The Role of the Psychological Contract on Health Care Workers? Commitment in Public Health Sector in Uganda: A Case Study of Medical Doctors in Mulago National Referral Hospital (MNRH)

This study assessed the role of the psychological contract on the commitment of health care workers in public health care facilities of Uganda, with specific reference to medical doctors in Mulago National Referral Hospital. Specifically, the study sought to assess the effect of the transactional factors, relational factors and organizational support, towards health care workers commitment and establish whether there is an association between health workers commitment and the quality of healthcare service delivery. A cross sectional research design was used, adopting both qualitative and quantitative approaches of data collection and analysis. A sample of 146 respondents was identified, and out of these, 112 dully completed and returned the questionnaires, while 04 responded to the interviews. Overall, the response rate was 79.4 %. Quantitative data was analyzed using descriptive statistics, factor analysis, One-sample test, Pearson correlation and regression analysis techniques, while qualitative data was summarized and presented using verbatim statements. The findings showed that, the transactional factors accounted for 40.1 % of the variation in health workers commitment, the relational factors were positively related to health workers commitment by 31 %, while organizational support was also cited to play a significant role towards health care workers commitment, indicating a correlation coefficient of.489**. Notably still, 53 % of the doctors who participated in the study indicated that they preferred working in NGOs, compared to 26 % who preferred working with Government. Among the factors explaining the transactional aspects, poor pay and rewards was key in influencing health care service delivery in public health care facilities, with 61 % of the respondents attesting to it. From the relational factors, 42 % cited poor work environment as having very high influence on the quality of health care service delivery, while 45 % pointed at lack of support from the employer as a major factor influencing the quality of health care service delivery. Further, using the One-sample Test, it was noted that poor pay and rewards registered the highest mean difference of 4.223, implying that it had the greatest effect on health workers commitment and the quality of public health care service delivery, followed by lack of employer support and poor work environment. The study thus recommends that Ministry of Health should come up with a competitive compensation package, especially for the medical doctors, management of MNRH should develop transparent strategies for career growth of the doctors and devise means such PPP to ensure the work environment is safe and conducive to her staff. Lastly, management of MNRH together with the planning and Human Resource departments should devise means to improve staff welfare.