Factors affecting performance of professional nurses and midwives in health facilities in Lira district
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Performance of professional nurses and midwives is a major concern in health service delivery all over the world. There is wide acceptance that a professional nurses and midwives sufficient in numbers, adequately distributed, and well performing is a central health systems input, and critical for the achievements of Sustainable Development Goals (SDGs (Kenneth & Ottar , 2016). The objective of the study was to determine factors affecting performance of professional nurses and midwives in health facilities in Lira district. Primary data from a cross-sectional study of professional nurses and midwives in Lira district was analyzed. A structured questionnaire administered to 156 respondents using simple random sampling with lottery method. Data were analysed using STATA 14 at three levels: Univariate, Bivariate and Multivariate. At Univariate analysis, the background information was presented using descriptive statistics. At bivariate analysis, Pearson product moment correlation were used to determine the relationship between the dependent variables and independent variables (components). At multivariate analysis, linear regression was used to determine the predictors of performance (Availability, competency, productivity & responsiveness) by regressing the components (1, 2, 3, 4, 5 & 6). The results indicated that components (1, 2, 3 & 4) statistically significantly predict competencies with (p=0.012, = −0.010 , p=0.000, = 0.066 ,p=0.000, = 0.039 , p=0.000, = 0.080 ) respectively ; components (1, 2, 3 & 4) predicts productivity with (p=0.000, = 0.029 ; p=0.006, = 0.030 ; p=0.005, = 0.044 ; p=0.000, = −0.131 ) respectively; component 2, 4, 5 & 6) predicts availability with (p=0.000, = 0.090 , p=0.000, = 0.131 ,p=0.000, = −0.060 , p=0.004, = −0.020 ) respectively; components (2, 4 & 5) predicts responsiveness with (p=0.000, = 0.070 ; p=0.000, = 0.139 ; p=0.000, = −0.047 ) respectively, component (1, 2, 3, 4 & 5) predicts general performance with (p=0.006, = −0.011 ; p=0.000, = 0.064 ; p=0.023, = 0.020 ; p=0.000, = 0.120 ; p=0.001, = −0.036 ) respectively. The majority of professional nurses and midwives have competencies level between 0-50% & productivity, availability, responsiveness level between 51%-75%. The qualitative findings indicated that: The majority of the community has very poor health seeking behaviors (85%), political leaders’ influences recruitment and promotion of health workers at the district (70%) & xiii community lacked sense of ownership of their health facility (80%). Generally, the individual factors & organizational factors statistically significantly predict the performance of professional nurses & midwives in Lira District. Basing on the findings, the study recommended that: Recruitment and promotion of health workers should be centralized, MOH to design standard operating procedures to support nurses’ activities, Updated Uganda national treatment guidelines should be disseminated or distributed to all health facilities to guide health workers in making correct diagnosis and giving treatment., The district leadership and other stakeholder should be sensitized to address the concern raised by professional nurses and midwives which are directly affecting their performance negatively, MOH and the District Local Government to strengthen technical support supervision and monitoring of health services, the community to be sensitized on attitude change towards health seeking behaviors & professional nurses to develop positive attitudes towards their job & customers.