Prof. Maniple’s Thesis on HR for Health

Our Vice Chancellor’s PhD thesis is now available for free download. He completed the thesis in 2015  at the School of Postgraduate Studies, Faculty of Medicine and
Health Sciences, Royal College of Surgeons in Ireland.


Everd Maniple Bikaitwoha

‘ “I found myself staying”: A case study of the job embeddedness and retention of qualified health workers in rural and remote areas of Uganda’


Global health worker maldistribution affects poor countries and rural areas most
adversely, despite their high disease burden. Health workers reject rural areas due
to isolation, and lack of facilities. Recommended extrinsic interventions to address
rural-urban imbalance are costly and not sustainable in most developing countries.
However, some health workers serve in rural areas without such interventions,
suggesting existence of strong intrinsic motives for rural practice choice and
retention, knowledge of which could be used to select retainable staff. This PhD
research, a mixed-methods case study of 50 purposively-selected doctors and
nurses retained in 12 Ugandan rural government and private general hospitals for
three or more years, sought to find the reasons some qualified health workers get
retained in rural areas, and the role of job embeddedness, a construct which
predicts employee turnover, in their retention.
Rural practice choices were made for personal or altruistic reasons and in
obedience to authorities. Rural integration and embeddedness depended upon
social and pre-service technical preparation, leading to cultural competence,
adaptability, self-efficacy and resilience to shocks. Retention depended on feeling
satisfied with achievements or self-adjustment. Despite a modest average degree of
rural job embeddedness, rural retention averaged 19 years and most participants
did not intend to leave soon. Job embeddedness predicted the duration of
retention but not intention to leave. The strongest dimensions of job
embeddedness were “fit-organisation” and “fit-community”.
Prosocial behaviour and self-efficacy in rural practice influence rural practice choice
and retention, and job embeddedness generally increases with retention. The study
contributes the job embeddedness construct to the theory of health worker
retention research. It also extends the use of the construct to mixed-methods
studies, raises rural retention to the policy and research agendas and highlights the
role of prosocial behaviour, self-efficacy and good managerial practices in rural
practice choice and retention.

If you are interested in public health issues in Africa, download the thesis here:

Prof. Maniple’s PhD Thesis

You can contact Prof. Maniple at:


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