Job satisfaction in sub-Saharan Africa is crucial as it directly impacts employee productivity, retention, and overall economic growth, fostering a motivated workforce that drives regional development. In sub–Saharan Africa, poor remuneration, limited professional development opportunities, and inadequate working conditions impact satisfaction. This study examined job-satisfaction predictors among health workers in primary healthcare settings across eight countries: Ethiopia, Kenya, Malawi, Senegal, South Sudan, Tanzania, Uganda, and Zambia. A cross-sectional study surveyed 1711 health workers, assessing five dimensions: employer–2employee relationships, remuneration and recognition, professional development, physical work environment, and supportive supervision. The study was conducted from October 2023 to March 2024. The job-satisfaction assessment tool was adopted from a validated tool originally developed for use in low-income healthcare settings. The tool was reviewed by staff from all the country offices to ensure contextual relevance and organization alignment. The responses were measured on a five-point Likert scale: 0: Not applicable, 1: Very dissatisfied, 2: Dissatisfied, 3: Neutral, 4: Satisfied, and 5: Very satisfied. The analysis employed descriptive and multivariable regression methods. Job satisfaction varied significantly by country. Satisfaction with the employer–employee relationship was highest in Zambia (80%) and lowest in Tanzania (16%). Remuneration satisfaction was highest in Senegal (63%) and Zambia (49%), while it was very low in Malawi (9.8%) and Ethiopia (2.3%). Overall, 44% of respondents were satisfied with their professional development, with Uganda leading (62%) and Ethiopia having the lowest satisfaction level (29%). Satisfaction with the physical environment was at 27%, with Uganda at 40% and Kenya at 12%. Satisfaction with supervisory support stood at 62%, with Zambia at 73% and Ethiopia at 30%. Key predictors of job satisfaction included a strong employer–employee relationships (OR = 2.20, p < 0.001), fair remuneration (OR = 1.59, p = 0.002), conducive work environments (OR = 1.71, p < 0.001), and supervisory support (OR = 3.58, p < 0.001. Improving the job satisfaction, retention, and performance of health workers in sub-Saharan Africa requires targeted interventions in employer–employee relationships, fair compensation, supportive supervision, and working conditions. Strategies must be tailored to each country’s unique challenges, as one-size-fits-all solutions may not be effective. Policymakers should prioritize these factors to build a motivated, resilient workforce, with ongoing research and monitoring essential to ensure sustained progress and improved healthcare delivery.

Introduction: Effective risk pooling plays a critical role in advancing universal health coverage by improving financial protection and access to healthcare. However, in sub-Saharan Africa, insurance coverage remains low, and satisfaction with existing schemes is inconsistent, raising concerns about their effectiveness. This study examines the factors influencing health insurance coverage and satisfaction across eight countries in sub-Saharan Africa Materials and Methods: Using household survey data, the levels and predictors of health insurance coverage as well as satisfaction with health insurance mechanisms were examined. The predictors of health insurance coverage, satisfaction with health insurance mechanisms and health care providers were modeled using a combination of bivariate and multivariate analyses. Results: Overall, 24% of households included in the study reported having some form of health insurance, with wide variation across countries. Ethiopia recorded the highest coverage (55%), followed by Kenya (23%) and Senegal (17%), while the lowest levels were observed in South Sudan (7.7%) and Zambia (12%). Insurance coverage was slightly higher among men (28%) than women (22%), and uptake increased with age, education, and household income, with insured households reporting lower out-of-pocket expenditures. Multivariable analysis showed that country, age, household size, and education significantly predicted insurance enrollment; compared to Ethiopia, all other countries had substantially lower odds of coverage (aOR 0.06–0.27, p<0.001), while older age, larger households, and secondary education increased the likelihood of being insured. Insurance mechanisms varied by context, with community-based schemes dominant in Ethiopia and Uganda, social/national insurance common in Kenya, Tanzania, and Zambia, and private insurance more prevalent in Kenya, Ethiopia, and Uganda. Among the uninsured (70%), key barriers included high premium costs (38%), lack of awareness (35%), and perceived lack of value (15%), with affordability concerns more common among women. Satisfaction levels were moderate with 43% satisfied and 11% dissatisfied with their insurance, while satisfaction with healthcare providers was highest in Tanzania and Uganda, which also showed the strongest adjusted odds of satisfaction (aOR 6.60–11.85 and 8.15–8.40, respectively). Conclusion: Health insurance coverage in sub-Saharan Africa remains low and uneven, reflecting deep socioeconomic and geographic disparities. Education, age, and household size significantly influence enrollment, highlighting the role of awareness and affordability. High premium costs and limited understanding remain major barriers to participation. Satisfaction with insurance and healthcare providers is moderate, with many respondents expressing neutrality about service quality. Strengthening health financing requires subsidies for vulnerable groups, better awareness campaigns, and integration of community schemes into national systems. Such measures are vital to promote equity, sustainability, and progress toward universal health coverage. This demands reimagining benefit design, strengthening provider networks, and leveraging strategic purchasing to drive both equity and satisfaction

Job satisfaction among health workers is crucial for retention and service delivery. In sub Saharan Africa, poor remuneration, limited professional development opportunities and inadequate working conditions impact satisfaction. This study examines job satisfaction predictors among health workers in primary healthcare across eight countries: Ethiopia, Kenya, Malawi, Senegal, South Sudan, Tanzania, Uganda, and Zambia. A cross- sectional study surveyed 1,711 health workers, assessing five dimensions: employer-employee relationships, remuneration and recognition, professional development, physical work environment, and supportive supervision. Analysis employed descriptive and multivariable regression methods. Employer-employee satisfaction was highest in Zambia (80%) and lowest in Tanzania (16%). Remuneration satisfaction was highest in Senegal (63%) and lowest in Ethiopia (2.3%). Uganda reported highest satisfaction with professional development (62%). Support supervision and physical work environment were high in Zambia (73%) and Uganda (40%) respectively. Key predictors of job satisfaction included strong employer-employee relationships (OR = 2.20, p < 0.001), fair remuneration (OR = 1.59, p = 0.002), conducive work environments (OR = 1.71, p < 0.001), and supervisory support (OR = 3.58, p < 0.001. Improving employer-employee relationships, remuneration, support supervision and conducive working conditions can enhance retention and performance. Country specific strategies are essential for a resilient health workforce is sub-Saharan Africa