Globally healthcare sector has been showing a dynamic change and improvement. Although being a developing country, has achieved very good health indicators compared to other similar settings. Certain indicators such as related to the control of vaccine preventable diseases are in par with developed countries. In Sri Lanka healthcare services are mainly provided by the government sector. The healthcare institutions range from primary health care institutions at the community level which provides mainly Out Patient (OPD) treatment to tertiary care hospitals with major specialties and sub specialties. The healthcare service network is spread throughout the country and goes up to grass root level where even domiciliary healthcare services are also provided .
Preventive healthcare service is considered as the backbone of the healthcare services in a country. The main emphasis of this healthcare system is to prevent diseases and thereby minimize the burden otherwise the curative sector would be subjected to . The government healthcare system curative and preventive sector. Curative sector is hospital-based treatment services and are manned by Medical Officers. The preventive health services at the community level is provided by the Medical Officers of Health (MOH) office. Curative healthcare institutions (Hospitals) and MOH Offices are can be located in the same geographical area. However, the type of service provided by the two institution categories are different where hospitals provide treatment and MOH Offices provides preventive healthcare services. The medical officers in the curative sector work within hospitals and services of medical officers in the preventive sector are mainly in the field/community setting. The Medical Officers attached to the preventive sector are called Medical Officer of Heath (MOH). The entire country is covered by geographically demarcated Medical Officers of Health areas. Medical Officers of Health (MOH) are the main medical staff in a MOH office. They are responsible for the preventive health services in their respective MOH area and play a vital role in preventing diseases and promoting health at the community level [2,3]. These services provided by the MOH office include: immunization for disease prevention, disease control programmes such as dengue, leptospirosis, malaria, filaria, maternal health services, child health services, services for youth and elderly, school health services, food safety, environmental health services, occupational health services, well women services, prevention programmes for Non Communicable Diseases and health promotion etc. . The function of the MOH area mainly depends on the performance of the MOH as they not only functions as service providers but also as a technical expert in preventive health, as supervisors and managers.
Employee retention refers to the length of time employees stay with the organization . Retention of productive employees is a major concern of Human Resource (HR) professionals and business executives. It is more efficient in the system’s perspective to retain a quality employee than to recruit, train and orient a replacement employee of the same quality [5,6]. Retention of human resources in the healthcare system, particularly doctors at district level is a great challenge faced by the decentralized health systems in poorly-resourced countries .
There are several predictors of a medical officer’s willingness to retain in the preventive healthcare sector. It is a common belief that remuneration is one of the most important determinants of job retention. An attractive compensation package plays a critical role in retaining the employees [8,9,10,11]. Recognition is considered as one of the most important factors among non -financial rewards to increase retention of employees. It is used to strengthen the relationship between organization and people. Through the recognition employee feel rewarded and motivated [12.13]. Recognition can be described as the process where employees are rewarded in organizations by different status . Intrinsic rewards like recognition, growth, feedback, opportunities lead employees more towards high job performance and motivation than extrinsic rewards like salary [15, 16]. The amount of responsibility placed on the employee can have either negative or positive effects on employee-retention [17,18]. Doctors have different work schedules depending on their place of work and the work schedule has a big impact on their retention [19,20].
Sri Lanka has a doctor to population ratio of around 1: 671 and the percentage need met is 91%. When the “percentage need met” is less than 100% it means a shortage . In Sri Lanka the curative health sector is preferred by medical officers. Preventive health sector has become seemingly less attractive and medical officers in the preventive health sector tend to leave to the curative health sector . When there is shortage of doctors and the preventive sector being less attractive, invariably the shortage in the preventive sector will be higher than the curative sector. The number of applicants for preventive health posts are low compared to curative health sector posts. For an example, in the Colombo Regional Director of Health Services area which include the administrative capital of the country, at the end of 2018 of the approved cadre of 86 Medical Officer of Health, there were only 74 attached to MOH Offices. Of these 74 MOH, 12 MOH have applied/requested transfers to curative care institutions for the year 2019 under the 2019 annual transfers . This can potentially results in shortage of MOH. If MOH are not retained in the preventive health sector there would be a vacuum created and it would be improbable to maintain quality preventive health services at the divisional level.. This would ultimately cause a major negative impact on the entire healthcare system.
This study was done to explore the factors affecting retention of Medical Officers of Health in the preventive health sector in Sri Lanka.