| Backgrounds:Medical migration involves the movement of a qualified doctor from one country to another to practice medicine.It includes those who commute across borders and those who migrate temporarily to obtain specialist training,as well as those who migrate on a permanent basis.Since three decades,many Congolese physicians have been immigrating abroad for practicing medicine and this situation has become normal especially for number of young Congolese physicians,who just graduated from universities.This could be explained by the fact that medical emigration has the advantage,at a national level of reducing doctor unemployment and/or underemployment and generate a valuable remittance flow to the source country.In the past,the migration of skilled health professionals from poorer to richer countries was essentially a passive process.Movement was driven mainly by the political,economic,social,and professional circumstances of the individual migrant.In recent years,however,demand for health workers in many countries in the Organization for Economic Cooperation and Development have been greatly increased by changes in population dynamics.Studies focusing on why skilled health professionals emigrate have identified two broad categories:the "push" and the "pull"factors.Among the push factors are low wages,poor motivation,persistent shortages of basic medical supplies,dangerous working conditions,outdated equipment,lack of supervision,and limited career opportunities.Economic reasons,access to professional development opportunities,and job security are among the most important pull factors.Job satisfaction is believed to be a key factor that it influences performance of individuals and organizations.Dissatisfied work force has a negative impact on performance of the facilities.Moreover,it is a pushing factor for migration of health workers,both from rural areas to the cities and out of the country.Limited studies have been done to evaluate the level of job satisfaction among health workers in the DRC.However,a study done in 2014 in Katanga region(South of the DRC),in the teaching Hospital of University of Lubumbashi shows that the physicians were the most unsatisfied group against the nurses,and the biologists who were moderately dissatisfied.So far,there are fewer studies that explore job satisfaction and medical emigration of physicians in the DRC.This study aims to assess the level of job satisfaction and its association to the Medical Emigration Intention(MEI)of physician in Katanga region,southern DRC and in those working abroad(Southern African countries).Methods:This study was focused on two principal variables,job satisfaction as the independent variable and the MEI as the dependent variable.Job satisfaction was measured using Minnesota satisfaction Questionnaire(MSQ),it contained 20 items,and each question has 5 levels of satisfaction from 1(very dissatisfied)to 5(very satisfied)each participant has it score calculated on 100(20 items with each 5 scales).And the total score determines the level of satisfaction,which was divided into 3,from 0 to 55(low satisfaction),from 56 to 70(Average satisfaction)and from 70 to 100(High Satisfaction).The data collection instrument is originally written in English,but in this study we used the French version for better understanding of the participants.MEI was measured as a dichotomous question of yes or not,participants have considered moving and working abroad.This is a descriptive cross sectional multicenter study.This study used two sampling methods to build the size of the size of the main sample(N).It is call a multi-sampling method.The first method will be a simple random method and the second will be a convenient sampling method.N was constituted of two samples:N1 and N2;N=N1+N2.N1 is the first group constituted of medical doctors working in the DRC,especially in the Katanga region.To estimate the sample size of this formula was used:N1 =(Z ?)2× P×(1-P)/d2.Where N1 represent the required sample size,considering 95%confidence level,the margin error will be of 5%(d = 0.05),using a proportion of medical immigration in Africa estimated to 50%and non-response rate of 10%.So,N1=(1.96)2× 0.5×(0.5)/(0.05)2=384,Non-response rate = 10%of 384= 38.The final sample size was 422.The sample size was proportionally adjusted to each hospital,since there are rural areas with few medical doctors and urban area which have a considerable concentration of medical doctors.A registered list of all medical doctors working at each hospital was used as sampling setting.N2 is the second group constituted of medical doctors working abroad,especially in the southern African countries.Convenience sampling method was used to select participantsData collectionThe data collection period was agreed by the research advisor,from 1st March to 1 st September 2017,but the period was extended from 6 months to 9 months to access other rural areas of the district,so the definitive data collection period was from 1st March to 1st December 2017.Hospitals in which we conducted the research were selected by the following procedure:medical doctors working in public or private hospital(for more than 6 months)were considered for participating to the study.Katanga region is now divided into 4 districts,three hospitals were selected from each district,so the study was conducted in 12 different hospital.The questionnaire was distributed after getting permission from the administration of each Health facility and from participants too.Some participants were physically contacted but some were contacted via mail.An explanation on the aim of the study,informing about the benefit of the study,was attached to each questionnaire.Confidentiality of the study subjects was preserved.Data analysisSPSS version 20 statistical software was used for analysis.Data expressed as mean ±standard deviation(SD),cross tabulation was done via chi-square,t-test for comparison of mean and binary logistic regression was also used to describe the degree of association between dependent and independent variables using adjusted odds ratio with 95%confidence interval and p-value less than 0.05 was considered as significant.Results:From the cross-sectional study done in the Katanga region,a total of 422 questionnaires were distributed to medical doctors who responded to the inclusion criteria in the 4 sub-provinces of this region.The response rate was 55.5%,n=55.5 x 422/100 =234(responses),of whom 8 filled questionnaires did not provide corrected answers and were removed from the sample,so definitive n was 234-8 =226 participants(N1).Mean age for these participants was 39.69±8.862;the minimum age was 26 and the maximum age of 68 years.Form these 226 participants 155(68.6%)have Intention to leave the country(MEI).Age,sector of the hospital and marital status influence MEI(p value less than 0.05),the mean score of overall job satisfaction among the medical doctors working in the DRC was of 63.62±9.807.Age,the medical department and sector of the hospital influence the level of job satisfaction.Exploring the factors of job satisfaction which can influence the MEI,the study shows that,being busy all the time,being happy to be somebody in the community,the way the boss handle workers,salary,working conditions are associated with MEI.Multivariate logistic regression shows that fully dissatisfied medical doctors are 8.1 times more likely to have MEI than those satisfied(p=0.019).From the 80 Congolese medical doctors working in 8 southern Africa countries(Zambia,Botswana,Namibia,Swaziland,Lesotho,South Africa,Zimbabwe and Mozambique),ten questionnaires by countries were sent for data collection).Only 37(46.25%)out of 80 doctors responded positively by sending back the filled forms to us.From this,2 questionnaires were not correctly answer and removed from the sample,so n was of 35 participants(N2).The mean age of this participants was of 34.57± 3.35.Form these 35 participants 11(31.43%)have Intention to leave their current country of work for other countries(MEI).Age,sector of the hospital,medical department and marital status influence MEI(p value less than 0.05).The mean score of overall job satisfaction among these medical doctors was of 76.43±5.8.Age and sector of the hospital was found to influence the level of job satisfaction.Comparing mean of each item of job satisfaction,between the two groups of doctors having MEI and those without MEI,p value was statistically significant for 3 items only:company policy,supervisor competence and stability of the work.Taking into consideration the two sample,Multivariate logistic regression shows that low level of satisfaction is associated with MEI,with doctors having low overall job satisfaction been 6.5 times more likely to have MEI than those with high overall job satisfaction(p=0.002).Comparison of the level of overall job satisfaction shows that 30.53%have high level of job satisfaction,51.70%have average level of job satisfaction and 17.7%have low level of satisfaction among doctors working in the DRC,while 69%have high level of satisfaction,31%have average level of satisfaction and 0%have low level of job satisfaction among those working abroad.Conclusion:Emigration of medical doctors is still a problem in the Katanga region and so in the DRC,where the population still in need of them.Average satisfaction of these medical doctors remains a key factor that pushes them to go abroad,in expectation of high job satisfaction.Dissatisfaction about their payment amount and working conditions of their job also constituted the brain of their emigration intentions.It is important then for the Congolese government to increase the level of satisfaction among these medical doctors,in increasing their salary as improving training and supervising,and working conditions of these medical doctors,especially in the public hospitals,for better progression in their job,so that they could stay a serve their country which really need them. |
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