LABORATORY ASSISTANTS WELFARE

SURVEY REPORT

OCTOBER 2010

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Table of Contents
ACRONYMS/ABBREVIATIONS.......................................................................................2
ACKNOWLEDGEMENTS...............................................................................................4
EXECUTIVE SUMMARY.................................................................................................5
1.0 BACKGROUND......................................................................................................6
2.0 OBJECTIVES OF THE SURVEY................................................................................7
3.0 METHODOLOGY....................................................................................................8
3.1 Data Collection and Data Collection Tools.........................................................8
3.2 Sampling...........................................................................................................8
3.3Limitations of the study......................................................................................8
4.0 FINDINGS..............................................................................................................9
4.1 Laboratory assistants in allocated health facilities............................................9
4.2 Performance of laboratory assistants..............................................................12
4.3 Levels of satisfaction of the laboratory assistants with their pay and other
incentives..............................................................................................................18
4.4 Supervision and support of laboratory assistants by supervisors....................21
4.5 Working conditions of laboratory assistants....................................................26
4.6 Level of motivation of the laboratory assistants.............................................30
4.7 Chances of career progression of the laboratory assistants............................36
4.8 Level of commitment of the laboratory assistants to a long term career with
MOH......................................................................................................................38
5.0 RECOMMENDATIONS..........................................................................................39
5.1 To MOH............................................................................................................40
5.2 To DHOs..........................................................................................................40
5.2 To DHOs

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ACRONYMS/ABBREVIATIONS
CD4 Helper Lymphocytes

CHAI Clinton Health Access Initiative

CHSU Community Health Sciences Unit

DHO District Health Officer

DMO District Medical Officer

EMLS Essential Medical Laboratory Services

Hb Haemoglobin

HIV Human Immunodeficiency Virus

HSA Health Surveillance Assistant

HTC HIV Testing and Counseling

MCHS Malawi College of Health Sciences

MOH Ministry of Health

TB Tuberculosis

ACKNOWLEDGEMENTS
The author is thankful to the Country Director of Clinton Health Access Initiative
(CHAI) Malawi, Mr. Thomas Kisimbi, for giving a go ahead to the survey.

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He is more than thankful to the Deputy Country Director of CHAI, Mrs. Veronica
Chipeta Chirwa, for all the advice and technical support during preparation, data
collection and report writing.

In addition he is thankful to Rose Rioja for the data collection in Machinga. Thanks
also to Edson Lungu, the driver, for the hard work and sacrifice.

Lastly the author wishes to thank all the Clinton Foundation staff for their great
support.

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EXECUTIVE SUMMARY
The Clinton Health Access Initiative (CHAI) in collaboration with the Malawi College
of Health Sciences (MCHS) began the training of laboratory assistants in 2008. This
was aimed at strengthening the laboratory system of the Ministry of Health (MOH)
by providing laboratory personnel in health centers and rural hospitals. These
laboratory assistants graduated in 2009 and began working in MOH health facilities.

The survey was conducted in order to assess the welfare of the laboratory
assistants and it was done in all the 28 districts in Malawi. It was started on 1
September and ended on 3 October 2010. It has been established that 58 percent
of the laboratory assistants are in health centers, 33 percent are still at district
hospitals while 4.5 percent left and the other 4.5 percent never reported at their
health facilities. The survey uncovered issues that are affecting the performance of
the laboratory assistants including dissatisfaction with their entry grade, scarcity of
laboratory equipment and reagents, lack of electricity in some laboratories and
many more.

Appropriate recommendations have been made to MOH and District Health Officers
on how to improve the welfare of the laboratory assistants.

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1.0 BACKGROUND
The Clinton Health Access Initiative (CHAI) in collaboration with the Malawi College
of Health Sciences (MCHS) began the training of laboratory assistants on 7th
January, 2008. The intention was to strengthen the laboratory system in Malawi in
the area of human resource. Eighty one students were registered for the program.
They began with a six weeks orientation program which was aimed at imparting the
following skills:

• Reagents preparation
• Adherence to laboratory ethics
• Sample collection, processing and testing
• Operation of simple/standard laboratory equipment
• Maintenance of safe environment in the laboratory
• Management of laboratory inventory and records; and
• Maintenance of quality assurance in the laboratory.

Soon after the orientation 63 of the 81 students were sent for practicals to different
District and Central hospitals across Malawi. The other students were on campus
pursuing a modular certificate program. The students kept on rotating until all the
81 students had gone through the modular program.

At the end of the program it was 67 students who graduated. These were awarded
Certificates in Biomedical Sciences and on 2nd December, 2009 they were allocated
health centers/rural hospitals where they were supposed to work. Most laboratory
assistants reported for duties at their respective health facilities in January 2010.

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2.0 OBJECTIVES OF THE SURVEY

The main objective of the survey was to assess the welfare of the laboratory
assistants so as to get a better understanding of how they are settling down in the
Ministry of Health (MOH) system. The following were the specific objectives:

• To establish if the laboratory assistants are in the facilities they were

allocated.
• To assess the performance of the laboratory assistants.
• To determine the levels of satisfaction of the laboratory assistants with their
pay and other incentives they get.
• To assess the supervision and support laboratory assistants get from their
supervisors.
• To assess the working conditions of laboratory assistants.
• To determine the level of motivation of the laboratory assistants.
• To assess the chances of career progression of the laboratory assistants.
• To determine the level of commitment of the laboratory assistants to a long
term career with the MOH.

The findings of the survey will be used by CHAI and MOH in developing ways of
retaining the laboratory assistants who are still working in government health
facilities. In addition, the findings will also show areas that need improvements in
order to get the best out of the laboratory assistants.

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3.0 METHODOLOGY

3.1 Data Collection and Data Collection Tools

The survey was started on 1st September, 2010 and ended on 3rd October, 2010. It
was conducted in all the 28 districts in Malawi. It was first conducted in the Central
region but some districts were left out, then the North, the South and finally the
Central region again in order to finish the remaining districts.

In each district the District Health Officer (DHO) or anyone acting as the DHO was
first approached in order to obtain permission to conduct the survey.

Structured questions were used during interviews with DHOs and the answers for
each interview were recorded. Self-administered questionnaires were used to
collect data from the laboratory assistants.

DHOs were interviewed in order to collect data on the number of laboratory

assistants they have. They were also asked on location and performance of the
laboratory assistants. Furthermore, the DHOs were interviewed on the incentives
they provide to their laboratory assistants.

Laboratory assistants were followed in their health facilities and a questionnaire was
handed to each laboratory assistant. The questionnaires were collected as soon as
the laboratory assistants finished answering them.

3.2 Sampling
All the 29 DHOs were selected for the study. Where the DHO was not available for
interview the District Medical Officer (DMO) or any person delegated by the DHO
would be interviewed (these were usually Clinical Superintendents or Laboratory In-
Charges).

In the case of laboratory assistants all the 67 laboratory assistants who were
allocated to different health centers/rural hospitals across Malawi were selected.
During the study it was discovered that 3 laboratory assistants had quit, 3 never
reported for duties and 1 refused to take part in the survey. Consequently 60
laboratory assistants were the ones who participated in the survey.

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3.3Limitations of the study
One of the limitations of this study is the fact that assessment of the laboratory
assistants’ performance was based on information obtained from their supervisors
rather than observing them work in the laboratory. Observation was not possible
because it would have been very time consuming as such it would not have fitted
into the time frame of the survey.

The other limitation is that we were not able to track the laboratory assistants who
had left or never reported to their facilities. It would have been much better if their
reasons of departure or not reporting were heard.

4.0 FINDINGS

4.1 Laboratory assistants in allocated health

facilities
The aim of training these laboratory assistants was that they should work in health
centers or rural hospitals in order to improve the quality of laboratory services in
these health facilities. Thirty one percent of the laboratory assistants are in the
health facilities where they were allocated after graduation, while 60 percent are in
health facilities which were not allocated to them after graduation and 9 percent are
those who left/never reported for duties at their health facilities. This is illustrated in
figure 1 below.

Figure 1: Laboratory assistants in health facilities.

Figure 1 above does not give a clear picture of what percentages of laboratory
assistants are in health centers and rural hospitals, at the district, those who left
and those who never reported. It should be understood that some laboratory
assistants are in facilities not allocated to them after graduation but were moved
from their allocated health centers to other health centers due to reasons to be
discussed later in this report. Figure 2 below clearly shows that 58 percent of

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laboratory assistants are in health centers and rural hospitals, 33 percent are still at
district hospitals, 4.5 percent left and 4.5 percent never reported for duties.

Figure2: Location of laboratory assistants by type of facility.

It is encouraging to learn that a larger percentage of the laboratory assistants are in

health centers but it is still not good enough because those at district hospitals are
still needed in health centers. It is also disappointing that some laboratory
assistants left their health facilities while others did not even report for duties.

The DHOs in various districts had reasons why the laboratory assistants were still at
district hospitals or transferred from one health center to another. Among the
reasons given inavailability of laboratories at the allocated health facilities was a
problem for 48 percent of the DHOs, lack of accommodation for the laboratory
assistants at the allocated facilities constituted 26 percent and re-allocation of the
laboratory assistants to replace staff that had left other facilities or to go where
there was a greater need for their services was a problem for 30 percent of the
DHOs. Eleven percent of the DHOs had to relocate laboratory assistants due to
family issues i.e. following a spouse. This is illustrated in figure 3 below.

Figure 3: Reasons for the retention/relocation of laboratory assistants.

From the statistics in figure 3 above it is very clear that inavailability of laboratories
at health centers is the major hurdle towards achieving the goal of strengthening
the laboratory system in health centers. As a result laboratory assistants are still
working at the district laboratories or at health centers where there are already
laboratory staff.

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Accommodation for the laboratory assistants is another major problem. There were
scenarios where laboratories were available at the health centers but the laboratory
assistants would not go to the health centers because there were no houses
available at the health centers and houses in the surrounding villages were of poor
condition such that they could not even dare to rent them.

Some laboratory assistants were at the district hospitals in order to cover for staff
shortage at district laboratories. Some laboratory assistants were sent to different
health centers other than those allocated either to fill the gaps of transferred
laboratory staff or because there was little work at the originally allocated health
facility. As long as staff shortages exists at district laboratories some laboratory
assistants will still remain at district hospitals.

There were some laboratory assistants who were not at the originally allocated
health facilities because they were following their spouses. These moved to health
facilities that could keep them closer to family.

4.2 Performance of laboratory assistants

When DHOs were asked on how they rate the laboratory assistants it was
discovered that 60 percent of the laboratory assistants were rated as good while
the remaining 40 percent were rated as excellent.

Figure 4: Rating of the laboratory assistants

It is encouraging to note that DHOs had full confidence in the competence of the
laboratory assistants. All the DHOs confirmed that they had never received
complaints on laboratory assistants failing to perform their duties.

Despite the fact that the laboratory assistants were highly rated some DHOs
mentioned of areas that needed improvement in order to get the best out of the
laboratory assistants. Except for the CD4 training, the other trainings would be
refresher courses. Twenty two percent of the DHOs talked of the need to train the
laboratory assistants in CD4 testing, 15% percent of the DHOs talked of the need to
train them in Chemistry, 11 percent of the DHOs were for the need to train them in
laboratory management and 7 percent of the DHOs were for the need to allow the
laboratory assistants accumulate more experience. This is illustrated in figure 5
below.

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Figure 5: Gaps in the performance of the laboratory assistants.

It is important to train the laboratory assistants in CD4 testing but the major
setback is that where most laboratory assistants work they do not have the CD4
machines as such they would start to forget the skills due to lack of practice. The
inexperience issue will eventually be ironed out with time.

The Essential Medical Laboratory Services (EMLS) classified the following tests as
`critical’: haemoglobin (Hb) estimation, Malaria microscopy, TB testing using
sputum smear microscopy, HIV testing using rapid testing devices, blood screening
for transfusion ( looking for blood-borne diseases). The project also classified the
following tests as `important’ once the critical tests are established; cerebrospinal
fluid examination, stool and urine examination, blood glucose testing, syphilis
screening and white blood cells count (CD4 count).

All the laboratory assistants are able to carry out malaria tests at their health
facilities, 78 percent of the laboratory assistants are able to test haemoglobin in
their laboratories, while 86 percent can test tuberculosis (TB) in their laboratories
and 28 percent can screen blood in their laboratories. Only 16 percent of the
laboratory assistants are involved in HIV testing using rapid testing kits. This is
illustrated in figure 6 below.

Figure 6: Critical tests done by laboratory assistants.

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The reason why all the laboratory assistants are able to carry out malaria tests is
because malaria testing equipment and materials are readily available in every
district. During the survey it was mentioned that the Community Health Sciences
Unit (CHSU) had distributed microscopes in order to scale up malaria diagnosis. It
would have been great news as well if all the laboratory assistants could estimate
haemoglobin in their laboratories but due to inavailability of materials and
equipment it was not possible. Tuberculosis testing would also have scored 100
percent like malaria because the two most basic tests that are done at health
centers where microscopes are available are malaria and TB microscopy but there
is no clear explanation as to why this was not the case.

Blood screening requires much more sophisticated tests never wonder it is done by
very few laboratory assistants most of whom are at district hospitals or rural
hospitals. It is understandable as to why there are very few laboratory assistants
doing HIV testing using rapid kits because most hospitals have separated
laboratories from HIV testing and counseling (HTC) centers.

On tests classified as important by the EMLS only 9 percent of the laboratory

assistants can do CD4 count tests at their laboratories, 22 percent are able to do
cerebrospinal fluid analysis, 41 percent can do stool analysis, 53 percent can
examine urine, 16 percent can test blood glucose and 56 percent can test for
syphilis in their laboratories. This is illustrated in figure 7 below.

Figure 7: Important tests done by laboratory assistants.

It is very important to understand that the laboratory assistants are very capable of
doing all the tests in figure 7 above except the CD4 test which has restrictions on
who does it in some districts (However, some laboratory assistants do CD4 tests). In
ability of the laboratory assistants to do the tests in their laboratories is mainly due
to lack of laboratory equipment and reagents.

Other tests done by the laboratory assistants are pregnancy tests which are done
by 69 percent of them, sperm analysis done by 3 percent and sickle cell tests done
by 9 percent of the laboratory assistants.

Figure 8: Other tests done by laboratory assistants.

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It is good to know that despite the fact that the laboratory assistants are in limited
resource settings some of their management take the initiative to make resources
available for the tests in figure 8 above. The presence of the laboratory assistants in
the health centers should be motivation to DHOs to increase the number of tests
health centers offer.

On availability of materials required to do their job 19 percent of the laboratory

assistants rated their laboratories as excellent, 36 percent rated them as good while
32 percent,10 percent and 3 percent rated their laboratories as average, poor and
very poor respectively. This is shown in figure 9 below.

Figure 9: Laboratory assistants' ratings of availability of work necessities.

The ratings above are promising and it is hoped that availability of materials and
equipment will improve with time.

On issues affecting the performance of the laboratory assistants 47 percent of the

laboratory assistants complained about their entry grade, 41 percent of them
complained about inavailability of materials and equipment in their laboratories, 27
percent talked about lack of trainings while 14 percent, 12 percent and 32 percent
complained of electricity, allowances and other issues respectively. This is shown in
figure 10 below.

Figure 10: Issues affecting performance of laboratory assistants

Laboratory assistants talked of being given grade M while Medical Assistants who
also have certificates and were trained at the same institution were given a higher
grade called L. The implications are that the laboratory assistants get a salary lower
than that of their counterparts. Worse still the laboratory assistants are at the same
grade as Health Surveillance Assistants (HSAs) who are trained at the district only
for six weeks.

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Some laboratory assistants fail to carry out important tests due to lack of
equipment and materials. On trainings laboratory assistants complained of not
being recognized for trainings especially those that come from the Ministry. Only
names of laboratory technicians come from the Ministry for such trainings. Lack of
reliable electricity was also implicated in failure to carry out some tests. Some
laboratory assistants rely on solar power which usually runs out while they are still
working.

Other laboratory assistants complained of not getting incentives like LOCUM and
allowances. They quoted this as a cause of demotivation. On the category of `other’
complaints were on weather, too much work and an eye problem requiring glasses.

Lastly on performance 19 percent of the laboratory assistants rated their ability to

have an impact as excellent, 36 percent rated it as good, 32 percent rated it as
average, 10 percent rated it as poor and the remaining 3 percent rated it as very
poor. This is shown in figure 11 below.

Figure 11: Laboratory assistants' ratings of their ability to have an impact

4.3 Levels of satisfaction of the laboratory

assistants with their pay and other incentives
Ninety eight percent of the laboratory assistants are on payroll. The remaining 2
percent is one laboratory assistant who is not on payroll.

Figure 12: percentage of laboratory assistants on payroll

The laboratory assistant is from Neno and he complained that he has been working
for nine months without pay. It appears that the human resource department from
the district is failing to put him on payroll. Reasons were not given as to why this
person is not on payroll.

Ninety three percent of the DHOs said that they give their laboratory assistants
LOCUM or other allowances, 81 percent of the DHOs involve the laboratory
assistants in trainings or seminars and 7 percent of the DHOs involve laboratory
assistants in activities requiring laboratory personnel.

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Figure 13: Incentives given to laboratory assistants.

It is great that most DHOs give allowances or LOCUM to laboratory assistants but it
would also be good if the remaining DHOs did the same. Likewise on seminars and
trainings it is a good gesture to allow the new cadre to keep up with latest
developments in their field. It would also be awesome to see their involvement in
activities at district level improve.

Thirty one percent of the laboratory assistants are very dissatisfied with their
amount of pay, 52 percent are dissatisfied while 10 percent and 7 percent are `not
sure’ and satisfied respectively. This is shown in figure 14 below.

Figure14: Satisfaction of laboratory assistants with amount of pay

The very high percentages in dissatisfaction are mainly due to the low grade the
laboratory assistants were given. It is the grade that determines how much money
one gets at the end of the month.

On how their pay compares with that for similar jobs in other organizations 63
percent of the laboratory assistants are very dissatisfied, 22 percent are
dissatisfied, 10 percent are neutral and 5 percent are satisfied. This is shown in
figure

Figure 15: Satisfaction of laboratory assistants with how their pay compares with
that for similar jobs in other organizations.

Unless things improve this is an early warning sign that most of the laboratory
assistants may go to the private sector once their government bonds are over or
worse still anytime they get the opportunity.

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Fifty four percent of the laboratory assistants are satisfied with their job as a steady
source of income, 20 percent are very satisfied, 9 percent are neutral, 15 percent
are dissatisfied and 2 percent are very dissatisfied. Figure 16 below shows the
scenario.

Figure 16: Satisfaction of laboratory assistants with their job as steady employment

This is a good indicator that most laboratory assistants rely mainly on their job as a
reliable source of income. The more their conditions improve the more laboratory
assistants remain with MOH.

4.4 Supervision and support of laboratory

assistants by supervisors
Sixty seven percent of the districts in Malawi have laboratory technicians as direct
supervisors of the laboratory assistants, 26 percent have laboratory technologists
as direct supervisors and 7 percent have other direct supervisors (DMO or Medical
Assistant). This is in figure 17 below.

Figure 17: Direct supervisors of laboratory assistants.

It is great that most direct supervisors are people who actually work in the
laboratory because it becomes easier to pass on skills to the laboratory assistants.
It is hoped that the other supervisors (7 percent) will also be replaced in due time
with laboratory people.

On frequency of supervision 59 percent of the supervisors supervise daily, 22

percent supervise monthly and 19 percent supervise quarterly as in figure 18 below.

Figure 18: Frequency of supervision

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The minimum requirement is to supervise monthly as per see most supervisors are
doing well. It is also desired that those who supervise quarterly should improve to
monthly.

Sixty three percent of the laboratory assistants are satisfied with their supervisors,
20 percent are very satisfied, 6 percent are neutral (not sure), 8 percent are
dissatisfied and 3 percent are very dissatisfied. This is shown in figure 19 below.

Figure 19: Satisfaction of laboratory assistants with their supervisor.

The overall picture is that most laboratory assistants are satisfied with their
supervisors’ competence and this is positive news.

On updates from their supervisors 17 percent of the laboratory assistants are very
satisfied, 53 percent of the laboratory assistants are satisfied, 8 percent are neutral,
19 percent are dissatisfied and 3 percent are very dissatisfied. This is shown in
figure 20 below.

Figure 20: Satisfaction of laboratory assistants with updates from supervisors.

Keeping the laboratory assistants well informed about what is going on in their area
of work improves their efficiency in their service delivery. It is good that more
laboratory assistants are well informed.

Twenty two percent of the laboratory assistants are very satisfied that their
supervisors care and respond to issues of most importance, 42 percent are
satisfied, 15 percent are neutral, another 15 percent are dissatisfied and 6 percent
are very dissatisfied. This is shown in figure 21 below.

Figure 21: Satisfaction of lab assistants that supervisors care and respond to issues
of most importance

This is also encouraging that most laboratory assistants have caring supervisors
who have their welfare at heart. This kind of relationship improves communication
between the two parties which is good for service delivery.

On satisfaction due to the fact that their views and participation are valued 22
percent of the laboratory assistants are very satisfied, 53 percent are satisfied, 14
percent are neutral, 8 percent are dissatisfied and 3 percent are very dissatisfied.

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Figure 22: Satisfaction of laboratory assistants that their views and participation are
valued

The trend is also promising since most laboratory assistants feel that their views
and participation are valued. This builds self-confidence in the laboratory assistants
and can encourage creativity.

In a nutshell 24 percent of the laboratory assistants look at the way they receive
supervision and feedback as being excellent, 37 percent think it is good, 29 percent
feel it is average while 5 percent think it is poor and the other 5 percent think it is
very poor.

Figure 23: Laboratory assistants' ratings of their reception of supervision and

feedback.

The trend appears to tilt much to the positive side which indicates that most
laboratory assistants rate highly their reception of supervision and feedback.

4.5 Working conditions of laboratory assistants

Fifteen percent of the laboratory assistants are very satisfied with the
professionalism of their workmates, 71 percent are satisfied, 7 percent are neutral
and 7 percent are dissatisfied. None of them is very dissatisfied. This is shown in
figure 24 below.

Figure 24: Satisfaction of laboratory assistants with the professionalism of

workmates.

The fact that most laboratory assistants are satisfied with the professionalism of
their workmates is an indication that their work is not made complex by
incompetence of their workmates. A work place where everyone fulfils his roles
makes life easier.

Twenty seven percent of the laboratory assistants are very satisfied with the
reasonableness of their responsibilities, 65 percent are satisfied, 5 percent are
neutral and 3 percent are dissatisfied. None of them are very dissatisfied. This is
illustrated in the figure below.

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Figure 25: Satisfaction of laboratory assistants with the reasonableness of their
responsibilities.

The figure above indicates that most of the laboratory assistants are not being
made to over work. Those who overwork are very likely to be at busy district
hospitals that have acute staff shortages.

On ability to maintain a reasonable balance between work life and family life 20
percent of the laboratory assistants are very satisfied, 56 percent are satisfied, 11
percent are neutral, 10 percent are dissatisfied and 3 percent are very dissatisfied.
This is shown in figure 26 below.

Figure 26: Satisfaction of laboratory assistants with balance between work life and
family life

Ability of most laboratory assistants to maintain a reasonable balance between work

and family is good. In health centers this can be improved by allowing
microscopists to work hand in hand with laboratory assistants.

Ten percent of the laboratory assistants are very satisfied with their health facilities
as work places, 54 percent are satisfied, 9 percent are neutral, 15 percent are
dissatisfied and 12 percent are very dissatisfied.

Figure 27: Satisfaction of laboratory assistants with their facilities as work places.

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For those who are very dissatisfied and dissatisfied the likely causes are
inavailability of equipment and reagents. However it is still good that a larger
number of the laboratory assistants are either very satisfied or satisfied.

Seven percent of the laboratory assistants are very satisfied with the physical
working conditions of their job, 56 percent are satisfied, 12 percent are neutral, 17
percent are dissatisfied and 8 percent are very dissatisfied. This is in figure 28
below.

Figure 28: Satisfaction of laboratory assistants with their physical working

conditions.

Poor physical working conditions result in less productivity because they are
responsible for distractions and making workers uncomfortable in their work
environment. Health facilities should work to improve these conditions for those
laboratory assistants who are dissatisfied.

On teamwork in their laboratories 25 percent of the laboratory assistants consider it

to be excellent, 53 percent consider it to be good, 18 percent think it is average
while 2 percent think it is poor and the other 2 percent think it is very poor.

Figure 29: Laboratory assistants' rating of teamwork in their laboratories.

From figure 29 above it appears that teamwork is there in most health facilities
which is something desirable. There is the need, however, to improve it in health
facilities where it is average, poor and very poor.

4.6 Level of motivation of the laboratory assistants

Thirty one percent of the laboratory assistants are very satisfied with their own
morale, 57 percent are satisfied, 10 percent are neutral and 2 percent are
dissatisfied. None of them is very dissatisfied. This is illustrated in figure 30 below.

Figure 30: Satisfaction of laboratory assistants with their own morale.

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It appears that most laboratory assistants have high levels of morale. High morale
implies a great desire to work which translates into high productivity.

On satisfaction with the morale of their workmates 24 percent of the laboratory

assistants are very satisfied, 64 percent are satisfied, 10 percent are neutral and 2
percent are dissatisfied. None is very dissatisfied as shown in figure 31 below.

Figure 31: Satisfaction of laboratory assistants with morale of their workmates.

Most workmates of the laboratory assistants appear to have high levels of morale.
These people motivate the laboratory assistants to work hard as well.

On laboratory assistants’ satisfaction with the feeling of personal accomplishment

they get from their job, 16 percent are very satisfied, 42 percent are satisfied, 19
percent are neutral, 18 percent are dissatisfied and 5 percent are very dissatisfied.
This is indicated in figure 32 below.

Figure 32: Laboratory assistants' satisfaction with the feeling of personal

accomplishment from their job.

From figure 32 above one can tell that most of the laboratory assistants are happy
with what they achieve at work. This is enough motivation to make them do more at
work.

As far as the chance to serve others is concerned 31 percent of the laboratory

assistants are very satisfied to have that chance, 58 percent are satisfied, 6 percent
are neutral and 5 percent are dissatisfied. None is very dissatisfied.

Figure 33: Satisfaction of laboratory assistants with the chance to serve others

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For those who are dissatisfied it should be because of inavailability of materials and
equipment which denies them that chance. It is great to note that most laboratory
assistants are very willing to serve others. This is the core motivation for a health
worker.

On Satisfaction of the laboratory assistants with the chance to work independently,

36 percent are very satisfied with it, 51 percent are satisfied, 6 percent are neutral,
5 percent are dissatisfied and 2 percent are very dissatisfied. This is shown in figure
34 below.

Figure 34: Satisfaction of laboratory assistants with the chance to work

independently.

It can be deduced from figure 34 that most laboratory assistants are excited with
the opportunity to work independently. Let us hope that they will turn this
excitement into action always.

Thirty nine percent of the laboratory assistants are very satisfied with the chance to
offer direction to other workers, 49 percent are satisfied, 7 percent are neutral, 3
percent are dissatisfied and 2 percent are very dissatisfied. This is shown in figure
35 below.

Figure 35: Satisfaction of laboratory assistants with the chance to offer direction to
co-workers.

The fact that most laboratory assistants are very satisfied or satisfied with such an
opportunity it shows that there is great leadership potential in the laboratory
assistants. This is very promising.

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Seventeen percent of the laboratory assistants are very satisfied with the social
position that comes with the job in their communities, 59 percent are satisfied, 12
percent are neutral and 12 percent are dissatisfied. None is very dissatisfied. This is
in figure 36 below.

Figure 36: Satisfaction of laboratory assistants with the job's social position in the
community.

The indication that most laboratory assistants are very satisfied or satisfied with
their social positions is a confirmation that most laboratory assistants have good
relationships with their communities.

Thirty nine percent of the laboratory assistants are very satisfied with the chance to
be active, 49 percent are satisfied, 7 percent are neutral, 3 percent are dissatisfied
and 2 percent are very dissatisfied.

Figure 37: Satisfaction of laboratory assistants with the chance to be active.

The largest group of the laboratory assistants appears to be happy with how their
job keeps them busy. This means they have work to do in their health facilities.

The chance for the laboratory assistants to use the best of their abilities leaves 46
percent of the laboratory assistants very satisfied, 41 percent satisfied, 1 percent
neutral, and 12 percent dissatisfied. None is very dissatisfied.

Figure 38: Satisfaction of laboratory assistants with the chance to use their best
abilities.

Figure 8 indicates that most laboratory assistants are able to use the best of their
abilities where they are. This gives room to creativity and improves performance.

In brief this is how the laboratory assistants see opportunities for personal
development on their job. Sixteen percent think the chances are excellent, 26
percent think they are good, 23 percent think they are average while 19 percent
think they are poor and 16 percent think they are very poor.

Figure 39: Laboratory assistants' ratings of personal development on their job.

The ratings in figure 39 show that the percentages are very close to each other.
This shows that most of the laboratory assistants have mixed feelings about their
development as individuals. This should be the effect of how much they get paid
because it is the money one earns that determines how much he develops.

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4.7 Chances of career progression for the
laboratory assistants
The laboratory assistants who think that their on the job training is excellent are 26
percent, those who think it is good are 19 percent, those who say it is average are
17 percent while 21 percent think it is poor and 17 percent think it is very poor.

Figure 40: Laboratory assistants' ratings of on the job training.

These ratings are almost evenly distributed as well an indication that most
laboratory assistants cannot clearly make up their minds. This should be largely
influenced by the fact that laboratory assistants are not included on the lists of
laboratory personnel that are called by the Ministry for training while at district level
most DHOs involve them as shown by figure 13. This creates some confusion in
their minds.

On opportunities for advancement on the job, 21 percent of the laboratory

assistants think they are excellent, 26 percent think they are good, 20 percent think
they are average while 28 percent think they are poor and 5 percent think they are
very poor.

Figure 41: Laboratory assistants' ratings of opportunities for advancement on the

job.

Figure 41 also shows that the percentages are very close to each other which
indicate that the laboratory assistants also have confused minds as far as their
promotions and upgrading are concerned.

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4.8 Level of commitment of the laboratory
assistants to a long term career with MOH
Seventy three percent of the laboratory assistants are committed to a long term
career with MOH, 7 percent are somewhat committed, 16 percent are not sure how
long they plan to stay and 4 percent would prefer not to remain. This information is
on figure 42 below.

Figure 42: Commitment to a long term career with MOH

The levels of commitment are high but it would be much better if all the laboratory
assistants can be made to stay. This can be achieved by addressing their most
pressing concerns immediately.

On satisfaction of the laboratory assistants with their job security, 19 percent of the
laboratory assistants are very satisfied, 49 percent are satisfied, 15 percent are
neutral and 17 percent are dissatisfied. This is shown in figure 43 below.

Figure 43: Satisfaction of laboratory assistants with their job security.

Most of the laboratory assistants are very satisfied with their job security because in
government institutions people do not lose their jobs anyhow. In Malawi the
government is the employer with the best job security. This is why people do not
easily quit government jobs despite the fact that most of them are not well paying.
It is the same reason why there are more laboratory assistants willing to stick with
MOH.

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5.0 RECOMMENDATIONS

5.1 To MOH
➢ Change the entry grade of the laboratory assistants from grade M to L.
➢ Increase the number of laboratories in health centers and rural hospitals.
➢ Increase accommodation (houses) in health centers and rural hospitals.
➢ Consider the laboratory assistants for trainings.
➢ Put in place clear procedures for the upgrading and promotions of laboratory
assistants.

5.2 To DHOs
➢ Put the remaining laboratory assistant on payroll.
➢ Work towards sending the laboratory assistants at district hospitals to health
centers as soon as possible.
➢ Organize refresher courses for the laboratory assistants.
➢ Work towards steady supply of reagents and equipment in laboratories.
➢ Encourage laboratory in-charges who supervise quarterly to improve to
monthly supervision.
➢ Extend electricity to health centers with laboratories that have no electricity
or solar power.