Prevalence and factors associated with burnout among frontline primary health care providers in low- and middle-income countries: A systematic review

Abstract

Background: Primary health care (PHC) systems require motivated and well-trained frontline providers, but are increasingly challenged by the growing global shortage of health care workers. Burnout, defined as emotional exhaustion, depersonalization, and low personal achievement, negatively impacts motivation and may further decrease productivity of already limited workforces. The objective of this review was to analyze the prevalence of and factors associated with provider burnout in low and middle-income countries (LMICs). Methods: We performed a systematic review of articles on outpatient provider burnout in LMICs published up to 2016 in three electronic databases (EMBASE, MEDLINE, and CAB). Articles were reviewed to identify prevalence of factors associated with provider burnout. Results: A total of 6,182 articles were identified, with 20 meeting eligibility criteria. We found heterogeneity in definition and prevalence of burnout. Most studies assessed burnout using the Maslach Burnout Inventory. All three dimensions of burnout were seen across multiple cadres (physicians, nurses, community health workers, midwives, and pharmacists). Frontline nurses in South Africa had the highest prevalence of high emotional exhaustion and depersonalization, while PHC providers in Lebanon had the highest reported prevalence of low personal achievement. Higher provider burnout (for example, among nurses, pharmacists, and rural health workers) was associated with high job stress, high time pressure and workload, and lack of organizational support. Conclusions: Our comprehensive review of published literature showed that provider burnout is prevalent across various health care providers in LMICs. Further studies are required to better measure the causes and consequences of burnout and guide the development of effective interventions to reduce or prevent burnout.

References 62

1. 1.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1016/s0140-6736(14)60605-x

2. 2.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1016/s0140-6736(14)61467-7

3. 3.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1016/s0140-6736(14)61646-9

4. 4.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1016/s0140-6736(09)60693-0

5. 5.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1111/j.1468-0009.2005.00409.x

6. 6.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.1056/nejmra1110897

7. 7.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library

8. 8.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library

9. 9.

   This reference’s wording can’t be shown under the paper’s licence.

   Not in our library10.2471/blt.13.118810

10. 10.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

11. 11.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

12. 12.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1016/s0277-9536(01)00094-6

13. 13.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1111/j.1540-4560.1974.tb00706.x

14. 14.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

15. 15.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1002/job.4030020205

16. 16.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1146/annurev.psych.52.1.397

17. 17.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1080/02678370500297720

18. 18.
    Internal construct validity of the Shirom-Melamed Burnout Questionnaire (SMBQ) · 2012

    No notice
19. 19.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

20. 20.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

21. 21.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1002/jhm.2146

22. 22.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1093/fampra/cmn038

23. 23.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1002/jhm.2093

24. 24.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1016/j.jclinepi.2007.04.008

25. 25.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1001/jama.296.9.1071

26. 26.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1007/s11606-008-0702-1

27. 27.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1097/mcc.0b013e3282efd28a

28. 28.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1007/s10880-011-9278-8

29. 29.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1053/j.ajkd.2007.09.011

30. 30.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1016/j.burn.2014.07.004

31. 31.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

32. 32.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1111/jan.12166

33. 33.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1080/09540120600722775

34. 34.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1590/1413-812320152010.19912014

35. 35.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1097/jnr.0000000000000072

36. 36.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1590/s0034-89102008000500019

37. 37.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1111/j.1813-6982.2008.00164.x

38. 38.
    Work related characteristics, work-home and home-work interference and burnout among primary healthcare physicians: A gender perspective in a Serbian context · 2011

    Not checked
39. 39.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library10.1186/1471-2458-11-884

40. 40.

    This reference’s wording can’t be shown under the paper’s licence.

    Not in our library

Cited by papers we hold 4

• Stigma among primary care providers: characterizing attitudes and behaviors in the care of people with chronic hepatitis in the Philippines · 2025
  Not checked
• Reducing psychological distress and depression in humanitarian emergencies: An essential role for nonspecialists. · 2021
  Not checked
• Systematic review of burnout among healthcare providers in sub-Saharan Africa · 2019
  No notice
• Burnout syndrome among medical residents: A systematic review and meta-analysis · 2018
  No notice

Reads

A person counts once a day per paper. We keep no cookie and no address: a reader is a hash that changes every day. Any month under five reads shows no number.