Understanding key drivers of job satisfaction in primary health care organizations in Kazakhstan: a Herzberg's two-factor theory-based qualitative study.

BACKGROUND: Primary healthcare (PHC) is the first point of contact between populations and health systems, and physician workforce satisfaction is central to its effective functioning. In Kazakhstan, despite successive healthcare reforms, public polyclinics face persistent workforce challenges including high burnout rates, turnover, and low morale. Empirical evidence specifically examining the drivers of job satisfaction among physicians in public primary care organization remains limited. This study explored motivational and hygiene factors influencing job satisfaction and dissatisfaction among physicians working in public polyclinics in Astana, Kazakhstan, guided by Herzberg's Two-Factor Theory. METHODS: A qualitative study using in-depth semi-structured interviews was conducted between January and March 2025. Seventeen physicians from three public polyclinics in Astana were recruited through purposive and snowball sampling. Interview guides followed Herzberg's motivator and hygiene factor domains. Data were analyzed thematically, with the theory serving as the organizing structure. Trustworthiness was ensured through peer debriefing, field notes, reflexivity and thick description. RESULTS: Nine themes emerged across two categories. Hygiene factors generating dissatisfaction included inadequate salary and limited non-monetary benefits, poor infrastructure, hierarchical management and limited autonomy, and job instability linked to mandatory work obligations. Motivator factors sustaining engagement included intrinsic satisfaction from patient care, supportive colleagues, commitment to professional excellence, continuing medical education and recognition. Salary was the most dominant source of dissatisfaction. Participants indicated that compensation issues needed to be resolved first before any social intervention strategies could be meaningfully assessed. CONCLUSIONS: Physicians in Kazakhstani public primary healthcare organizations are sustained primarily by intrinsic motivators despite pervasive extrinsic dissatisfiers. Findings map onto Herzberg's Two-Factor Theory and suggest priorities for PHC human resources for health (HRH) policy in Kazakhstan, including compensation reform, workload rationalization, reduced administrative burden, and investment in non-monetary recognition. These findings provide an evidence base for HRH reform within Kazakhstan's ongoing Primary Health Care transformation agenda.