Subsequent questions, e.g. how health workers could improve their performance, persistently revealed the frustrations that health workers experience because of the lack of means and materials and the inadequate work environments as well as deficits in HRM.
The emotional dissatisfaction was further exacerbated by a poor work environment, such as inadequate infrastructure, which impedes privacy and confidentiality practices during counselling sessions, this being a major concern among the counsellors.
This was linked to poor work environments characterized by inadequate skill-mix, low nurse-to-patient ratios and reduced physical resources, accompanied by a lack of involvement in decision making, constant changes, issues related to leave and shifts, poor staff relationships and patient expectations.
(FGD, provider) The inadequate working environment also reduced staff motivation.
In fact, there is a danger that perceived self-efficacy, constrained by inadequate HRM and work environment, becomes so weak that it may ultimately negatively affect health workers' commitment and professional ethos.
Health professionals identified the following as some of the challenges there faced: inequitable and poor remuneration, overwhelming responsibilities with limited resources, lack of a stimulating work environment, inadequate supervision, poor access to continued professionals training, limited career progression, lack of transparent recruitment and discriminatory remuneration.
In terms of work environment, inadequate access to electricity, equipment, transport, housing, and the physical state of the health facility were cited as most critical, particularly in Turkana.
A range of correlations highlights the salience of inadequate resources in the work environment to job dissatisfaction, dissatisfaction with one's profession, thinking about leaving one's job and, more worryingly, to mid-level providers' active plans to seek other employment and plans to leave their jobs within the next 12 months.
Other studies have similarly identified inadequate resources and the stressful work environment it creates as major barriers to providing culturally competent care (19, 27).
A study conducted on managing the work environment of MLPs found that inadequate resources lead to job dissatisfaction, dissatisfaction with one's profession, thinking about leaving one's job and, more worryingly, to active plans to seek other employment [ 26].
