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American Journal of  Medical 
Science and Innovation (AJMSI) 

Job Satisfaction of  Health Professionals Working in Governmental 
Tertiary Level Hospitals of  Nepal

Damodar Rokka1*, Namrata Khanal2

Volume 2 Issue 1, Year 2023
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Article Information ABSTRACT

Received: February 23, 2023

Accepted: March 17, 2023

Published: March 20, 2023

The extent to which an individual feels self-motivated, content & satisfied with his/her job 
is job satisfaction. By enhancing job satisfaction among the employees, the organization can 
creates happier employees. It will eventually lower costs for hiring and training new personnel 
and also create more motivated and productive employees. This descriptive study was 
carried out to find out the various factors that influence job satisfaction of  health employees 
of  varying specializations working in a tertiary level Governmental Hospital of  Nepal. The 
participants were asked to respond the questionnaires largely based upon the Job Satisfaction 
Scale (JSS) questionnaires developed by Paul E. Spector (1997) using 5-point likert scale. 
Convenience sampling method was employed in the study. Similarly, the study also relied on 
the publications of  the various related agencies for its secondary sources in regard to data 
collection. Only 28.1% of  the participants were found to be satisfied. The study proposes 
that hospital employees perceive supervision, recognition, pay& benefits, promotion, work 
environment and autonomy as significant factors affecting their job satisfaction. Also 
demographic variables like age, rank and education qualification has a significant relationship 
with job satisfaction while gender, marital status and work experience didn’t show any 
significant correlation with job satisfaction. The study provides an insight to the policy makers 
about the various factors that need to be considered for uplifting the job satisfaction level 
of  the health professionals and hence uplifting the standard of  the health care system of  the 
Governmental Hospital.

Keywords
Health Professionals, Job 
Satisfaction, Tertiary 
Level Hospital

1 Department of  Radiology and Imaging Technology, National Academy of  Medical Sciences (NAMS), National Trauma      
  Center,Kathmandu, Nepal
2 Gurans Life Insurance, Kathmandu, Nepal
* Corresponding author’s e-mail: rokkadamodar@gmail.com

INTRODUCTION
The extent to which an employee feels self-motivated, 
content & satisfied with his/her job is job satisfaction. 
In the area of  organizational performance and human 
resource management, job satisfaction is largely sought 
subject. If  an employee feels happy with their company 
& work, they look to perform better for the company 
with all their efforts. Managers should focus on employee 
satisfaction because dissatisfied employees may get 
irritated and there may be possibility of  providing inferior 
service by him/her. So, job satisfaction is an indicator of  
an emotional well-being and a fair treatment in an extent.
The people of  all over the world want a Universal Health 
Coverage (UHC) of  excellent quality to make sure their 
access to healthcare services for disease prevention and 
cure, palliation, health promotion, and rehabilitation, 
as and when needed which are not a financial burden 
for users (WHO, 2017). The dream of  UHC can 
become reality through a well-functioning health system 
equipped with skilled workforce, as consumers of  
health system today are more conscious of  their rights. 
This is why the health institutions of  today prioritize 
even more to possess an upgraded, well abreast with 
knowledge and skilled workforce who is satisfied with 
their jobs (Janicijevic et al., 2013). These healthcare 
services providers are indispensable for an efficient 
and effective healthcare system and their worldwide 
shortage is also a major challenge for thrachievement of  
Millennium Development Goals, more so in the low and 

middle-income countries. According to World Health 
Organization by the year 2035 the health workforce 
shortage will reach up to 12.9 million(WHO, 2013).
Stress in the workplace can lead to poor health and work-
related injuries (Iglehert, 2000). Health care professionals 
comprise a crucial group which will be impacted by 
workplace stress due to their unique work environment 
(Grunfeld et al., 2005) .Nepalese governmental health 
sector is relatively not well organized. The workers within 
the governmental health sector face various issues that 
have a huge impact on the level of  job satisfaction. 
Among health care employees, job satisfaction has a 
huge impact on work efficiency and quality, including 
health care costs (Bovier & Pernege, 2003). Studies 
showed that job satisfaction among health care workers 
is influenced by many factors, including gender, age, and 
level of  education, work experience, working conditions, 
salary, working hours, and the possibility of  promotion 
(Fahrenkopf  et al., 2008).This intricate phenomenon is 
an attitude towards one’s job that has an impression not 
only on the personnel’s motivation, but also on career, 
health and relationships with co-workers (Visser et al., 
2007) . Moreover, low salaries, lack of  fringe benefits, job 
insecurity, nepotism, political influences and improper 
career development structure are some of  the important 
factors that either hinder qualified health professionals 
from joining the governmental sector or increase the 
turnover rate (Makowiec-Dabrowska et al., 2001).
The World Health Organization (WHO) defines the 

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health workforce as “all people engaged in actions whose 
primary intent is to reinforce health” (WHO SEARO, 
2008). Human resources for the health are often defined 
as the various types and specializations of  medical and 
Para-medical staffs liable for individual and public health 
intervention. This includes both public and personal 
sectors and different areas of  health systems, like curative, 
preventive care, personal and non-personal public health 
interventions, disease prevention, health promotion 
services, and research, management and support services. 
The health resources include different categories of  
health professionals ranging from doctors, nurses, 
paramedics, mid-level health professionals of  different 
specialty of  health sciences, public health professionals 
and researchers. Human Resources in any health system 
and their proper utilization in work environment is a 
major requisite for better functioning of  health care 
system. (WHO SEARO, 2008).
In Nepal, Human Resources for Health (HRH) situation 
have been met with various notable challenges particularly 
associated to the acute shortage and uneven distribution 
of  the health workforce in the country (MOHP, 2012). 
Despite the necessity for an appropriate number and 
distribution of  different categories or level of  health 
professionals, who are socially responsible, technically 
competent and are available at the right time and place, 
as outlined in the National Health Policy 1991, these 
limitations have prevented policy from being implemented 
into the practice. Moreover, the National Health Policy 
has not taken into consideration the epidemiological 
transitions and demographic developments that have 
occurred over the last two decades. 
Nepal has been identified by the World Health 
Organization as one of  57 nations with a critical shortage 
of  health workers (WHO report). This creates a huge 
deficit in the requirements for the coverage of  essential 
interventions; including those necessary to meet the 
health related Millennium Development Goals (MDGs). 
In Nepal, this is unlikely until the threshold density of  
health workers (doctors, nurses and midwives) is at least 
23 per 10,000 in the population (NHSP II, MOHP 2010). 
Furthermore, policy has not addressed the changing 
demographics in the country, as despite a population 
increase of  more than 45 percent in the last two decades 
the human health resources has increased by 3.4 percent 
during that time (NHSP II, MOHP 2010). 
The distribution of  health workers has been raised as a 
concern in Nepal, with huge variations between ecological 
zones (Mountain, Hill and Terai) and among the 7 federal 
states of  the country. The absence of  doctors and qualified 
health professionals in the most remote areas has also 
been a long standing issue. These issues are compounded 
by the movement of  high-level health workers, such as 
doctors, nurses and professionals of  other specialties to 
private health institutions or overseas, due to the high 
demand for health workers in industrialized countries, as 
well as attractive incentives that they offer. 
In Nepal like in other developing countries; the “brain 

drain” of  health workers has been identified as a major 
concern. Previous research has identified that the 
professional councils approached for letters of  good 
standing by staff  wanting to work abroad and data 
suggests approximately 16% of  registered doctors are 
outside the country studying or working (Blair, 2011). 
Nearly more than half  of  health staffs are working in 
either the Kathmandu Valley or in other cities, leaving 
rural areas under-staffed, with absenteeism a growing 
problem for the effective delivery. The main issues in 
the human resource for health of  Nepal are retention, 
inadequate skill manpower with improper distribution, 
and inadequate finance, low opportunity for pre and 
in service training. Current recognition of  these issues 
by the government of  Nepal, developed the Human 
Resource for Health Strategy in 2003 for 14 years, i.e. 
2003 – 2017. However, this could not become effective 
because of  inadequate and unscientific projection, poor 
implementation of  the policy, inadequate funding, and 
ownership by the concerned stakeholders. In addition, 
the notable point in the Nepal is that the private sector 
has emerged as a substantial force in HRH; however the 
coordination between these two sectors are very weak and 
the private sectors are more concerned to the Urban area 
for the profit. So, governmental health facilities should 
be strengthened and for that the health professionals 
working in public hospital should be prioritized and 
retained (Shrestha, 2012).
Employee job satisfaction is considered as a critical 
factor for the success and better functioning of  any 
organizations including health care institutions. There 
have been numerous researches on this topic that are 
conducted all around the world. In recent decades, this 
issue has aroused interest in Nepal as well. Unfortunately, 
it is observed that there is not enough research made in 
Nepalese major governmental health care institutions 
about job satisfaction.  To the best of  our knowledge, no 
any published study covering major health professionals 
of  varying specializations has been found in our scenario. 
Non-profit public organizations are pivotal for the nation 
and its economy. Therefore, the issue is very important 
for governmental institutions. 
In developing countries like Nepal many of  the 
healthcare workers are unsatisfiedwith the quality of  life 
they themselves or their families can have in their country 
with their earnings or job incentives. They even think that 
there is not adequate opportunities to learn advanced 
technologies, enhance skills and career development, have 
poor working conditions, face violence at workplaces and 
are under political influences. Thus, they search for jobs 
in developed countries which have a higher pull force.
For these reasons, the tertiary level governmental 
healthcare institutions are selected for this study on 
measuring job satisfaction among health professionals. 
The public institutions where this study is performed 
are central governmental institutions, subject to central 
government budget applications and limitations. These 
institutions implement fundamental health policies and 

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activities mainly related to health. Therefore, the job 
satisfaction is worth to be investigated and very important 
to be kept at high level in this kind of  institutions. The 
intention of  this study is to recommend the Government 
and public health institution of  our country to take 
necessary steps to keep the employees satisfied with their 
work and other work-related factors for the success and 
better functioning of  the institution.
This research gains its importance from the subject 
matter itself, because it opens the scope for the officials 
and policy makers to consider job satisfaction as a very 
important issue among health workers in Government 
Hospital of  Nepal. The lack of  the previous studies 
on our scenario also makes this study important. This 
research focuses on the sources of  job satisfaction for 
health care providers and trying to make it better. The 
importance of  this study is that it will enrich the libraries 
of  the Ministry of  Health and Population for the future 
planning with suitable interventions to increase the level 
of  job satisfaction among health professionals and thus 
uplifting the standard of  health care service delivery in 
governmental hospital.

MATERIALS AND METHODS
Research Design
Design of  this study is not correlative. It is more of  opinion 
survey which identifies various factors that influence job 
satisfaction level among healthcare employees of  public 
hospitals of  Nepal. Thus, the research can be categorized 
as a descriptive study. For the purpose of  the study, 
500 hospital employees were selected randomly from 3 
hospitals of  Kathmandu. As indicated, 250 questionnaires 
in one major hospital and 125 in each to other two 
hospitals were distributed to hospital employees working 
in government hospital of  Kathmandu. Personal efforts 
were made on behalf  of  the researcher on delivering and 
collecting questionnaires. Of  the total 325 responses 
from the participants, 24 questionnaires were unusable. 
These excluded questionnaires, were missing key 
information. Thus, the usable returned questionnaires 
were 301 representing a response rate of  slightly more 
than 60%. In the present study, two sampling techniques 
i.e. multi stage sampling and convenience sampling was 
adopted. The first stage sampling involved selection of  
public health institution operating in Kathmandu valley 
at different locations. In the second stage, depending on 
the number of  bed capacity, three hospitals were selected. 
In the third stage, the convenience sampling was adopted.
 
Sources of  Data
The information has been collected from both primary as 
well as secondary sources.

Secondary Source
This study relies on publications of  the respective agencies 
for its secondary sources with regard to collection of  data. 
Thus, the present study depends heavily upon the relevant 
information from such secondary data. This secondary 

information has been collected from various publications 
relating to health workers, healthcare system etc. Different 
books, magazines, journals, newspapers, publications of  
executing agencies viz. World Health Organization (WHO), 
publications of  Ministry of  Health and Family Population, 
Government of  Nepal; Department of  Health Services, 
Government of  Nepal; Planning Board, Government of  
Nepal have been consulted to make the study meaningful. 
Various e-resources have been extensively consulted to 
make the study more updated, comprehensive and also to 
supplement the findings of  the study.

Primary Source
In order to obtain desired information regarding job 
satisfaction level among health workers, primary data was 
collected and analyzed. There are various methods for the 
collection of  primary data and information. However, 
the present study bases itself  on a questionnaire which is 
explained below:

Development of  Questionnaire
In this survey general information about the respondent 
and information relevant to the topic was asked of  the 
respondents. Structured, non-disguise questionnaire was 
used i.e. pre-determined and pre-drafted questionnaire has 
been used to collect the information. Since, the proposed 
questions were fairly harmless, it was decided not to change 
the major objectives of  the study. The questionnaire 
consisted of  fixed choice questions both dichotomous 
and multiple choice ones. But some questions were kept 
open ended to know the personal attitudes more clearly. 
In order to obtain unhesitant and honest responses by the 
respondents, they were assured that information collected 
would be kept strictly confidential and would only be used 
for academic purpose.
The questionnaire used in this study consists of  three 
different sections. The first section contains questions 
pertaining to the personal demographics about the 
respondents-specifically about age group, gender, 
marital status, highest level of  education, salary, years 
of  experience, and job level. The second section of  the 
survey measures job satisfaction. Specifically, the Job 
Satisfaction Survey (JSS) questionnaire developed by 
Paul. E. Spector (1997) has been mainly used to measure 
job satisfaction level of  healthcare employees of  public 
hospitals. Finally, the third section of  the questionnaire 
comprises of  open-ended questions just to know their 
preference of  working and to know their suggestions for 
improvement.

Job Satisfaction Survey (JSS)
The JSS includes thirty-questions that test attitudes toward 
six different aspects of  work. The six areas or subscales 
are autonomy, recognition, promotion, supervision, pay 
and work environment and group cohesion.

JSS Scoring
The JSS consist of  30 questions. The response format 

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used in the study incorporated a 5-point Likert-type scale. 
Respondents were asked to tick one of  five numbers that 
corresponded to their satisfaction or dissatisfaction about 
each question with one being the lowest and five being the 
highest score. Response choices for each question were 
scored as l=very dissatisfied, 2=dissatisfied, 3=Neutral, 
4=satisfied slightly and  5=very satisfied. Each subscale 
has five questions.
The Cronbach’s alpha internal consistency test was 
used to determine the reliability of  the test for each 
dimension. The values of  Cronbach’s alpha greater than 
0.7 were regarded as acceptable and those ≥ 0.7 were 
subjected to factor/principal component analysis (PCA). 
The Cronbach’s alpha value in our study was 0.87 which 
shows a good reliability of  the questionnaire used.
A pilot study was conducted with an effort to provide 
feedback regarding questions or any errors about the 
Demographic Questionnaire, JSS instrument and its scale. 
Eight participants agreed to participate in the pilot study. 
The participants were employed at National Trauma 
Center, Kathmandu where the actual survey was later 
distributed. A response sheet was attached to the survey; 
suggestions for improving the clarity of  instruction and 
general layout of  the instrument were obtained from 
the pilot study participants. The length of  time for 
completing the survey was also recorded on the response 
sheet. Results of  the pilot study demonstrated the average 
time for completing the survey was approximately 10 
minutes, with minimum ranging from 7 minutes to 
slightly more than 10 minutes. This information was later 
used in the request for participation in the actual study. 
Change made to the survey following the pilot study 
improved the clarity of  instructions and some content of  
the demographic questionnaire. The pilot study raised no 
major questions and the respondents did not have any 
difficulty in understanding and answering the questions. 
To make the study meaningful the data was analyzed and 
interpreted with the help of  certain statistical tools and 
techniques. The data for this research were analyzed using 
the Statistical Package for Social Science (SPSS). There 
are a number of  criteria to select a suitable statistical 
technique, two of  which are the appropriateness of  the 
technique to the research question and the characteristics 
of  data. Accordingly, different statistical techniques 
were used in the analysis based on their relevance to the 
research objectives, questions and hypotheses. Among 
the techniques that have been used in the present study 
are frequencies analysis, histograms, Chi-Square, Pearson 
Coefficient of  Correlation and t-test at 5% level of  
significance.

RESULTS AND DISCUSSION
Socio-demographic information
Age group of  the participants was divided into four 
groups as 20-30, 31-40, 41-50 and 51-60 years.  We 
included the age up to 60 years in consideration to the 
compulsory retirement age of  60 years according to the 
Heath Service Act of  Nepal.  There were 79 (26.2%), 167 

(55.5%), 50 (16.6%) and 5 (1.7%) respondents in 20-30, 
31-40, 41-50 and 51-60 years age groups respectively.
Table-1 presents the age distribution of  the respondents. 
Out of  301 respondents, there were 157 males and 144 
females that account for 52.2% males and 47.8% females. 

Table 1: Age group of  the participants
Age group (in years) Frequency Percentage
20-30 79 26.2
31-40 167 55.5
41-50 50 16.6
51-60 5 1.7

This shows that the majority of  the participants were 
males. Table-2 represent the gender distribution of  the 
respondents. Among the respondents, 244 were married 
and 57 were single with the majority of  participants i.e. 
81.06% married. In this study, there were 9 (3%), 36(12%), 
9(3%), 44(14.6%), 38(12.6%), 59(19.6%), 100(33.2%) and 
6(2%) of  the participants in 11th, 10th,9th, 8th, 7th, 6th, 5th 
and 4th level respectively. The majority of  the participants 
were of  the 5th level followed by 6th, 8th, 7th, 10th, 9th and 
11th level. 

Table 2: Rank/ level of  the participants according to 
Nepal Health Service Act
Rank Frequency Percent
11 9 3%
10 36 12%
9 9 3%
8 44 14.6%
7 38 12.6%
6 59 19.6%
5 100 33.2%
4 6 2%

In the study, the educational qualification of  the 
respondents were 58(19.3%), 137(45.5%) and 106(35.2%) 
of  certificate, undergraduate and postgraduate level 
respectively. Table-4 represents the educational 

Table 3: Educational qualification of  the participants
Frequency Percentage

Certificate 58 19.3%
Bachelor (Undergraduate) 137 45.5%
Masters (Postgraduate) 106 35.2%

Table 4: Work experience of  the participants (in years)
Years of  Experience Frequency Percentage
<1yrs 28 9.3%
1-5yrs 103 34.2
5-10yrs 101 33.6%
>10yrs 69 22.9%

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qualification of  the respondents. 

Job satisfaction scale (JSS)
The study consists of  the participants of  varying work 
experience in terms of  duration. 

Table-5 represents the data regarding the working 
experience of  the participants in years. After calculating 
the total facet score for each of  the six aspects of  job 
satisfaction, the total score was calculated on a scale from 
30-150. The score values of  30-54 were considered as very 
dissatisfied, 55-78 as dissatisfied, 79-102 as neutral, 103-
126 as satisfied and 127-150 as very satisfied. Observing 

these values, 0.7%, 10.4%, 60.7%, 26.2%, and 1.9% 
of  the participants were very dissatisfied, dissatisfied, 
neutral, satisfied and very satisfied respectively. Table-6 
represents the data regarding overall job satisfaction of  
the participants. 
The overall job satisfaction was studied under six sub-
scales i.e. Autonomy, Recognition, Work environment, 
promotion, Supervision and pay and benefits. On 
analyzing the satisfaction level on those sub-scales, 
recognition holds the highest percentage of  satisfaction 
(58.1%) followed by work environment (43.5%) and 
autonomy (33.2%).
When the job satisfaction of  the health professionals 
according to the area of  specialization was analyzed 
taking into account the average total job satisfaction 
score, pharmacists were found to have the highest score 
(108.36). They were followed by chief  consultant doctor 
of  11th level (103.67), medical recorder (102), consultant 
doctor i.e. 9/10th level (100.71), physiotherapist ( 100.20), 
medical officer, Biomedical technicians/engineers, Health 
Assistant, Laboratory technologists, Radiographers and 
Nurses. Nurses were found to have the lowest score 
among all of  the specializations. 

Table 6: Job satisfaction in different sub-scales
Sub-scale Very Dissatisfied Dissatisfied Neutral Satisfied Very satisfied
Autonomy 0.7% 9.3% 56.8% 31.3% 1.9%
Work Environment 0.7% 6.9% 48.9% 39.6% 3.9%
Recognition 0.7% 2.6% 38.6% 56.8% 1.3%
Promotion 10.6% 26.6% 36.5% 26.3% -
Supervision 3.3% 28.6% 47.1% 20.3% 0.7%
Pay and Benefits 11.7% 39.2% 45.2% 3.9% -

Table 7: Correlation between overall job satisfaction and each sub-scale of  satisfaction
Sub-scales Spearman correlation coefficient p-value*
Autonomy 0.46 <0.001
Work environment 0.65 <0.001
Recognition 0.75 <0.001
Supervision 0.79 <0.001
Promotion 0.67 <0.001
Pay and Benefits 0.72 <0.001
*statistical significance at 0.05

Table 5: Overall job satisfaction of  the participants
Frequency Percentage

Very Dissatisfied 2 0.7%
Dissatisfied 31 10.4%
Neutral 183 60.8%
>10yrs 69 22.9%
Satisfied 79 26.2%
Very Satisfied 6 1.9%

Correlation between overall job satisfaction and each 
sub-scale of  satisfaction
In order to determine the main factors that were 
correlated with satisfaction and/or dissatisfaction with a 
job, the relationship between overall job satisfaction and 
job characteristics was analyzed (Table-8). Spearman’s 
ratio demonstrated that the strongest correlation factor 
was in supervision (0.79). Other factors that influenced 
satisfaction were recognition (0.75) and pay and benefits 
(0.72), respectively.

Socio-demographic predictors of  health professional’s 
job satisfaction score
The relationship between socio-demographic variables 
and job satisfaction score was quantified. Age, rank and 
educational qualification showed statistically significant 
relation with the overall job satisfaction (p<0.05). 
Gender, marital status and work experience did not show 
any significant correlation with the overall job satisfaction 
(p>0.05).

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DISCUSSION
The health system of  Nepal is struggling with various 
issues. Those major issues are due to the economic, 
political and peace instability in the country. Among 
various blocks that are affected, one of  those prime area is 
human resources for health. As observed in a developing 
country, there is increased dissatisfaction in all aspects of  
life of  a person and healthcare resources are no exception 
to this. This is a very important aspect which cannot be 
neglected as it will not only worsen the gap between the 
desired and the actual numbers of  health care workers 
but will also seriously affect their performance, efficiency 
and effectiveness in the long run.
In an international commitment in order to reduce global 
poverty and improve population health, the governments 
of  the world have committed, in the Sustainable 
Development Goals, to achieve universal health coverage 
(UHC), including financial risk protection by 2030 (WHO, 
2017). A critical decision in the progressive realization 
of  UHC is which health services to include in essential 
packages of  care. To realize the goal of  comprehensive 
universal health coverage, it is important to increase the 
utilization of  public health services through effective 
care. As per the data provided by the National Health 
Account 2016, the household out of  pocket, expenditure 
is 53% and is one of  the highest in the world (NHA, 
MOHP, 2016). The Government of  Nepal has always 
prioritized for the improved health services in the country. 
The constitution of  Nepal, 2015 has established health 
as the fundamental right of  the people. But all these 
efforts cannot achieve the desired goal until we have self  
motivated and efficient healthcare providers at primary, 
secondary and tertiary healthcare levels. However, the 
motivation of  the healthcare service providers is the 
key to effective delivery of  the health service and the 
motivation depends upon their job satisfaction. Hence, it 
is critical to ensure that they feel satisfied with their jobs. 
Our study included healthcare workers with different 
specializations including doctors to have a holistic picture 
and approach to assess job satisfaction. 
Past studies focused mainly on doctors and nurses (Jharana 
et al., 2019; Chaulagai & Khadka, 2012; Peters et al., 2010). 
This study has included different health professionals 
of  varying specialization.  Our study has used JSS. This 
is a frequently used validated instrument that allows 
comparisons with previous studies (Sibbald et al., 2000). 
Only 28.1 % of  the study participants showed satisfaction 
with their jobs based on the absolute approach used for 
computing the job satisfaction scores ranging from 30-
150. Low levels of  job satisfaction were also reported in 
a job satisfaction study regarding Pakistan where 14% 
of  the employees showed high dissatisfaction with their 
jobs (Kumar et al., 2013). This has big implications for the 
public health system like ours, which is already facing a 
significant lack of  financial resources and can’t afford to 
lose the skilled workforce. Another study done in Lahore 
showed that only 31.1% of  doctors were satisfied with 
their jobs (Deeba et al., 2015). In another study, the result 

showed that only 13% of  the doctors were well satisfied 
with their jobs while a significant number had either 
below average or average satisfaction for their job (Nikic 
et al., 2008).
This dissatisfied workforce will be further increasing 
to the number of  workers who leave their country or 
their cities and migrate to other areas in search of  better 
opportunities and developments. It can be observed 
that previous studies showed similar results.  It is a clear 
evidence that despite being brought to the notice of  people 
and policy makers in the country where these studies were, 
still not suitable intervention has been made in order to 
bring improvement in the satisfaction of  health services 
employees who are integral part of  the health system and 
without the satisfaction of  whom the effective delivery 
of  healthcare services to the poor or the needy public 
cannot be achieved. Any level of  dissatisfaction among 
healthcare providers in the public sector demands further 
assessment and intervention, as this could have deterrent 
consequences in terms of  overall efficiency, effectiveness, 
and sustainability of  any health system around the world. 
Our findings of  this study on job satisfaction was carried 
out in Government hospital of  Kathmandu .Thus, the 
results are of  the serious concern for the policy makers. 
Even though the study was conducted in the capital which 
is presumed to have a comfortable working environment, 
good infrastructure, and a convenient life, the results 
showed a very less satisfaction among the professionals. 
Job satisfaction was similar in all age groups in our 
study. Some studies have reported higher satisfaction in 
elderly professionals compared to younger professionals 
(Carrillo-Garcia et al., 2019).  When analyzed with the 
gender, marital status and the work experience, the result 
showed no statistical significance in this study. This 
contradicts with the results from some of  the previous 
studies. Male workers felt more satisfied compared to 
females similar to a survey conducted among German 
physicians (Behmannet et al., 2012).  However, a 
Spanish study reported the opposite results (Carrilo et 
al.., 2013). Some other reviews concluded that gender 
is not a strong independent predictor (Keeton et al., 
2000). The differences may be due to cultural variations. 
The professionals in the higher rank and with higher 
educational qualification showed higher satisfaction 
and was found to be statistically significant. This can be 
attributed to the fact that the professionals in the higher 
position and with higher qualification enjoy more respect 
and the pay than the others and can also have a influence 
on the management.
The three highest levels of  satisfaction were the 
recognition, work environment and autonomy. This 
agrees with the findings of  Cooper et al. who reported 
that health-care providers appreciated their freedom and 
independence to work, as well as enjoyed the responsibility 
and variety of  their job with the recognition. The 
autonomy at one’s work is a feature which distinguishes 
healthcare from other service industries. If  the workers 
feel they are handcuffed due to the conditions at the 

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work/workplace and believe that the procedures pose 
barriers in the effective performance of  their duties, then 
the quality of  services that they offer are also affected 
significantly as many treatment options or timely decisions 
for the treatment or the services cannot be taken due to 
these red tapes.
Our study revealed that the participants had overall low 
satisfaction with various global dimensions of  job with 
only 3.9 % satisfied with remuneration, 21% satisfied with 
the supervision and 26.3 % satisfied with their promotion 
chances. All these results in regard to pay, promotion 
opportunities, benefits and rewards are similar with the 
findings which were presented in the study assessing job 
satisfaction among public health care workers in Pakistan 
(Kumar R et al, 2013). Low satisfaction with salaries/
pay and development opportunities of  an individual 
was also reported in a study conducted in healthcare 
workers in Tanzania (Nikic et al., 2008). The healthcare 
profession is not similar to other professions in the sense 
that here the biggest reward for any service provider is 
the satisfaction of  providing services to mankind and 
in return get appreciation. But if  the workers don’t get 
their due reward for their duty, then it adds to their 
dissatisfaction and can negatively influence the delivery 
of  the effective quality of  care to be provided. The results 
for supervision showed that most of  the respondents 
were dissatisfied with the capabilities of  their supervisor, 
the role he plays in mentoring them. This is particularly 
important in regards to sensitive healthcare industry as 
the workers have to deal with patients and their emotions 
not machines. For this, they need to learn skills to scale 
up their capabilities. If  they believe that their supervisor 
lacks the ability to guide/supervise them and does not 
entrust them with tasks that can add to their skills, then 
they will be at a loss. 
Dissatisfaction with one’s salary in our findings seems to 
be a common issue that is also evident in several other 
studies (Kinzl et al., 2005; Ekeret et al., 2004; Goetz et al., 
2011; Burnard et al., 1999).  Many managers consider that 
the key motivation for their employees is pay, bonuses 
or raises. This suggests that health-care systems should 
provide an adeqaute salary and fringe benefits scheme 
to satisfy their workers and maintain their loyalty. In 
contrast, that does not seem to be a problem in Australia 
as evidenced by a previous studydone in 2002. That 
discrepancy may be due to differences in the economic 
status of  Australian health-care systems and ours (Ulmer 
& Harris, 2002)
The main factors that correlated with the overall job 
satisfaction were supervision followed by recognition and 
pay. Thus, the study suggested on improving the quality 
of  supervision, recognition of  one’s work or contribution 
and also increasing the incentives. For improving the 
quality of  supervision, the policy makers must ensure 
the adequate training and education of  the supervisors in 
order to enhance their skills.
When asked about the preference of  their working, 
more than 80% of  the participants preferred working 

in governmental hospital with the major reason being 
the job stability. Similarly, the study also asked for their 
suggestion for the overall improvement in job satisfaction. 
Among the various suggestions, the major suggestions 
were the increase in salary and benefits, creating good 
and fair opportunities for the training and education and 
good performance appraisal system.

CONCLUSION AND RECOMMENDATIONS
The study intends to sensitize the policy makers on the 
subject of  satisfaction of  the workforce and its implications 
in the governmental hospital of  Nepal. It is essential 
to regularly improve the policies related to healthcare 
providers and their working conditions in certain interval 
of  time. Among various factors, the study proposes that 
hospital employees perceive supervision, recognition, pay 
& benefits, promotion, work environment and autonomy 
as significant factors affecting their job satisfaction. Any 
interventions directed at improving the various facets 
of  the job satisfaction will surely have a positive impact 
on job satisfaction. A conducive working ecosystem in 
addition to a satisfied and ambitious workforce can and 
have a positive impact on the evolving health system of  
a country.
It is time that job satisfaction surveys should be conducted 
frequently in a regular basis in the provincial and federal 
sector public hospitals of  the country. The data collected 
from such surveys will provide a very fruitful insight into 
the expectations of  the workers as well as provide the 
employee’s views regarding the various shortcomings of  
different dimensions at their workplaces. These results 
can then be looked and thus incorporated into newer 
human resources policies for health that can surely 
provide better compensation packages, provide clear job 
description to the employees and these in turn will help 
improve satisfaction of  health care workers in future. It 
is advised that an all-inclusive approach be undertaken 
in order to strengthen the policies addressing employee 
satisfaction which can bring a noticeable improvement in 
the quality and performance of  organization.

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