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PHIs dissatisfied with income, allowances, pay including OT – Study 

07 May 2021

BY Ruwan Laknath Jayakody    The vast majority of Public Health Inspectors (PHIs) are dissatisfied with their pay including for overtime, and income including allowances, a local study conducted during the pre-Covid-19 era found.  The study also found that in terms of job satisfaction, while the majority were satisfied with the responsibilities their work entailed and their interpersonal relationships, and approximately half were satisfied with the nature of the work, roughly speaking, only one third were satisfied with the supervision and the work environment, and further, only a minority were satisfied with the recognition, advancement and achievement gained from the job, and concerning the organisational policies.  Furthermore, the majority perceived the available legal provisions for vector control activities in order to prevent dengue and to address the sanitary facilities of buildings (existing and new), as inadequate.  It was also found that while increased time spent in field work in areas with a higher population was significantly associated with lower overall job satisfaction, the experience of the PHI, age and exposure to unnecessary political influence (more than one third of the PHIs in the said study claimed that there was “political interference” at least once during the past six months), did not, however, significantly influence their overall job satisfaction.  These findings were made by M. Kumarasinghe (attached to the Family Health Bureau of the Ministry of Health) and D. Samaranayake (attached to the Faculty of Medicine of the University of Colombo) in a research article titled Job satisfaction and associated factors among PHIs in the Sabaragamuwa Province: pre-Covid-19 era and published recently in the Sri Lanka Journal of Social Sciences.  PHIs are among the designated preventive health personnel attached to Medical Officer of Health (MOH) offices. Field activities conducted and performed by PHIs include all types of work including those concerning and pertaining to housing and sanitation, water and food safety (hygiene), the maintenance of environmental and occupational health and safety, activities related to school health programmes, disease surveillance, activities pertaining to the prevention and control of communicable diseases, rabies control activities, the control of environmental pollution, family planning activities concerning the male partner, health education and promotion, volunteer training programmes, and the inspection of institutions such as those related to rehabilitation, welfare and early childhood care and development. Field activities do not include other work done by PHIs pertaining to legal action, training programmes and workshops (including life skills development at schools and institutions), office and administrative work, and monthly conferences and other meetings.  The role of PHIs is critical at present, due to the emergence of the Covid-19 pandemic, as PHIs are, as per the Ministry of Health, responsible for the prevention of the pandemic in the community.  There are however, Kumarasinghe and Samaranayake noted, many challenges faced by PHIs while carrying out their duties, in their interactions with numerous sectors and the performance of field work. As revealed in the 2006 Report on the Rapid Assessment of Essential Public Health Functions in Sri Lanka by D. Fernando, N. Gunawardena and C. Weerasinghe, most of the participants had not seen a PHI in their uniform, coming to their close community, for disease surveillance and activities related to the prevention of communicable diseases (also, they were not even aware that such a system functions) while only a very small percentage, were able to recall any inquiry by health related officers at their houses or close proximities regarding a patient with a communicable disease (even then they did not recognise the officials they had met or spoken with as being PHIs). Additionally, Fernando et al., reported that only a few had seen an officer during the supervision of a food handling place within their community. Further, Fernando et al., ascertained that community awareness of the disease surveillance system including the detection of patients and follow up, as well as environmental control and preventive activities, were extremely weak.  Also with regard to the PHIs work, Kumarasinghe and Samaranayake pointed out that due to the meagre resources made available and the incentives that are in place, it is questionable as to whether they have sufficient job satisfaction to motivate them.  A study conducted by N.B. Gamini in 2008 among Public Health Midwives (PHMs) in the Ratnapura District regarding job satisfaction and its correlates found that only less than half of them (43.9%) were satisfied or strongly satisfied with motivational intrinsic factors of job satisfaction, whereas the overall percentage recorded for job satisfaction was only 25.3%.  Therefore, Kumarasinghe and Samaranayake carried out a descriptive cross sectional study in the Districts of Ratnapura and Kegalle. PHIs working in the Sabaragamuwa Province, 128 out of 141 in total, who also had worked for more than one year in any area in the country, were taken as the study unit. A total of 119 PHIs responded (response rate - 92.7%). The sample size covered 10% of the total national PHIs population (1,304 as per the Ministry of Finance and Planning, 2012).  A self-administered questionnaire based on American psychologist Frederick Irving Herzberg's Two Factor Theory, and a diary for self reporting on time utilisation, were used for data collection.  According to Herzberg’s said Theory, motivational and hygienic factors would determine the job satisfaction level. Characteristics of the job which give rise to satisfaction are motivational or intrinsic factors, and these include the nature of the work, recognition, responsibility, achievement and advancement. Characteristics of the job which lead to dissatisfaction are hygienic or extrinsic factors, and these include supervision, income, job security, the working environment, external influences, co-worker relationships and industrial policies. It must be noted that according to Herzberg, the opposite of job satisfaction is not dissatisfaction but the lack of satisfaction while the opposite of dissatisfaction is not satisfaction but the lack of dissatisfaction.  The mean age was 40.5 years. The majority were Sinhalese (114 - 95.8%) and Buddhists (114 - 95.8%). The mean work experience was 12.45 years.  More than 19% (23) were working in the same station for the past four years or more even though transfers are expected to be implemented for islandwide PHIs every four years as per the Establishments Code of 1985. This, according to Kumarasinghe and Samaranayake, highlights the doubts on the effectiveness of the transfer scheme in place. A similar finding was made among PHMs by Gamini (2008) where 41% were either dissatisfied or strongly dissatisfied with the transfer policy.  Only 16% resided in their respective PHI areas while more than 32% travelled in excess of 15 kilometres daily to reach their PHI area. The majority had received official motorcycles for transportation.  More than 17% (21) had an area population in excess of 15,000. The majority, the study revealed, were dissatisfied when their area population increased and this was found to be statistically significant.  In terms of dissatisfaction, the majority were either dissatisfied or strongly dissatisfied with the allowances and overtime (OT) payments they were receiving (91 - 76.5%), the facilities provided by the Government to carry out their duties (86 - 72.3%), the level of consideration given with regard to promotions and the contributions rendered by the officers (76 - 63.9%), the transfer policy (73 - 61.3%), the training they were receiving on the new technologies and knowledge (66 - 55.4%), the system in place in MOH and Regional Director of Health Services offices for the recognition and felicitation of hard working officers (64 - 53.8%) and timely feedback they were receiving from MOHs (61 - 51.2%).  In terms of satisfaction, the majority were satisfied with their working hours (107 - 89.9%) and the guidance provided by the MOHs in performing their duties (79 - 66.4%). One of the reasons for the high satisfaction rate for duty hours, according to Kumarasinghe and Samaranayake, might be the fixed working hours, with no duties at night, except in special situations.  Among the motivational intrinsic factors, responsibility showed the highest level of satisfaction (100 - 84%), followed by the official duties or the nature of the work (57 - 47.9%).  Among the motivational intrinsic factors, the highest percentage of dissatisfaction was reported for advancement (88 - 73.9%), followed by achievement (61 - 51.3%).  Among the hygienic extrinsic factors, interpersonal relationships (108 - 90.8%) followed by supervision (49 - 41.2%) showed the highest level of satisfaction, and with regard to the supervision factor, the majority (60.5%) were satisfied or strongly satisfied with regard to the impartiality and completeness of the supervision.  Among the hygienic extrinsic factors, the highest percentage of dissatisfaction was over the income and payments (74 - 62.2%) where the majority (over 76.8%) were not satisfied with the allowances and OT payments they were receiving, followed by organisational policies (35 - 29.4%).  Overall, more than 73% (92) were neither satisfied nor dissatisfied regarding their job, though 10.1% (12) showed dissatisfaction.  The majority believed that the existing and available legal provisions were inadequate for vector control activities to prevent dengue (77 - 64.7%) and concerning the sanitary facilities of buildings (existing and new) (80 - 67.2%). The majority were not happy with the facilities the Government had provided to implement the Food Act as amended and the Mosquito Breeding Prevention Act as amended (76 - 63.9%). There was general dissatisfaction with the facilities provided by the Government to carry out their duties (73.7%). These findings highlight, as explained by Kumarasinghe and Samaranayake, the importance of providing adequate remuneration and facilities to grassroots level health workers as such might be critical in controlling the current outbreak of Covid-19.  On average, one fourth of the time of PHIs duties was spent on preventing communicable diseases. Approximately, 15% of their time was spent on water and food safety. They spent the least amount of time on rabies control activities, the inspection of institutions and occupational health safety. PHIs have also spent around 40% of their time on training, legal actions, office and administrative work, meetings and monthly conferences. This, according to Kumarasinghe and Samaranayake, raises the question as to whether the PHIs spend adequate time in the field and also raises serious concerns regarding the practicability of the PHIs profession, as highlighted in the Report by Fernando et al., where it was noted that, “There was a general consensus among the participants that PHIs have minimal contact with the communities” and that such was “the main reason for sub optimal functioning”.  In this regard, there was a statistically significant difference regarding job satisfaction, as officers who spent more time in the field were less satisfied compared to officers who spent less time in the field.  “If field work causes dissatisfaction among the PHIs, it is a serious concern regarding the effective fulfillment of their duties. Further, this raises the question as to why the PHIs who were engaged in field activities were less satisfied. Was it due to the work load or more physical and psychological exertion?,” Kumarasinghe and Samaranayake queried.


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