Socio-demographic factors
The response rate of this study was 100%. Of which respondents’ 92 (65.7%) of the respondents were females. Regarding to their religion, 128(91.4%) were Orthodox. The table also revealed that 85(60.7%) of the respondents were under the age of 30 and 30-40 age of the respondents were 31(22.1%). 69(49.3%) and 41(29.3%) of the respondents were married and single respectively. Regarding to their educational qualifications, the majority 122 (87.1%) were diploma holders. We saw 73 (52.1%) of the respondents work experience was less or equal to five years and nearly half of the respondents get monthly salary of >2000 birr per month (Table 1).
Table 1.Distribution of job satisfaction related variables among midwives working in central zone Health Centers, 2019
Variables
|
Category
|
Frequencies
|
Percentage
|
Sex
|
Male
Female
|
48
92
|
34.3
65.7
|
Religion
|
Orthodox
Muslim
|
128
12
|
91.4
8.6
|
Age
|
<30
30-40
>40
|
85
31
24
|
60.7
22.2
17.1
|
Marital status
|
Married
Single
Divorced
Widowed
|
69
41
17
13
|
49.3
29.3
12.1
8.3
|
Educational qualification
|
Diploma
BSc
|
122
18
|
87.1
12.9
|
Work experience
|
<5
5-10
>10
|
73
55
12
|
52.1
39.3
8.6
|
Monthly salary (ETB)
|
≤2000
>2000
|
68
72
|
48.6
51.4
|
Distribution of job satisfaction related variables
Respondents were requested about variables related to job satisfaction. Accordingly, 60 (42.9%) of the respondents replied that there was adequate training in their institution. Whereas, 80 (57.1%) were agreed that there was no adequate training. Similarly, the response obtained from in-depth interview, two midwifery’s interviewees replied; …...There is no adequate training given in this health center; even when training programs are arranged by other concerned bodies, the chance is given to others out of the department.
Respondents were also requested regarding to their salary. Accordingly, the finding revealed that 120 (85.7%) of the respondents were not satisfied. The data which was also obtained by the use of in-depth interview showed that almost all participants were not satisfied with their monthly salary. In supporting this view, a 25 year working experiences midwife stated:
We are dissatisfied with our salary as well as duties and risk payments. We are working half of the health center activities. We work more than 20 hours per day and the payment is not delivered accordingly. We have children and we are working only for the sake of feeding them and to sustain our lives. We still ask for the betterment of our payment, though no change is being made. It is already known that the risk and duty payment of each individual is 470 birr per month and 80 birr per day respectively. But no one can be paid according to the standard and taxed 30% together with our salary: surprisingly, we get only 8 hours duty per day.
Regarding to motivation, the finding revealed that 72 (51.4%) were not motivated to do their job in their health center. Similarly, one midwives stated: …… There is no any significant motivator given to ours ……. Even, midwives are just lumped as a nurse.
Concerning the management system, 93 (66.4%) of the respondents were not satisfied with the management system of the health centers. The rest, 47 (33.6%) were satisfied. Respondents were requested about the availability of equipment in their health center. Accordingly, 80 (57.1%) of the respondents replied that the health center equipment was not fulfilled. In the same way, one MCH case team coordinator midwives said: … Some midwives work with only one glove; work with no antiseptic, not supported by the system, but because of passion; few midwives planned to leave the profession to do their own private business, because they have lost satisfaction in the profession.
A single item was prepared to measure midwives related to their work that they are providing to their customers. Accordingly, the response obtained from the majority of respondents showed that 88 (62.9%) were not satisfied with the work they are providing. The remaining, 52 (37.1%) were satisfied (Table 2)
Table 2. Distribution of job satisfaction related variables among midwives working in central zone Health Centers, 2019
Items
|
Response
|
Frequency
|
Percentage
|
Is there adequate training for your job?
|
No
Yes
|
80
60
|
57.1
42.9
|
Is your monthly salary adequate?
|
No
Yes
|
120
20
|
85.7
14.3
|
Are you motivated to do your job?
|
No
Yes
|
72
68
|
51.4
48.6
|
Are you satisfied with the management system?
|
No
Yes
|
93
47
|
66.4
33.6
|
Is there adequate equipment to do your job?
|
No
Yes
|
60
80
|
42.9
57.1
|
Are you satisfied with the work that you are providing to your customers?
|
No
Yes
|
88
52
|
62.9
37.1
|
Results of job satisfaction variables
Respondents were requested to rate the level of their satisfaction to their job. Accordingly, regarding to fair distribution of justice, 50 (35.7%) and 26 (18.6) of the respondents were very dissatisfied and dissatisfied respectively. On the other hand, 52 (37.1%) respondents were satisfied. With regard to the physical working environment, the finding depicts 40(28.6%) respondents were satisfied. Whereas 48(34.3%) were very dissatisfied and 33 (23.6%) were dissatisfied.
Regarding to the availability of resources as indicated in table 3 below, the finding showed that, 59 (42.1%) and 31 (22.1%) of the respondents were very dissatisfied and dissatisfied respectively. On the other hand, 37 (26.4%) were satisfied. Similarly, on the qualitative study one midwife interviewee replied
One day a laboring mother was coming to our health center for delivery service. During this time there was no network to communicate with other professionals for support. I diagnosed that case CPD, so the best management was referring the mother, but there was no ambulance service. Due to the severity of the problem, I went to Axum on my bare foot to call the ambulance at 7:00 o clock at night. This and other factors make me very dissatisfied with my job
With regard to work overload, almost half, 71 (50.7%) of the respondents were very dissatisfied whereas 35 (25%) of the respondents were dissatisfied. One midwife interviewee on the qualitative study was also replied:
We work a lot and engaged in labor and delivery, ANC, family planning, under five, and immunization. We are always on duty on behalf of our colleagues when they leave for break and when they are asking sick leave. This is mainly due to less number of midwives in our health center.
Respondents were also asked regarding the level of their interpersonal relationship. 31 (22.1%) of the respondents were very satisfied while 39 (27.9%) and 20 (14.3%) were dissatisfied and very dissatisfied respectively. Similarly, on the qualitative study, one midwife said
….. Midwives don’t have good interaction with other groups. Particularly, we don’t have a smooth relationship with our heads; they are fault finders. Since labor is unpredictable, mothers sometimes get birth at their home after they have been checked in our health center. If so, our heads demoralized and gave us a written warning. For instance, due to the above reason our heads gave a written warning for two of my friends including me.
Regarding the supervision made by higher officials, the finding revealed that 45 (32.1%) and 28 (20%) of the respondents were very dissatisfied and dissatisfied respectively. 41 (29.3%) respondents were satisfied with the overall supervisory practice done by higher officials. In relation to midwives’ participation in decision making, 45 (32.1%) of the respondents were very dissatisfied. Whereas, 76 (54.2%) of the respondents were satisfied. Regarding to staff-client interaction, 34 (24.3%) and 62 (44.3%) of the participants were satisfied and very satisfied respectively. On the other hand, 27 (19.3%) of the respondents were dissatisfied (Table 3).
Table 3. Results of job satisfaction variables among midwives who were working in Central Zone Health Centers, 2019.
Variables
|
Very Dissatisfied
Freq (%)
|
Dissatisfied
Freq (%)
|
Neither
Freq (%)
|
Satisfied
Freq (%)
|
Very Satisfied
Freq (%)
|
Fair distribution of justice
|
50(35.7)
|
26(18.6)
|
4(2.9)
|
52(37.1)
|
8(5.7)
|
Physical working environment
|
48(34.3)
|
33(23.6)
|
6(4.3)
|
40(28.6)
|
13(9.3)
|
Availability of resources
|
59(42.1)
|
31(22.1)
|
8(5.7)
|
37(26.4)
|
5(3.6)
|
Work overload in relation to the number of staff
|
71(50.7)
|
35(25.0)
|
4(2.9)
|
21(15.0)
|
9(6.4)
|
Interpersonal relationship between co-workers
|
39(27.9)
|
20(14.3)
|
5(3.6)
|
45(32.1)
|
31(22.1)
|
Work appraisal by the heads
|
52(37.1)
|
34(24.3)
|
4(2.9)
|
32(22.9)
|
18(12.9)
|
Supervision made by heads
|
45(32.1)
|
28(20.0)
|
3(2.1)
|
41(29.3)
|
23(16.4)
|
Staff involvement in decision making
|
45(32.1)
|
14(10.0)
|
5(3.6)
|
45(32.1)
|
31(22.1)
|
Staff interaction with clients
|
27(19.3)
|
13(9.3)
|
4(2.9)
|
34(24.3)
|
62(44.3)
|
Incentives
|
82(58.6)
|
22(15.7)
|
7(5.0)
|
21(15.0)
|
8(5.7)
|
An educational opportunity
|
92(65.7)
|
28(20.0)
|
3(2.1)
|
10(7.1)
|
7(5.0)
|
Applying your skill in the working area
|
25(17.9)
|
14(10.0)
|
7(5.0)
|
55(39.3)
|
39(27.9)
|
Job autonomy
|
58(41.4)
|
13(9.3)
|
3(2.1)
|
37(26.4)
|
29(20.7)
|
Working environment free from health risky situations
|
82(58.6)
|
22(15.7)
|
2(1.4)
|
21(15.0)
|
13(9.3)
|
Over all job satisfaction level
|
Satisfied
|
61(43.57%)
|
Not satisfied
|
79 (56.43%)
|
Regarding to educational opportunity, the majority of respondents 92(65.7) and 28(20.0) were very dissatisfied and dissatisfied respectively. Whereas 10 (7.1%) were satisfied. On the qualitative result from one interviewee:
…….. There is no any opportunity for further education; few of them start to upgrade their education by their own. Sometimes when we are starting to learn by ourselves higher official gave a written warning. Even we are also upset by other people sayings like “there is no need of learning more than diploma and no need of more than two midwives in one health center!!!” This leads us job dissatisfaction.
Respondents were requested whether they were applying their skills in their work they are assigned. Accordingly, the finding revealed 39 (27.9%) of the respondents were satisfied. On the other hand, 25 (17.9) % of the respondents were very dissatisfied. Regarding job autonomy, 37 (26.4%) of the respondents were satisfied. Whereas 58 (41.4%) of the respondents were very dissatisfied. In the same vein, two midwives stated that few health officers interfere in our work.
Respondents were also requested whether the working environment is free from health risky situations. Accordingly, 82 (58.6%) and 22 (15.7%) of the respondents were very dissatisfied and dissatisfied respectively. Similarly, one midwife stated:
… Midwife is risky job; nobody loves MCH. We wash our body with blood, amniotic fluid and vaginal secretion. No one gives due attention to our lives, risk and others. After doing certain activities we feel bad. One day, the cord detached and flushed with my face. This makes me fear of HIV, HBV and others.
The mean value of overall satisfaction is 38.2 with a standard deviation of 12.3. With this value, equal or less than this mean value was categorized as not satisfied and more than this mean value was satisfied. Based on this value the overall job satisfaction of midwives using Likert scale question items, the finding revealed, 61 (43.57%) were satisfied, the remaining 79 (56.43%) were not satisfied. Two midwifery participants during semi structured interview said:
…. I am dissatisfied with my job due to professional bias. Even though midwifery was my choice, due to different factors I am very disappointed; I considered myself below other health professionals. Other people also perceive midwifery as less interesting department than other health professions. We also hate our profession. ….. Midwifery is the lowest job from the alternative professions. There is no any midwife expert who evaluates, comment and give feedback for the program in general and for us in particular.
From all measuring Likert scale variables, the lowest levels of job satisfaction are obtained from educational development (Mean = 1.66 ±1.143) followed by the salary (Mean = 1.14 ±0.351) and then workload (Mean = 1.94±1.326). The highest level of satisfaction was get from applying their skills in the working areas.
Based on this value the overall job satisfaction of midwives using Likert scale question items, the finding revealed, 61 (43.57%) were satisfied, the remaining 79 (56.43%) were not satisfied. Two midwifery participants during in-depth interview said figure 1):
…. I am dissatisfied with my job due to professional bias. Even though midwifery was my choice, due to different factors I am very disappointed; I considered myself below other health professionals. We also hate our profession. ….. Midwifery is the lowest job from the alternative professions. There is no any midwife expert who evaluates, comment and give feedback for the program in general and for us in particular.
Factors associated with job satisfaction
Job satisfaction results of the bivariate analysis result like socio demographic factors, training, salary, motivation, management system, equipment, and work. From those variables motivation, management system, and work in the multivariate analysis were again statistically significant for the overall satisfaction. Regarding motivation with the overall satisfaction, the probability of being satisfied with their job among midwives with not motivated to do their job were 76% times less likely compared to their counterpart [AOR=0.24; 95% CI (0.087, 0.665)]. When we see the management system in relation to the overall satisfaction, the probability of not satisfied with the management system were 79.2% times less likely satisfied with their job than those who were satisfied with the management system [AOR, 0.208, 95% C.I, (0.074, 0.583)]. On the other variable which was the most statistically significant from the alternative in multivariate analysis was work satisfaction, the probability of not satisfied with their work was 91.6% times less likely satisfied with their job than those who were satisfied with their work [AOR=0.084; 95%, CI (0.03, 0.234)] (Table 4) .
Table 4.Factors associated with job satisfaction among midwives who are working in Central Zone of Tigray, 2019
Variables for health center midwives
|
|
Overall Satisfaction
|
COR (95% C.I.)
|
AOR (95% C.I.)
|
|
|
Satisfied
|
Not satisfied
|
|
|
|
|
No (%)
|
No (%)
|
|
|
|
Sex
|
Female(ref) Male
|
41 (44.6)
20(41.7)
|
51 (55.4)
28 (58.3)
|
1.125 (0.556, 2.280)
|
|
|
Religion
|
Muslim(ref)
Orthodox
|
6(50)
55 (43)
|
6(50)
73(57)
|
1.327 (0.406, 4.339)
|
|
|
Age
|
<30
30-40
>40(ref)
|
38 (44.7)
12(38.7)
11 (45.8)
|
47(55.3)
19(61.3)
13 (54.2)
|
0.956 (0.385, 2.373)
0.746(0.253, 2.199)
|
|
|
Marital status
|
Married
Single
Divorced
Widowed(ref)
|
28(40.6)
21(51.2)
7(38.9)
5(41.7)
|
41(59.4)
20(48.8) 11(61.1)
7 (58.3)
|
0.956 (0.276, 3.318)
1.470 (0.400, 5.398)
0.891 (0.201, 3.946)
|
|
|
Educational qualification
|
Diploma
BSc(ref)
|
52(42.6)
9 (50)
|
70(57.4)
9 (50)
|
0.743 (0.276, 2.002)
|
|
|
Work experience
|
<5
5-10
>10(ref)
|
32(43.8)
24(43.6)
5(41.7)
|
41(56.2)
31(56.4)
7(58.3)
|
1.093(0.317, 3.766)
1.084(0.306, 3.842
|
|
|
Monthly salary
|
≤2000
>2000(ref)
|
29 (42.6)
32 (44.4)
|
39 (57.4)
40(55.6)
|
0.929(0.476, 1.814)
|
|
|
Training
|
No
|
26(42.1)
|
54(68.4)
|
0.34(0.17, 0.69)*
|
0.706 (0.268, 1.858)
|
|
Yes (ref)
|
35(57.9)
|
25(31.6)
|
|
Salary in relation to Workload
|
No
|
45(73.8)
|
75(94.9)
|
0.15(0.047, 0.477) **
|
0.699 (0.161, 3.032)
|
|
Yes (ref)
|
16(26.2)
|
4(5.1)
|
|
Motivation
|
No
|
16(26.2)
|
56(70.9)
|
0.146(0.069,0.309) ***
|
0.240(0.087, 0.665) *
|
|
Yes (ref)
|
45(73.8)
|
23(29.1)
|
|
Management system
|
No
|
36(76.6)
|
11(23.4)
|
0.112(0.050,0.254) ***
|
0.208(0.074, 0.583) *
|
|
Yes (ref)
|
25(26.9)
|
68(73.1)
|
|
Equipment
|
No
|
16(26.7)
|
44(73.3)
|
0.283(0.137, 0.583) **
|
0.768(0.278, 2.78)
|
|
Yes (ref)
|
45(56.2)
|
35(43.8)
|
|
Work
|
No
|
19(21.6)
|
69(78.4)
|
0.0656(0.028,0.154) ***
|
0.084(0.03, 0.234) ***
|
|
Yes (ref)
|
42(80.8)
|
10(19.2)
|
|
|
|
|
|
|
|
|
|
|
|
|
Key
* p< 0.05, ** p< 0.001, *** p< 0.000
Ref= reference