gms | German Medical Science

Research questions: (1) What are the contributions of the Bachelor of Science in Paediatric and Child Health Clinical Officers (COs) to child care at their workplace in Malawi? (2) What are the enabling and limiting factors for them to provide services at their health facilities?

Method: We conducted a mixed-method study, sequential explanatory design (quantitative followed by qualitative), between Jan. and Dec. 2022. A workplace satisfaction survey (5-point Likert Scale) was used as a quantitative data collection tool for COs (N=27). As a qualitative data collection tool, we used an in-depth and key informant interview guide for COs (N=15) and key informants (N=14), respectively.

Results: The mean (SD) scores of the workplace satisfaction survey for workload, tasks, work environment, and workplace harmony were 3.43 (0.12), 3.19 (1.29), 3.01 (1.3), and 3.27 (1.27), respectively. The mean (SD) scores for continuous professional development and career advancement opportunities, job stability, salary and benefits were 3.68 (0.99), 2.01 (1.14), 3.70 (1.16), and 2.47 (1.03), respectively. Despite the overall job satisfaction mean (SD) being 4.00 (0.78) (i.e., “very happy”), 63% of graduates intended to leave their current position soon. During interviews, COs reported increased clinical knowledge and skills, which helped them to manage more patients at district hospitals and to reduce unnecessary referrals to the central hospitals. The leadership skills transferred at the training enabled them to manage the health facilities more efficiently. COs acknowledged the supportive environment (teamwork, recognition by team members, good communication, and a functional referral system) at their workplace but mentioned infrastructure limitations that often hinder their work. Moreover, they stated a lack of recognition as graduates by the Ministry of Health and Population (MoHP), a specific job description, and future career paths as a clinician, which demotivated them. The COs and KIs recommended continuing the training programme with more student intake per year considering their role in child health care. Besides, COs urged the MoHP and the Medical Council to work together and develop a proper policy for this cadre’s recognition, promotion, and career advancement.

Discussion: The national training programme seems to affect child health services positively, especially at the district level. As proposed by other studies, it is recommended to continue the programme by paying attention to graduates’ workplace conditions as a prerequisite for their motivation and retention in the public system. Moreover, policies addressing the appropriate skill mix and task shifting might be helpful.