https://journal.achsm.org.au/index.php/achsm/issue/feed 2026-10-08T16:01:25+00:00 Yaping Liu yaping.liu@achsm.org.au Open Journal Systems <p>The Asia Pacific Journal of Health Management (APJHM) is a peer-reviewed journal for managers of organisations offering healthcare and aged care services. The APJHM aims to promote the discipline of health management throughout the region by facilitating the transfer of knowledge among readers by widening the evidence base for management practices.<br /><br />*Print 1(1);2006 - 5(1);2010 Online 4(2);2009 - current<br />*ISSN 2204-3136 (online); ISSN 1833-3818 (print)</p> https://journal.achsm.org.au/index.php/achsm/article/view/6465 2026-10-08T16:01:25+00:00 Eka Nurhayati ekanhayati@almaata.ac.id Eka Kurniati 230800085@almaata.ac.id Theodola Baning Rahayujati baningrahayu@gmail.com Hamam Hadi hhadi@almaata.ac.id Edi Sampurno Ridwan edisampurno@almaata.ac.id Effatul Afifah effatulafifah1@almaata.ac.id Lisana Shidiq Aliya lisanashidiqaliya@almaata.ac.id

<p style="font-weight: 400;"><strong><em>Objective</em></strong>: To explore health workforce and service delivery challenges associated with maternal mortality in an island-dispersed Indonesian district using the Donabedian framework, given limited evidence on how workforce capacity and service delivery processes interact to shape maternal health outcomes in remote settings.</p> <p style="font-weight: 400;"><strong><em>Design</em></strong>: A qualitative study guided by a constructivist paradigm, using focus group discussions and in-depth interviews. Data were analysed thematically, with categories organised deductively using the Donabedian structure-process-outcome framework.</p> <p style="font-weight: 400;"><strong><em>Setting</em></strong>: Six primary healthcare centres, purposively selected by the presence or absence of recurrent maternal deaths in 2023-2024, and the district referral hospital in Kayong Utara District, West Kalimantan, Indonesia.</p> <p style="font-weight: 400;"><strong><em>Main outcome measures</em></strong>: Perceived workforce-related structural, process, and outcome factors associated with maternal mortality, derived from themes, categories, and codes identified across focus group discussions and in-depth interviews.</p> <p style="font-weight: 400;"><strong><em>Results</em></strong><strong>:</strong> Thematic analysis identified three major themes, nine categories, and 53 codes. At the structural level, uneven workforce distribution and competency gaps constrained service capacity. At the process level, coordination barriers, particularly in the referral system, limited timely access to care, while primary care health workers adapted to geographical, organisational, and socio-cultural conditions. At the outcome level, maternal mortality was perceived to be linked to persistent structural and procedural constraints. Adaptive strategies could not fully compensate for underlying health system weaknesses.</p> <p style="font-weight: 400;"><strong><em>Conclusions</em></strong>: Maternal health service delivery in this district is affected by interconnected workforce and system level constraints. Improving maternal outcomes requires strengthening workforce capacity and referral-system performance and supporting adaptation by primary care health workers.</p>

Copyright (c) https://journal.achsm.org.au/index.php/achsm/article/view/6467 2026-10-08T06:18:33+00:00 Ruthashini Selvasingam ruthashini@gmail.com RAFDZAH AHMAD ZAKI rafdzah@ummc.edu.my KARUTHAN CHINNA karuthan@gmail.com Rosnawati Muhamad Robat Mohd dr_rosnawati@moh.gov.my Mohd Syaiful Mohd Aris syaifularis88@gmail.com Najihah Hassan Nudin dr.najihah@moh.gov.my Yin Cheng Lim limyc@ummc.edu.my

<p><strong>Objective:</strong> Turnover intention is a strong proximal indicator of actual turnover and may threaten continuity of healthcare services, yet evidence on its sociodemographic correlates among Malaysian healthcare workers is scarce. This study aimed to identify sociodemographic factors associated with turnover intention among public-sector healthcare workers in Selangor, Malaysia.</p> <p><strong>Design:</strong> Cross-sectional survey using a self-administered, bilingual online questionnaire, analysed with univariable and multivariable linear regression.</p> <p><strong>Setting:</strong> Hospitals, health clinics, dental facilities and district health offices under the Selangor State Health Department, Ministry of Health Malaysia, from October 2024 to March 2025. All eligible permanent and contract staff were invited, and 1,896 completed the questionnaire.</p> <p><strong>Main outcome measures:</strong> Turnover intention, measured using the three-item Turnover Intention Scale (TIS-3; possible score range 3–15).</p> <p><strong>Results:</strong> Participants’ mean age was 36.45 years (SD 6.54); most were female (79.3%), Malay (78.2%), married (79.7%) and permanently employed (90.0%). The mean turnover intention score was 6.14 (SD 2.95). After adjustment, turnover intention decreased with age (β=−0.064; 95% CI −0.101 to −0.027) and was higher among female than male healthcare workers (β=0.379; 95% CI 0.035 to 0.755) and among those with less than 5 years of work experience than among those with more than 20 years (β=0.869; 95% CI 0.028 to 1.710). Ethnicity, educational level, marital status, profession, employment status and work site were not independently associated with turnover intention.</p> <p><strong>Conclusions:</strong> Younger, female and early-career healthcare workers reported higher turnover intention, although the absolute differences were small. Managers could prioritise structured onboarding, mentoring and career-pathway support for early-career staff, and flexible work arrangements that address work–family demands, alongside broader organisational retention strategies.</p>

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