The literature also suggests that the migration of health professionals is highly associated with untenable working and living conditions, poor rates of remuneration or lack of professional advancement [ 14, 29, 30].
How do stigma, risk and conditions of service (pay and remuneration) affect the retention of CMHWs?
They suggested that flexibility could be improved by a) varying the time commitment across the working day and week (part-time, job-share, temporary, and short-term), b) offering wider choice of long-term career paths, c) offering more education and training, and d) widening the scope of remuneration and contract conditions.
The region is particularly facing challenges pertaining to shortages, poor working conditions and remuneration of health professionals, aging workforce, lack of strategies for recruitment and retention, skill and geographical imbalances, absence of HRH databases, lack of a strategy for educational reform and out-migration [ 18].
Equally important is the effective supervision, management and support of staff, better conditions of service and remuneration with a view to heightened work satisfaction, retention and productivity.
It also recognises that the improvement of the conditions of service and remuneration for health professionals constitute the most urgent priority.
Within South Africa, the need to address the problem of both internal and external movement of HWs led to the development and implementation of the Occupational Specific Dispensation for HWs in the public sector to improve their conditions of service and remuneration.
Although remuneration was not as strong a condition for women as for men to become a CHW, lack of remuneration and sometimes lack of spousal support (women were perceived to "waste time" if they engaged in community work) were reasons to drop out for female CHWs [ 63].
HWs in the public sector especially experience poorer working conditions, as indicated by participants' self-reports on stress, workload, level of remuneration, standard of work premises, level of human resources and frequency of in-service training.
HWs in the public sector reported the poorest working conditions, as indicated by participants' self-reports on stress, workloads, levels of remuneration, standard of work premises, level of human resources and frequency of in-service training.
- modification of the working conditions to promote staff mobility and greater flexibility in personnel deployment or to rationalize methods of remuneration to bring them more in line with the expected performance.
