Background
DRC context
Methods
Data analysis
Results
Sample characteristics
Facility characteristics of sampled (n) workers | Proportion of workers |
---|---|
% | |
Facility location (n = 453) | |
Rural | 80.6 |
Urban | 19.4 |
Province (n = 453) | |
Equateur | 23.0 |
Kasai Occidental | 29.8 |
Kasai Oriental | 5.7 |
Maniema | 27.6 |
Province Orientale | 13.9 |
Type of facility (n = 453) | |
Health centre | 81.7 |
Reference health centre | 17.2 |
Health post | 1.1 |
Distance of facility from the village (n = 443a) | |
Less than 1 km | 31.6 |
Between 1 and 5 km | 48.3 |
Between 5 and 10 km | 12.0 |
Greater than 10 km | 8.1 |
Number of services provided by facility (n = 435a) | |
3 to 5 services | 12.2 |
6 to 9 services | 76.1 |
Over 10 services | 3.0 |
Total clinical staff present on the day (n = 453) | |
1 | 13.3 |
2 | 34.0 |
3 | 23.8 |
4 | 16.8 |
5 | 6.6 |
6 | 4.0 |
7 | 1.6 |
Population catchment for area (n = 430a) | |
Less than 5000 | 48.9 |
5000 to 10,000 | 21.6 |
10,001 to 15,000 | 17.4 |
Greater than 15,000 | 12.1 |
Characteristics | Proportion of all workers interviewed | Proportion of nurses |
---|---|---|
% | % | |
Sex | (n = 453) | (n = 407) |
Male | 69.3 | 70.3 |
Female | 30.7 | 29.7 |
Age | (n = 453) | (n = 407) |
<30 years | 11.5 | 12.3 |
30–44 years | 59.7 | 60.7 |
45–60 years | 26.1 | 24.6 |
>60 years | 3.1 | 2.5 |
Marital status | (n = 447a) | (n = 407) |
Married | 90.4 | 91.8 |
Single | 3.8 | 3.5 |
Widowed | 3.4 | 2.5 |
Separated/divorced | 2.2 | 2.0 |
Other | 0.2 | 0.3 |
Education | (n = 453) | (n = 407) |
Primary school | 0.4 | 0.3 |
Secondary school | 60.3 | 62.9 |
University/post-secondary school | 33.1 | 35.1 |
Not specified | 6.2 | 1.7 |
Position | (n = 453) | N/A |
Doctor | 0.9 | |
Nurse | 89.8 | |
Laboratory worker | 1.1 | |
Pharmacy worker | 1.3 | |
Traditional birth attendant | 2.9 | |
Auxiliaries, medical and nursing assistants (other non-qualified personnel) | 4.0 | |
N, mean, SE (median, IQR) |
N, mean, SE (median, IQR) | |
Number of financial dependents | 437a, 9, 4.56. (8, 6–12) | 393a, 9, 4.63. (8, 6–12) |
Years worked in current position | 446a, 9, 8.72. (6, 3–12) | 403a, 9, 8.68. (6, 3–11) |
Income sources and levels
Source of income | Overall proportion of workers who received source of income | Median income per month among those receiving income in USD (IQR) | Mean income per month among those receiving income in USD (standard error) |
---|---|---|---|
Payments from government | |||
Salary from government (n = 407) | 31.2% | 52.76 (23–75) | 58.06 (60.45) |
Occupational risk allowance from government (n = 407) | 53.8% | 12.46 (11–16) | 36.57 (73.38) |
Payments from other sources | |||
Performance pay (n = 407) | 24.1% | 16.25 (9–46) | 35.79 (48.81) |
User fees (n = 406) | 74.6% | 19.50 (11–38) | 71.02 (157.95) |
Gifts/informal payments from patients (n = 406) | 16.8% | 4.60 (2–11) | 8.73 (10.43) |
Per diems (n = 406) | 51.7% | 4.06 (2–8) | 8.56 (26.35) |
Income from private clinical practice (n = 407) | 7.1% | 21.67 (11–54)a
| 34.02 (34.05)a
|
Income from supplemental (non-clinical) activities (n = 400) | 46.8% | 65.01 (33–114)a
| 119.27 (154.62)a
|
Total income (n = 300a) | N/A | 85.05 (36–176)a
| 165.26 (227.55)a
|
Income determinants
Odds ratio for dependent variables (SE) | ||||
---|---|---|---|---|
Explanatory variables | Salary | Occupational risk allowance | ||
Full model | Reduced model | Full model | Reduced model | |
Years in position | 1.06 (0.02)*** | 1.06 (0.02)*** | 1.19 (0.04)*** | 1.20 (0.04)*** (p < 0.001) |
Kasai Occidental (vs Equateur) | 1.48 (0.69) | 1.46 (0.64) | 0.17 (0.07)*** | 0.17 (0.07)*** (p < 0.001) |
Kasai Orientale (vs Equateur) | 1.02 (0.89) | 0.71 (0.48) | 0.03 (0.02)*** | 0.05 (0.04)*** (p < 0.001) |
Maniema (vs Equateur) | 0.20 (0.13)** | 0.22 (0.14)*** (p = 0.014) | 1.56 (0.76) | 1.30 (0.63) |
Province Orientale (vs Equateur) | 0.69 (0.43) | 1.05 (0.52) | 11.07 (7.28)*** | 9.58 (6.33)*** (p = 0.001) |
Population served | 1.00 (0.00)** | 1.00 (0.00)** (p = 0.043) | 1.00 (0.00) | |
Total personnel | 1.43 (0.25)** | 0.94 (0.19) | ||
Urban (vs rural) | 1.90 (0.86) | 2.48 (0.97)** (p = 0.021) | 2.42 (1.33) | 2.10 (0.91)* |
Number of services | 1.08 (0.12) | 0.84 (0.09) | ||
Distance of facility from village | 1.00 (0.03) | 1.07 (0.04)* | ||
Reference heath centre (vs heath centre) | 0.74 (0.36) | 0.49 (0.24) | 0.39 (0.20)* | |
Age | 1.02 (0.02) | 1.03 (0.02) | ||
Male (vs female) | 0.92 (0.31) | 0.66 (0.24) | ||
Number of dependents | 0.97 (0.03) | 1.11 (0.04)** | 1.12 (0.04)*** (p = 0.001) | |
Married (vs not married) | 1.10 (0.14) | 0.67 (0.12)** | 0.75 (0.12)* | |
University (vs school education) | 0.77 (0.27) | 1.07 (0.41) | ||
ASSP programme | 0.70 (0.28) | 0.58 (0.23) | ||
Received occupational allowance (salary model only) | 1.03 (0.35) | – | – | |
Received salary (occupational risk allowance model only) | – | – | 1.06 (0.39) | |
Constant | 0.04 (0.05)** | 0.09 (0.04)*** | 0.37 (0.41) | 0.21 (0.08)*** |
Pseudo R
2
| 0.17 | 0.14 | 0.35 | 0.33 |
Model χ
2
| 50.90*** | 46.98*** | 91.22*** | 77.56*** |
Number observations (n) | 337 | 383 | 318 | 318 |
User fees | Informal payments | Private payment | Non-clinical activities | Performance payments | Per diems | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Explanatory variables | Odds ratio (SE) | |||||||||||
Full | Reduced | Full | Reduced | Full | Reduced | Full | Reduced | Full | Reduced | Full | Reduced | |
Years in position | 1.02 (0.02) | 1.03 (0.03) | 1.02 (0.05) | 0.97 (0.02) | 1.02 (0.04) | 0.99 (0.02) | ||||||
Kasai Occidental (vs Equateur) | 0.52 (0.23) | 0.87 (0.32) | 3.13 (2.13)* | 2.34 (1.17)* | 8.72 (10.09)* | 8.42 (8.88)** | 0.69 (0.25) | 0.65 (0.23) | 2.62 (3.02) | 2.69 (3.13) | 1.29 (0.48) | 1.24 (0.41) |
Kasai Orientale (vs Equateur) | 3.22 (3.86) | 3.81 (2.94)* | 5.84 (4.64)** | 3.77 (2.37)** | 1 | 1 | 0.99 (0.91) | 0.46 (0.37) | 1 | 1 | 3.67 (3.50) | 2.02 (1.35) |
Maniema (vs Equateur) | 2.65 (1.58) | 3.76 (1.73)*** | 23.82 (18.79)*** | 12.49 (7.39)*** | 21.87 (25.97)*** | 14.53 (16.24)** | 3.59 (1.68)*** | 4.02 (1.81)*** | 158.86 (191.31)*** | 132.02 (147.97)*** | 0.50 (0.26) | 0.56 (0.25) |
Province Orientale (vs Equateur) | 1.54 (0.89) | 1.08 (0.47) | 9.18 (5.93)*** | 5.76 (3.00)*** | 1 | 1 | 3.99 (2.27)** | 4.42 (2.17)*** | 1 | 1 | 0.41 (0.20)* | 0.37 (0.15)** |
Population served | 1.00 (0.00) | 1.00 (0.00) | 1.00 (0.00) | 1.00 (0.00) | 1.00 (0.00)** | 1.00 (0.00)** | 1.00 (0.00) | |||||
Total personnel | 1.12 (0.20) | 0.69 (0.11)** | 0.67 (0.10)** | 0.83 (0.16) | 0.79 (0.11)* | 0.83 (0.12) | 0.98 (0.21) | 0.68 (0.11)** | 0.72 (0.10)** | |||
Urban (vs rural) | 0.63 (0.32) | 0.95 (0.48) | 2.81 (1.85) | 2.44 (0.99)** | 0.51 (0.18)* | 0.51 (0.15)** | 1.17 (0.82) | 1.37 (0.55) | ||||
Number of services | 0.98 (0.14) | 0.96 (0.14) | 0.90 (0.10) | 1.35 (0.12)*** | 1.24 (0.11)** | 1.71 (0.26)*** | 1.51 (0.22)*** | 1.24 (0.11)** | 1.24 (0.09)** | |||
Distance of facility from village | 0.98 (0.03) | 0.97 (0.05) | 0.78 (0.07)** | 0.88 (0.06)** | 0.99 (0.03) | 0.78 (0.05)*** | 0.79 (0.06)*** | 0.99 (0.03) | ||||
Reference heath centre (vs heath centre) | 0.49 (0.25) | 0.64 (0.26) | 0.54 (0.38) | 2.53 (1.27)* | 0.89 (0.36) | 0.45 (0.28) | 0.41 (0.16)** | 0.50 (0.16)** | ||||
Age | 0.97 (0.02)* | 0.97 (0.01)* | 0.94 (0.03)** | 0.96 (0.02)** | 0.89 (0.04)*** | 0.92 (0.02)*** | 1.03 (0.02) | 0.96 (0.03) | 1.01 (0.02) | |||
Male (vs female) | 0.82 (0.27) | 0.80 (0.32) | 1.32 (0.68) | 1.03 (0.32) | 3.37 (1.62)** | 2.36 (1.01)** | 1.57 (0.47) | 1.74 (0.44)** | ||||
Number of dependents | 1.08 (0.05)* | 1.07 (0.04)** | 0.99 (0.05) | 1.01 (0.08) | 1.06 (0.03)* | 1.08 (0.03)*** | 1.09 (0.04)** | 1.05 (0.03) | 1.04 (0.03) | |||
Married (vs not married) | 0.92 (0.11) | 0.95 (0.17) | 0.88 (0.20) | 1.08 (0.13) | 1.34 (0.24) | 0.84 (0.10) | ||||||
University (vs school education) | 0.83 (0.33) | 0.84 (0.38) | 1.32 (0.79) | 0.93 (0.27) | 1.02 (0.43) | 1.28 (0.36) | ||||||
ASSP programme | 1.55 (0.64) | 0.41 (0.17)** | 0.48 (0.17)** | 2.47 (1.13)** | 1.51 (0.44) | 1.74 (1.05) | 1.98 (0.64)** | 1.80 (0.49)** | ||||
Receives any government paya
| 0.20 (0.08)*** | 0.95 (0.39) | 4.11 (2.37)** | 2.76 (1.33)** | 0.55 (0.17)* | 0.51 (0.15)** |
b
| 1.68 (0.47)* | 1.92 (0.50)** | |||
Receives user fees | – | – | 0.89 (0.41) | – | – | 1.32 (0.41) | – | – | – | – | ||
Receives informal payments | – | – | – | – | – | – | 1.32 (0.48) | – | – | – | – | |
Receives payment from private practice | – | – | – | – | – | – | 3.00 (1.56)** | 2.64 (1.21)** | – | – | – | – |
Receives performance payments | – | – | – | – | – | – | 0.67 (0.21) | – | – | – | – | |
Constant | 14.87 (20.39)** | 4.24 (2.58)** | 2.54 (3.75) | 0.77 (0.65) | 0.27 (0.48) | 0.12 (0.13)* | 0.03 (0.03)*** | 0.18 (0.13)** | 0.00 (0.00)*** | 0.00 (0.00)*** | 0.15 (0.14)** | 0.19 (0.13)** |
Pseudo R
2
| 0.15 | 0.07 | 0.15 | 0.10 | 0.24 | 0.18 | 0.16 | 0.15 | 0.46*** | 0.44*** | 0.13 | 0.11 |
Model χ
2
| 44.56*** | 21.42*** | 35.55** | 29.59*** | 42.99*** | 29.19*** | 53.16*** | 44.09*** | 77.28 | 47.64 | 47.41*** | 52.87*** |
Number observations (n) | 333 | 391 | 332 | 405 | 286 | 329 | 326 | 367 | 266 | 266 | 333 | 372 |
The way in which we divide (user fees)…I don’t know if I receive the same thing. The IT (head nurse) and IA (assistant nurse) and me, I don’t know if they give the same thing. They give it to me, I sign, that is all.Female, 60 years
…everyone knows, that if you are going to ask for something someone will tell on you, you will be humiliated all the same, instead of asking, you must leave it.Male, 42 years
In the private (facilities) the staff are self-directed but they do not have any sanctions, they behave as they want. But with us here, the hierarchy demands explanations, there is monitoringFemale, 38 years
Because the state, I could stay with the state until death. But the partner, will always be there for a term of 5 yearsMale, 30 years
Ah, it is not well managed (per diems), if someone tells us there is maternity training, it is one person who can go, from the other side it is the IT (head nurse) and IA (assistant nurse), so we others…nothing!Female, 37 years
They become negligent…you see, at the end of each month, you go to the bank, you see (them) but you go to the office and there is no-one working. They end up perhaps going to sell things, but at the end of the month, they will go to get their money.Female, 30 years
Total remuneration
Explanatory variables | Coefficient (SE) | |
---|---|---|
Full model | Reduced model | |
Years in position | −0.01 (0.01) | |
Kasai Occidental (vs Equateur) | −0.37 (0.19)* | −0.27 (0.17) |
Kasai Orientale (vs Equateur) | −0.11 (0.30) | −0.07 (0.28) |
Maniema (vs Equateur) | −1.27 (0.26)*** | −1.26 (0.18)*** (p < 0.001) |
Province Orientale (vs Equateur) | −0.74 (0.24)*** | −0.47 (0.22)** (p = 0.032) |
Population served | 0.00 (0.00) | |
Total personnel | −0.01 (0.08) | |
Urban (vs rural) | 0.22 (0.26) | |
Number of services | 0.06 (0.04) | |
Distance of facility from village | 0.01 (0.02) | |
Reference heath centre (vs heath centre) | −0.26 (0.21) | |
Age | 0.01 (0.01) | |
Male (vs female) | 0.26 (0.13)** | 0.21 (0.12)* |
Number of dependents | −0.01 (0.02) | |
Married (vs not married) | −0.03 (0.04) | |
University (vs school education) | 0.11 (0.12) | |
Supported by ASSP programme | −0.13 (0.18) | |
Receives salary | 0.73 (0.14)*** | 0.79 (0.12)*** (p < 0.001) |
Receives occupational risk allowance | 0.81 (0.15)*** | 0.70 (0.12)***
p < 0.001 |
Receives performance payment | 0.59 (0.18)*** | 0.77 (0.15)***
p < 0.001 |
Receives user fees | 0.65 (0.20)*** | 0.75 (0.17)***
p < 0.001 |
Receives informal payments | 0.01 (0.17) | |
Receives income from private clinical work | −0.01 (0.25) | |
Receives supplemental income | 1.03 (0.13)*** | 1.00 (0.10)***
p < 0.001 |
Receives per diems | 0.20 (0.13) | 0.20 (0.11)* |
Constant | 2.45 (0.42)*** | 2.91 (0.22)*** |
R
2
| 0.48*** | 0.44*** |
Number observations (n) | 268 | 328 |