Determinants of safety climate at primary care level in Ghana, Malawi and Uganda: a cross-sectional study across 138 selected primary healthcare facilities

Abstract

Background: Safety climate is an essential component of achieving Universal Health Coverage, with several organi sational, unit or team-level, and individual health worker factors identifed as infuencing safety climate. Few studies however, have investigated how these factors contribute to safety climate within health care settings in low- and middle-income countries (LMICs). The current study examines the relationship between key organisational, unit and individual-level factors and safety climate across primary health care centres in Ghana, Malawi and Uganda. Methods: A cross-sectional, self-administered survey was conducted across 138 primary health care facilities in nine districts across Uganda, Ghana and Malawi. In total, 760 primary health workers completed the questionnaire. The relationships between individual (sex, job satisfaction), unit (teamwork climate, supportive supervision), organisa tional-level (district managerial support) and safety climate were tested using structural equation modelling (SEM) procedures. Post hoc analyses were also carried out to explore these relationships within each country. Results: Our model including all countries explained 55% of the variance in safety climate. In this model, safety climate was most strongly associated with teamwork (β=0.56, p<0.001), supportive supervision (β=0.34, p<0.001), and district managerial support (β=0.29, p<0.001). In Ghana, safety climate was positively associated with job satis faction (β=0.30, p<0.05), teamwork (β=0.46, p<0.001), and supportive supervision (β=0.21, p<0.05), whereby the model explained 43% of the variance in safety climate. In Uganda, the total variance explained by the model was 64%, with teamwork (β=0.56, p<0.001), supportive supervision (β=0.43, p<0.001), and perceived district managerial sup port (β=0.35, p<0.001) all found to be positively associated with climate. In Malawi, the total variance explained by the model was 63%, with teamwork (β=0.39, p=0.005) and supportive supervision (β=0.27, p=0.023) signifcantly and positively associated with safety climate. Discussion/conclusions: Our fndings highlight the importance of unit-level factors—and in specifc, teamwork and supportive supervision—as particularly important contributors to perceptions of safety climate among primary health workers in LMICs. Implications for practice are discussed.