to compare Raw-TLX scores across groups. Spearman’s correlation was used to assess the associations between the Raw-TLX dimensions and the overall score. Multiple linear regression with robust standard errors was conducted to identify factors independently associated with Raw-TLX. Statistical significance was set at p < 0.05. Results The overall median workload score (raw-TLX) was 69.2% (IQR 7.5), indicating a high workload. The mean scores for each workload dimension were also high: mental demand, 67.9 ± 8.7; physical demand, 69.0 ± 10.6; temporal demand, 70.5 ± 8.5; performance, 68.9 ± 10.1; effort, 67.1 ± 9.6; and frustration, 68.4 ± 6.1. The Spearman correlations between the Raw-TLX dimensions and the overall score were statistically significant (p < 0.001), with the highest coefficients observed for frustration (ρ = 0.73), effort (ρ = 0.70), and performance (ρ = 0.67). Older age (≥ 60 years) was significantly associated with increased Raw-TLX scores (B = 0.486; p = 0.0000). Conclusions Healthcare providers experience a globally high workload in the context of free maternity care policy, which is largely explained by advanced age. Workforce rejuvenation could help mitigate the effects of age-related workload burden. Additionally, integrating the NASA-TLX tool into health workforce management policies could enable routine monitoring of staff workload and support timely responses to excessive workload.