Workforce Satisfaction and Retention amid Healthcare Reform in Egypt : Insights from the General Health Authority = 이집트 보건의료 개혁 속 인력 만족도와 유지율 :일반보건청 사례를 중심으로

국문 초록 (Abstract)

본 연구는 이집트의 보건의료 개혁이 일반보건청(General Health Authority, GHA)을 통해 어떻게 운영되고 있으며, 이러한 개혁이 보건의료 인력의 직무만족도, 근무환경, 그리고 인력 유지(retention)에 어떠한 차이를 가져오는지를 보건복지부(Ministry of Health, MOH) 체계와 비교하여 분석한다. 본 개혁은 분권화, 전문성 강화, 성과 기반 관리로의 전환이라는 근본적인 패러다임 변화를 특징으로 하며, 의료 서비스의 질 향상과 인력 동기 부여 및 유지를 목표로 한다.
본 연구는 양적 횡단면 연구 설계를 채택하였으며, 정량적 분석 결과를 보완·설명하기 위해 일반보건청과 보건복지부의 다양한 관리 직급을 대상으로 한 심층 인터뷰를 병행하였다. 분석은 보건의료 종사자의 직무만족도, 근무환경, 이직 의도(turnover intention)라는 세 가지 핵심 차원에 초점을 두었다. 총 200명의 설문 응답자(보건복지부 94명, 일반보건청 106명)로부터 수집된 자료는 기술통계, 독립표본 t-검정, 다중회귀분석을 통해 분석되었으며, 질적 자료는 양적 결과의 맥락적 해석을 위해 활용되었다.
연구 결과, 일반보건청 소속 인력은 보건복지부 소속 인력에 비해 유의미하게 높은 직무만족도와 더 나은 근무환경을 보고하였다. 관리자 지원은 직무만족도의 가장 강력한 예측 요인으로 나타났으며, 그 다음으로 업무량 균형, 자원 충분성, 직업 안전, 그리고 인정과 보상이 중요한 요인으로 확인되었다. 또한 일반보건청 체계 하에서의 지속적 전문성 개발과 성과 기반 인센티브는 직원들의 동기 부여와 공정성 인식을 강화한 것으로 나타났다. 반면, 이직 의도는 여전히 중간 수준을 유지하고 있었으며, 이는 주로 경제적 불안정성과 해외 이주 압력과 같은 외생적 요인에 의해 영향을 받는 것으로 분석되었다.
이러한 결과는 허즈버그(Herzberg)의 이요인 이론(Two-Factor Theory)과 푸시–풀–모어링(Push–Pull–Mooring) 이직 모형을 통해 해석되었으며, 이를 통해 조직 개혁, 내재적 동기, 그리고 거시적 맥락 요인이 인력 유지 행태에 어떻게 상호작용하는지를 설명하였다. 본 연구는 구조적·관리적 개혁이 근무환경상의 주요 제약을 상당 부분 개선하였음을 확인하는 한편, 장기적인 인력 안정성을 확보하기 위해서는 거시경제 및 제도적 도전에 대한 정책적 대응이 병행되어야 함을 시사한다.

다국어 초록 (Multilingual Abstract)

This study explores how Egypt’s healthcare reform, operationalized through the General Health Authority (GHA) is associated with variations in workforce satisfaction, working conditions, and retention when compared with the Ministry of Health (MOH) framework. The reform constitutes a far-reaching paradigm shift toward decentralization, professional growth , and performance-based management, aiming to improve service quality and workforce motivation and retention. Adopting a quantitative cross-section design in addition to complementary interviews with various management levels in the in the general health authority and ministry of health for explanatory purposes. The study investigated three key dimensions: job satisfaction, working conditions, and turnover intention among healthcare workers. Survey data of total samples size (n = 200) where 94 respondents from the Ministry of health and 106 respondent from the general health authority, were gathered and analyzed using descriptive statistics, t-tests, and multiple regression models, while qualitative insights were used to contextualize and explain the quantitative patterns. The findings disclose that GHA employees report significantly higher job satisfaction and better working conditions than their MOH peers. Managerial support emerged as the strongest predictor of satisfaction, followed by workload balance, resource adequacy, occupational safety, and recognition. Continuous professional development and performance-based incentives under the GHA model have enhanced staff motivation and perceived fairness. Nevertheless, turnover intention remains moderate which is driven largely by external factors such as economic instability and migration pressures. The results were interpreted through Herzberg’s Two-Factor Theory and the Push–Pull–Mooring Model of Turnover in which explain how embedded motivation, organizational reform, and contextual constraints interact to shape retention behavior. The study concludes that while structural and managerial reforms have successfully addressed many workplace barriers, sustaining workforce stability will require coordinated policy actions that also address macroeconomic and systemic challenges.

목차 (Table of Contents)

• Table of Contents
• 1.Abstract 3
• Table of Contents 6
• Chapter 1. Introduction 10
• 1.1 introduction 10
• 1.2 Background of study 12
• 1.3 problem of statement 13
• 1.4 healthcare Worker Migration from Egypt 14
• 1.5 Significance of Study 15
• 1.6 Purpose of the Study 16
• 1.7 Scope of the Study 16
• 1.8 Research Outline 17
• Chapter 2. Literature Review 18
• 2.1 Overview of the extant literature 18
• 2.2 Definition of Healthcare reform in global contexts 19
• 2.3 Models of health care reform 21
• 2.3.1 Tax-Funded National Health Service Model 21
• 2.3.2 Social Health Insurance Model 22
• 2.3.3National Health Insurance (Single-Payer) Model 22
• 2.3.4 Private and Mixed Healthcare Models 23
• 2.3.5 Decentralization and Governance Reforms 24
• 2.3.6 Quality and Performance Improvement Reforms 24
• 2.4 Theories 25
• 2.4.1 Herzberg’s Two-factors analysis theory 26
• 2.4.2 Push -pull- mooring model of turnover theory 27
• Chapter .3 The Egyptian health care reform 29
• 3.1 In the context of Egypt 29
• 3.2 Universal health insurance law 29
• 3.3 The Health Care Reform Adopted Model in Egypt 30
• 3.4 The Structure of the Universal Health Insurance Reform. 31
• 3.4.1 Universal Health Insurance Authority (UHIA) 31
• 3.4.2 General Healthcare Authority (GHA) 32
• 3.4.3 General Authority for Healthcare Accreditation and Regulation (GAHAR) 33
• 3.5 Workforce Enhancement Under the GHA. 34
• 3.6 Pros and cons of the current health care reform 35
• 3.7 Key Differences Between the Universal Health Insurance and the Ministry of Health 36
• 3.8 Economic Conditions and Healthcare Workforce Well-being 37
• 3.9 Evidence to Date: 38
• Chapter 4. Methods 39
• 4.1 research question 39
• 4.2 The Main Research Hypothesis 39
• 4.2.1 Sub-Hypotheses: 39
• 4.2 Research design 40
• 4.3 Study Population 40
• 4.4 Data 41
• 4.4.1 Quantitative Data (Survey) 41
• 4.4.2 Supplementary Secondary Data (Interviews) 42
• 4.4.3 Data Collection Procedures 42
• 4.5 Sampling Strategy 42
• 4.6 Sample Size 43
• 4.7 Data Analysis Plan 43
• 4.7.1Quantitative Analysis 43
• 4.7.1.1 Variables 43
• 4.7.1.2 Regression Model 43
• 4.7.1.3 Supplementary Qualitative Analysis 44
• 4.8 Integration of Findings 44
• 4.9 Ethical Considerations 44
• Chapter 5. Analysis and findings 45
• Section 1. quantitative data 45
• Section 2. Qualitative Results 55
• 5.2.1 Job Satisfaction 55
• 5.2.2 Working Conditions 56
• 5.2.3 Turnover Intention 57
• Chapter 6. Discussion 60
• 6.1 Summary of the Research Findings 60
• 6.2 Theoretical Implications 62
• 6.2.1 Herzberg’s Two-Factor Theory: Motivation and Hygiene in a Reformed System 62
• 6.2.2The Push–Pull–Mooring Model: Explaining Turnover Intention 63
• 6.3 Practical policy Implications 64
• 6.4 Summary of Policy Implications 68
• 6.5 Limitations of the Study 68
• Chapter 7: Conclusion and Recommendations 70
• 7.1 Overview 70
• 7.2 Summary of Key Findings 71
• 7.3 Contributions of the Study 72
• 7.3 Practical Recommendations 73
• 7.4 Future Outlook 74
• 7.5 Concluding Remarks 75
• REFERENCES 75
• APPENDICE 81
• List of abbreviations: 81
• Appendix 1 81
• Appendix 2 83