Factors associated with burnout among healthcare providers in a rural context, South Africa
Open accessAbstract
Background: Healthcare providers (HCPs) are at risk of burnout in sub-Saharan Africa. However, there is little research in rural and primary care settings. Aim: To evaluate burnout and its associated factors among public sector HCPs in South Africa. Setting: Primary health care clinics, community health centres and district hospitals in Nkomazi Local Municipality, Mpumalanga province. Methods: Quantitative study design using a cross-sectional survey. Healthcare providers (n = 1139) working in Nkomazi Local Municipality were invited to participate. Burnout was assessed using the Maslach Burnout Inventory. A demographic and occupational questionnaire, the General Help-Seeking Questionnaire and the Health and Safety Executive Indicator Tool were used. Results: A total of 302 HCPs, between 23 and 61 years, mostly female (n = 252; 83.44%) and nurses (n = 235; 77.81%) participated. High burnout was observed for Emotional Exhaustion (median score 26 [IQR {interquartile range}: 34–16]) and Personal Accomplishment (median score 29 [IQR: 34–25]). Most participants (n = 215; 71.19%) would seek help if they had an emotional problem. Bivariate analysis revealed significant associations between workplace demands, control, management support, peer support, relationships, role and change with all subscales of burnout. Multivariate regression analysis found that Personal Accomplishment improved by 0.49 (95% CI: 0.10–0.89) for every point in improved work demands, by 0.84 (95% CI: 0.01–1.67) for every point towards improved management support and by 1.19 (95% CI: 0.48–1.90) for every point towards having an improved role. Conclusions: During 2022, HCPs working in a rural area in South Africa displayed high levels of burnout for Emotional Exhaustion and Personal Accomplishment but not for Depersonalisation. Contributions: Improvements in work demands, managerial support and role clarity may reduce burnout among HCP in a rural, primary care setting.
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Chronic understaffing, heavy workloads, and limited resources restricted the feasibility or impact of burnout-management strategies.
“Chronic understaffing, heavy workloads, and limited resources restricted the feasibility or impact of burnout-management strategies (28, 34).”
From Management strategies for healthcare worker burnout in Sub-Saharan Africa: an integrative review (2026) · cites this paper as [28]
The Introduction and Discussion link staff shortages, high workloads and poor resources to burnout. The Discussion also says improving Personal Accomplishment does not replace improving working conditions. However, the paper does not establish that these conditions restricted the feasibility or measured impact of burnout-management strategies; its Recommendations call for such solutions to be explored and implemented. (LLM, conf=0.84)
Experimental — accuracy not yet measuredStudies during COVID-19 demonstrated that weak infrastructure and insufficient institutional support intensified distress.
“Studies during COVID-19 similarly demonstrated that weak infrastructure and insufficient institutional support intensified distress (27, 28, 34).”
From Management strategies for healthcare worker burnout in Sub-Saharan Africa: an integrative review (2026) · cites this paper as [28]
The Introduction links insufficient resources and supplies to occupational stress and burnout, while the Discussion (Experience of burnout) associates less support or fewer resources with higher burnout. The paper does not present these findings as COVID-19-specific or establish that weak infrastructure and insufficient institutional support intensified distress during the pandemic. Our copy provides no page numbers for these passages. (LLM, conf=0.85)
Experimental — accuracy not yet measuredStudies from rural South Africa showed that burnout was highest in facilities with severe staff shortages, high workloads, role conflict, and limited organizational support.
“Studies from rural South Africa showed that burnout was highest in facilities with severe staff shortages, high workloads, role conflict, and limited organizational support (28).”
From Management strategies for healthcare worker burnout in Sub-Saharan Africa: an integrative review (2026) · cites this paper as [28]
The Abstract Results and Discussion link burnout measures to work demands, managerial support and role understanding among healthcare providers in rural South Africa. The Introduction also discusses staff shortages and high workloads. However, the paper does not show that burnout was highest in particular facilities with severe shortages or establish role conflict as a finding; its analysis concerns providers, not facility rankings. The indexed passages provide no page numbers. (LLM, conf=0.86)
Experimental — accuracy not yet measuredPlanning and problem-focused coping were linked with lower burnout levels across several quantitative datasets.
“Planning and problem-focused coping were linked with lower burnout levels across several quantitative datasets (18, 28).”
From Management strategies for healthcare worker burnout in Sub-Saharan Africa: an integrative review (2026) · cites this paper as [28]
The Data collection section lists burnout, help-seeking and workplace-condition measures, but not planning or problem-focused coping. The Results link improved work demands, management support and role to greater personal accomplishment in one sample of 302 healthcare providers; they do not address coping associations across several datasets. Searches for planning, problem-focused coping and coping-related burnout findings found no supporting passage in our copy (page numbers unavailable). (LLM, conf=0.76)
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Management strategies for healthcare worker burnout in Sub-Saharan Africa: an integrative review
Khangamwa-Singano, F., Singano, V. H., Kaunda, P., Machongo, R. B., & Nkhoma-Mussa, Y. B. (2026) · Frontiers in Public Health · doi:10.3389/fpubh.2026.1779807 · Cited by 1 · see citing works
“The cross-sectional studies by Moses et al. (28), Lee et al. (27), Ledikwe et al. (13), and Kabunga et al. (18),were appraised using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies (31).”
Influential
- Authors
- Moses, A. C., Dreyer, A. R., & Robertson, L.
- Affiliations
- University of the Witwatersrand (ZA)
- Corresponding author
- Moses, Alexandra C.
- Venue
- African Journal of Primary Health Care & Family Medicine
- Publisher
- AOSIS
- Published
- 2024-01-23
- Volume
- 16
- Issue
- 1
- Pages
- e1-e10
- ISSN
- 2071-2928 (ISSN-L)
- 2071-2936
- PMC
- PMC10839153
- OpenAlex
- W4391126611
- Cited by
- 12
- References
- 3
- Citations by year
- 2026: 8 · 2025: 3 · 2024: 1
- FWCI
- 7.05
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- African Journal of Primary Health Care & Family Medicine (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare professionals’ stress and burnout
- Health Sciences › Health Professions › Occupational Therapy › Occupational Health and Burnout
- Social Sciences › Psychology › Social Psychology › Stress and Burnout Research
- Keywords
- burnout, healthcare workers, rural health workforce, primary care, emotional exhaustion, personal accomplishment, depersonalization, job demands, management support, role clarity, help-seeking, nurses, Maslach Burnout Inventory
- MeSH terms
- Burnout, Professional, Cross-Sectional Studies, Female, Health Personnel, Humans, Male, Psychological Tests, Surveys and Questionnaires, South Africa, Self Report
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