Table 3 Context of Working Environment in Malawian District Hospitals

Too few staff: In maternity we are only six nurses. Six nurses to cover during the day, the same six nurses to cover during the night. So most of the times we work, we are, something like we are punished. (Ellen, Nurse midwife technician)

Not enough resources: A crisis of no delivery packs, no forceps, wherever there is a tear you have to run to the theatre to check for the needle in order to repair the tear. So that is our nice working place. (Chiso, Nurse Midwife Technician)

Inadequate facilities: The three beds assisting 400 women [in a month]. It’s, it’s, it’s a lot and ee I feel so bad because the space is so small and then, some of patients may be delivering on the floor. (Kingston, Nursing officer, incharge)

Increasing workload: The president announced that no one should be delivering to them [traditional birth attendants] so more are coming. And when they deliver at home they give penalty to the chief so in fear of giving penalty to the chief so they are forced to come to the hospital. (Aubrey, Clinical officer)

Low pay: The salaries are not enough to take us for thirty days. (Paul, Clinical officer)

Late pay for overtime: You find that you work. Instead of going home to rest, you know this, there’s a shortage, let me cover the shortage at the end you agree that at the end you will have such amount they don’t give you. Then it’s an embarrassing and you are discouraged to work in extra hours, eh, which makes the people who are on normal duty to feel the work because for example yesterday, yester night I was alone (Alile, Nurse midwife technician)