In the group over 45 years of age, only 23% (7/30) were female workers, whereas in the age group 25 to 29 years, women represented 55% (33/60) of this specific population. The decrease in number of female workers over time was not affected by the type of health facility nor the title earned, because the distribution of all laboratory professionals was very similar between the two genders across health facilities.
The years of laboratory experience seemed to be an important determinant for changing jobs, with 57% (66/115) of those who changed jobs in the past five years having between two and four years of experience. It was likely that less highly qualified laboratory professionals were more inclined to stay at their current job because their experience and educational level was less marketable and therefore, they had limited employment opportunities. On the other hand, highly trained laboratorians did not change their job as frequently because, most likely, their current job already matched their experience and educational level. In the countries where the survey was carried out, laboratory professionals tend to continue their studies while working, thereby explaining the correspondence between working experience and educational level at the time of relocation.
Laboratory professionals employed in the private sector were more likely to change jobs than those working in the public sector (P = 0.002). The lower workforce turnaround found in government facilities was dependent on country-specific factors, mainly salary scale, benefits, and allowances. In some countries the government employment is permanent with accumulated benefits received on retirement, when leaving before retirement results in loss of all benefits. In addition to these elements, an important role was played by the career prospects available in the public compared to the private sector.
Regardless of the satisfaction factors and incentives under consideration, the degree of agreement should be taken into account in the development of corrective actions and policies. As an early warning indicator, policy makers should consider those areas where moderate agreement between satisfaction factors and incentives has been observed. This approach would likely improve the adoption and implementation of national policies at each health facility by tailoring them to the specific findings observed locally.
A limitation of this study was that it did not comprise many laboratories in urban settings, because the majority of the health facilities included in this survey were located in rural and peri-urban areas. At these levels of the health system, demographics and some factors, such as working environment, working conditions and benefits, differed substantially from those present in urban settings and upper level laboratories.
Besides this, factors that might influence the behavior of local labour markets among countries were not considered, and their impact on willingness to seek other jobs should be explored further. In Zambia, laboratory technicians’ salaries in the public sector were more than three times lower than those in the private sector and between 23% and 46% of those paid by non-governmental organizations . This different salary scale probably contributed to the deficiency of laboratory technicians in the public sector in Zambia. In Nigeria it was likely that policies based on rural area incentives of 25% of salary and other benefits contributed to higher staff turnover in the private sector than in the public sector . In addition to government strategies, donors’ interventions also may influence domestic labour markets. In Kenya, where loss of laboratory staff was higher at lower-level facilities , gratuity allowances ranged from 12% to 23% from one province to another in the context of the same project . In Tanzania, fluctuations of health sector budget affected allocations to human resources in particular for recruitment, incentives, retention and capacity building . Despite the different strategies adopted to address local needs, national labour markets have similar dynamics due to the chronic problem of understaffed health care facilities. In this scenario it is likely that the mobility of laboratory professionals was not significantly influenced by determinants such as socio-economic factors and educational background.