Effect of differentiated service delivery models for HIV treatment on healthcare providers’ job satisfaction and workloads in sub-Saharan Africa: a mixed methods study from Malawi, Zambia, and South Africa

Abstract Introduction: Differentiated service delivery (DSD) models for HIV treatment aim to improve healthcare providers’ quality of professional life by reducing the patient/provider ratio and allowing for more time with recipients-of-care in need. We investigate current job satisfaction and perceived changes in job satisfaction among HIV treatment providers in Malawi, South Africa, and Zambia after the adoption of DSD models of care in each country. Methods: We conducted a concurrent, cross-sectional mixed-methods survey with clinical and non-clinical HIV care providers between April 2021 and January 2022 at public sector clinics in Malawi (n-12), South Africa (n=21), and Zambia (n=12). Questions investigated the effect of DSD models on provider responsibilities, work burden, time allocation, and job satisfaction. We conducted a principal components analysis using questions with responses to create an index score for job satisfaction and estimated odds ratios using logistic regression for associations between key variables and low reported job satisfaction. We reported emerging qualitative themes. We use Herzberg’s two-factor theory to organize and interpret the results of the study, identifying motivating factors (which lead to job satisfaction) and hygiene factors (which we refer to as maintenance factors and which lead to dissatisfaction if lacking). Results: Providers had generally high job satisfaction. Providers from Malawi were more likely to report lower job satisfaction than those from South Africa or Zambia. (adjusted odds ratio (aOR) 4.56, 95% confidence interval (CI) [2.12, 9.80]) ). Providers who believed their jobs became harder after the introduction of the DSD models (2.82[1.14-6.96]) or did not change (6.50[2.50-16.89]) were more likely to report lower job satisfaction. Qualitatively, providers felt DSD models improved their working conditions by decongesting the clinics and allowed them to spend more time on other tasks. Providers were particularly motivated when they could spend more time with patients. Conclusion: Findings highlight the importance of DSD models in maintaining or improving healthcare providers' quality of professional life and underscore the need for continued monitoring of the impact of these models on job satisfaction among HIV treatment providers in resource constrained settings.