abstract: 'Background: Low-and middle-income countries (LMICs) are the worst

  affected by a lack of safe and affordable access to safe surgery. The

  significant unmet surgical need can be in part attributed to surgical

  workforce shortages that disproportionately affect rural areas of these

  countries. To combat this, Malawi has introduced a cadre of

  non-physician clinicians (NPCs) called clinical officers (COs), trained

  to the level of a Bachelor of Science (BSc) in Surgery. This study

  explored the barriers and enablers to their retention in rural district

  hospitals (DHs), as perceived by the first cohort of COs trained to BSc

  in Surgery level in Malawi. Methods: A longitudinal qualitative research

  approach was used based on interviews with 16 COs, practicing at DHs,

  during their BSc training (2015); and again with 15 of them after their

  graduation (2019). Data from both time points were analysed and compared

  using a top-down thematic analysis approach. Results: Of the 16 COs

  interviewed in 2015, 11 intended to take up a post at a DH following

  graduation; however, only 6 subsequently did so. The major barriers to

  remaining in a DH post as perceived by these COs were lack of promotion,

  a more attractive salary elsewhere; and unclear, stagnant career

  progression within surgery. For those who remained working in DH posts,

  the main enablers are a willingness to accept a low salary, to generate

  greater opportunities to engage in additional earning opportunities; the

  hope of promotional opportunities within the government system; and

  greater responsibility and recognition of their surgical knowledge and

  skills as a BSc-holder at the district level. Conclusion: The

  sustainability of surgically trained NPCs in Malawi is not assured and

  further work is required to develop and implement successful retention

  strategies, which will require a multi-sector approach. This paper

  provides insights into barriers and enablers to retention of this

  newly-introduced cadre and has important lessons for policy makers in

  Malawi and other countries employing NPCs to deliver essential surgery.'
affiliation: 'Gajewski, J (Corresponding Author), Royal Coll Surgeons Ireland, Inst
  Global Surg, Dublin 2, Ireland.

  Gajewski, Jakub, Royal Coll Surgeons Ireland, Inst Global Surg, Dublin 2, Ireland.

  Wallace, Marisa, Maastricht Univ, Fac Hlth Med \& Life Sci, Maastricht, Netherlands.

  Pittalis, Chiara; Brugha, Ruairi, Royal Coll Surgeons Ireland, Div Populat Hlth
  Sci, Dublin 2, Ireland.

  Mwapasa, Gerald; Borgstein, Eric, Coll Med Malawi, Dept Surg, Blantyre, Malawi.

  Bijlmakers, Leon, Radboud Univ Nijmegen, Med Ctr, Nijmegen, Netherlands.'
author: Gajewski, Jakub and Wallace, Marisa and Pittalis, Chiara and Mwapasa, Gerald
  and Borgstein, Eric and Bijlmakers, Leon and Brugha, Ruairi
author-email: jakubgajewski@rcsi.ie
author_list:
- family: Gajewski
  given: Jakub
- family: Wallace
  given: Marisa
- family: Pittalis
  given: Chiara
- family: Mwapasa
  given: Gerald
- family: Borgstein
  given: Eric
- family: Bijlmakers
  given: Leon
- family: Brugha
  given: Ruairi
da: '2023-09-28'
doi: 10.34172/ijhpm.2020.142
earlyaccessdate: AUG 2020
eissn: 2322-5939
files: []
journal: INTERNATIONAL JOURNAL OF HEALTH POLICY AND MANAGEMENT
keywords: Non-physician Clinicians; Task-Sharing; Global Surgery; Malawi
keywords-plus: 'HEALTH-PROFESSIONALS; BRAIN-DRAIN; NONPHYSICIAN CLINICIAN; INTERNATIONAL

  NGOS; WORKFORCE; AFRICA; PROGRAM; CARE'
language: English
month: MAR
number: '3'
number-of-cited-references: '49'
orcid-numbers: 'Brugha, Ruairi/0000-0003-0729-0197

  Bijlmakers, Leon/0000-0003-2252-0579

  Pittalis, Chiara/0000-0003-3465-9850'
pages: 354-361
papis_id: 23a369294e810dabcf5dbb4a7fbb4728
ref: Gajewski2022whydo
researcherid-numbers: 'Brugha, Ruairi/C-8420-2012

  Bijlmakers, Leon/P-6949-2015

  '
times-cited: '5'
title: Why Do They Leave? Challenges to Retention of Surgical Clinical Officers in
  District Hospitals in Malawi
type: article
unique-id: WOS:000719922500001
usage-count-last-180-days: '0'
usage-count-since-2013: '1'
volume: '11'
web-of-science-categories: Health Care Sciences \& Services; Health Policy \& Services
year: '2022'