Malawi Laboratory Assistants Welfare Survey Survey Report

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LABORATORY ASSISTANTS WELFARE

SURVEY REPORT

OCTOBER 2010

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Table of ContentsACRONYMS/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

ACKNOWLEDGEMENTSThe 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 SUMMARYThe Clinton Health Access Initiative (CHAI) in collaboration with the Malawi Collegeof 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 ofthe 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 awardedCertificates 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 inorder to get the best out of the laboratory assistants.

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3.0 METHODOLOGY

3.1 Data Collection and Data Collection ToolsThe 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 SamplingAll 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 studyOne 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

facilitiesThe 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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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 assistantsWhen 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. Theinexperience 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 healthfacilities, 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 andequipment 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 testshealth 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 infigure 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 stillworking.

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 incentivesNinety 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 fromthe 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 supervisorsSixty 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 theirsupervisors 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 arevalued

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 assistantsFifteen 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


This is shown in figure 26 below.

Figure 26:Satisfaction of laboratory assistants with balance between work life andfamily 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, 17percent are dissatisfied and 8 percent are very dissatisfied. This is in figure 28

below.

Figure 28:Satisfaction of laboratory assistants with their physical workingconditions.

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 assistantsThirty 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


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 thisexcitement 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 toco-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 thecommunity.

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 assistantsThe 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 oflaboratory 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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Malawi Laboratory Assistants Welfare Survey Survey Report

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