Box 2.

How decentralisation influences the retention of primary health care (PHC) workers in rural Nigeria

Fragmentation of responsibilities in the health system among tiers of government

The salary to PHC workers is paid irregularly due to inefficiencies in the chain of funds transfer from one tier of government to another. Lower salaries at the PHC level compared to secondary and tertiary care because better funded tiers of government are responsible for the higher levels of health care.

Community engagement in PHC through the community health committees

Improved uptake of PHC services increases job satisfaction among health workers, leading to reduced absenteeism, which implies retention. Social and financial support for health workers by community members increases job satisfaction and motivate them to stay in rural communities. Co-financing and co-managing PHC facilities by community members ensures they function optimally, thereby increasing job satisfaction of health workers, which may lead to retention.