MOPDE0102 - Poster Discussion
Determinants of VMMC provider burnout in four sub-Saharan countries
Presented by Dino Rech (South Africa).
J. Bertrand1, D. Rech2, E. Njeuhmeli3, D. Castor3, S. Frade2, M. Loolpapit4, M. Machaku5, W. Mavhu6, L. Perry1
1Tulane SPHTM, Global Health Systems and Development, New Orleans, United States, 2CHAPS, Johannesburg, South Africa, 3USAID, Washington, United States, 4FHI360/Kenya, Nairobi, Kenya, 5Jhpiego/Tanzania, Dar es Salaam, United Republic of Tanzania, 6ZAPP, Harare, Zimbabwe
Systematic Monitoring of the Male Circumcision Scale-up (SYMMACS) is designed
to track voluntary male circumcision (VMMC) service delivery in Kenya, South
Africa, Tanzania, and Zimbabwe. The
study measured adoption of six elements to increase efficiency in the delivery
of clinical VMMC services, including:
method (e.g., forceps-guided)
shifting (allowing non-physicians to perform VMMC)
(allowing non-physicians to conduct aspects of VMMC)
among multiple bays in the operating theater
of supplies and tools
of electrocautery instead of ligating sutures
collection took place at 14-30 VMMC sites per country (73 sites total) from
April-December 2011. It included
observation of the clinical facilities, observation of VMMC procedures,
interviews with VMMC providers and the in-charge officer, and compilation of
service statistics. A total of 357 providers reported on their attitudes
towards their jobs and on the pervasiveness of burnout in the field of VMMC.
results are useful for monitoring service delivery in each country and
conducting cross country comparisons.
The data shows varied levels of burnout and job satisfaction among
providers across countries (see tables 1 and 2).
[Table 1. Occurrence of VMMC provider reported burn]
|Among all providers||Kenya (n=85)||South Africa (n=105)||Tanzania (n=93)||Zimbabwe (n=74)|
|% reporting to have noticed any provider fatigue/burnout among colleagues when they perform MC full-time as a primary work activity|| || || || |
|Yes, but very rarely||7.1||15.2||16.1||32.4|
|No, not at all||4.7||41.0||74.2||29.7|
[Table 2. VMMC provider personal job satisfaction a]
|% of providers who report to strongly agree or agree with the following statements on job satisfaction :||Kenya (n=85)||South Africa (n=105)||Tanzania (n=93)||Zimbabwe (n=74)|
|? Performing (or assisting in performing) male circumcision is a personally fulfilling job.||87.1||82.8||100.0||81.1|
|? I personally have begun to experience work fatigue or burnout from performing (or assisting in performing) male circumcision repeatedly.||70.6||36.2||53.8||27.0|
The various survey instruments allow for an
analysis of which program, site and provider level factors may contribute to
increased burnout. This paper presents results on: type of site (mobile/
static/ outreach), site volume, provider cadre, education and additional training,
time in field, full/part-time status, and variety of tasks performed. For
example, preliminary analyses from Zimbabwe indicated that physicians experience
higher levels of burnout than their nurse colleagues.
Conclusions: The review of these practices across the
four countries will shed light on alternative methods of staffing and service
delivery that contribute to lower levels of burnout among VMMC providers. The
results could inform policies and program planning for VMMC as well as other
clinical HIV services.
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