The Mediating Effect of Work Engagement on the Relationship Between Work Environment and Employee Quality Service Delivery in Rural Public Health Facilities
DOI:
https://doi.org/10.47941/hrlj.2896Keywords:
Work Environment, Work Engagement, Quality Service Delivery, Rural Public Health Facilities.Abstract
Purpose: This study investigates the mediating effect of work engagement in the relationship between the work environment and employee quality service delivery in rural public health facilities in Tanzania. It specifically examines how factors such as equipment availability, workplace safety, staff housing, workspace, and manageable workloads influence service delivery through employee engagement.
Methodology: This study adopted a positivist research philosophy with a deductive approach to test hypothesized relationships. A cross-sectional survey design was employed, using self-administered structured questionnaires to collect data from 285 healthcare professionals across 63 health centers and dispensaries in the Mtwara region. Respondents were selected through multistage sampling techniques. Data were analyzed using IBM SPSS version 25 and Partial Least Squares Structural Equation Modeling (PLS-SEM) via SmartPLS 3.
Findings: The results show that the work environment has a significant positive effect on both work engagement and employee service quality. Additionally, work engagement significantly mediates the relationship between work environment and service quality. This suggests that when healthcare workers experience better work conditions, they are more engaged and subsequently deliver higher quality services
Unique Contribution to Theory, Policy and Practice: The study offers theoretical insights by applying the Job Demands-Resources (JD-R) theory, Social Exchange Theory (SET) and SERVQUAL model in a rural healthcare context. It provides practical recommendations for policymakers and health administrators to improve rural healthcare service delivery by investing in supportive work environments and engagement strategies. These findings are relevant for other underserved regions aiming to enhance public sector performance through human resource interventions.
Downloads
References
Abiodun, A. J., Ibidunni, A. S., & Kehinde, O. J. (2021). Demographic determinants of communication and information technology appreciation and usage among health care professionals. International Journal of Health Economics, 5, 5–19.
Al-Hanawi, M. K., Khan, S. A., & Almubark, R. A. (2022). Workplace environment and service quality delivery in healthcare: Evidence from the Middle East. Healthcare, 10(1), 57. https://doi.org/10.3390/healthcare10010057
Alshammari, F., Alalawi, A., & Al-Ghamdi, S. (2022). Organizational support and work engagement among healthcare professionals: A social exchange perspective. Journal of Healthcare Management, 67(3), 211–223.
Andaleeb, S. S. (2021). Service quality perceptions and patient satisfaction: A study of hospitals in a developing country. Social Science & Medicine, 52(9), 1359–1370.
Aslam, H. D., Shumaila, S., & Sadaqat, S. (2021). The impact of supportive work environment on employee performance: A study of healthcare professionals in Pakistan. International Journal of Health Sciences, 15(3), 50–60.
Bai, Y., Lin, L., & Wang, H. (2023). The role of positive work environment in reducing burnout among nurses: A cross-sectional study in China. BMC Nursing, 22, 45. https://doi.org/10.1186/s12912-023-00789-1
Bakari, G. H., Mfinanga, S., & Tumbo, S. (2023). Health workers' perceptions of rural deployment and retention in Tanzania. BMC Health Services Research, 23(1), 132.
Bakker, A. B., Demerouti, E., & Sanz-Vergel, A. I. (2021). Burnout and work engagement: The JD-R approach. Annual Review of Organizational Psychology and Organizational Behavior, 8, 389–411.
Bakker, A. B., & Demerouti, E. (2017). Job demands–resources theory: Taking stock and looking forward. Journal of Occupational Health Psychology, 22(3), 273–285.
Blau, P. M. (1964). Exchange and power in social life. Wiley
Chilipweli, P., Basinda, N., Msilaga, E. V., Tuli, T., Setebe, F., Elias, E., Konje, E., Kapesa, A., Nyanza, E., & Morona, D. (2023). Assessment of working environment and satisfaction among health care workers in Sengerema District, Mwanza, Tanzania. Journal of Community Medicine & Public Health, 7, 355.
Cohen, J. (2008). Statistical power analysis for the behavioral sciences (2nd ed.). Routledge.
Cropanzano, R., Anthony, E. L., Daniels, S. R., & Hall, A. V. (2017). Social exchange theory: A critical review with theoretical remedies. Academy of Management Annals, 11(1), 479–516.
Demerouti, E., Bakker, A. B., Nachreiner, F., & Schaufeli, W. B. (2001). The Job Demands–Resources model of burnout. Journal of Applied Psychology, 86(3), 499–512.
Eisenberger, R., Malone, G. P., & Presson, W. D. (2020). Optimizing perceived organizational support to enhance employee engagement. Current Opinion in Psychology, 33, 35–40.
Endale, T., Mekonnen, T., & Tadesse, W. (2023). Work environment factors and their impact on work engagement among primary care professionals in Ethiopia. International Journal of Health Sciences, 17(2), 123–135.
Erney, S., & Halpern, H. (2018). Supporting healthcare professionals in a remote rural area of Tanzania. London Journal of Primary Care, 10(4), 89–92.
Fink, A. (2015). How to conduct surveys: A step-by-step guide. SAGE publications.
Hair, J. F., Black, W. C., Babin, B. J., Anderson, R. E., & Tatham, R. L. (2019). Multivariate data analysis (8th ed.). Cengage Learning.
Hair, J. F., Hult, G. T. M., Ringle, C. M., & Sarstedt, M. (2017). A primer on partial least squares structural equation modeling (PLS-SEM) (2nd ed.). Sage Publications.
Hair, J. F., Risher, J. J., Sarstedt, M., & Ringle, C. M. (2022). Partial least squares structural equation modeling: Rigorous applications, better results and higher acceptance. Journal of Business Research, 137, 361-377.
Heller, D. J., Kumar, A., Raghavan, M., & Knaul, F. M. (2023). The quality gap in health systems of low-income countries. The Lancet Global Health, 11(1), e14–e24.
Henseler, J., Ringle, C. M., & Sarstedt, M. (2015). A new criterion for assessing discriminant validity in variance-based structural equation modeling. Journal of the Academy of Marketing Science, 43(1), 115–135.
Jin, M. H., & McDonald, B. (2023). The mediating role of work engagement in the relationship between talent management and service quality in healthcare. Human Resource Management Journal, 33(1), 120–137.
Khan, M. A., Ahmed, S., & Rahman, M. M. (2023). Impact of work environment on employee performance in healthcare settings: A study in Bangladesh. Journal of Health Management, 25(1), 45–58.
Karatepe, O. M., & Karadas, G. (2021). Linking work engagement to customer satisfaction: A social exchange perspective in healthcare. Journal of Service Theory and Practice, 31(2), 251–273.
Kline, R. B. (2023). Principles and practice of structural equation modelling. Guilford publications.
Kruk, M. E., Gage, A. D., Joseph, N. T., Danaei, G., García-Saisó, S., & Salomon, J. A. (2018). Mortality due to low-quality health systems in the universal health coverage era: A systematic analysis of amenable deaths in 137 countries. The Lancet, 392(10160), 2203–2212.
Kuwawenaruwa, A., Wyss, K., & Wiedenmayer, K. (2022). Availability and affordability of essential medicines in Tanzania’s public sector: A cross-sectional survey. Health Policy and Planning, 37(2), 200–208.
Madede, T., Sidat, M., McAuliffe, E., & Martíns, J. M. (2018). The impact of a supportive supervision intervention on health workers in Niassa, Mozambique: A cluster-controlled trial. Human Resources for Health, 15(1), 58.
Masatu, M. C., Freeman, P., & Bryce, J. (2020). Quality of clinical assessment and treatment decisions in health care: A case of Tanzanian health facilities. Health Policy and Planning, 35(6), 601–610.
Mkoka, D. A., Goicolea, I., Kiwara, A., Mwangu, M., & Hurtig, A. K. (2021). Health worker retention strategies in Tanzania: A qualitative study of rural district-level strategies. Human Resources for Health, 19(1), 1–12.
MoHSCDGEC. (2021). Annual health sector performance profile 2020/2021. Ministry of Health, Tanzania.
MoH. (2023). Health sector strategic plan V (2023–2028). Ministry of Health, Community Development, Gender, Elderly and Children.
Munga, M. A., & Mbilinyi, D. R. (2020). Working conditions and motivation of health care workers in Tanzania: A literature review. Journal of Health Systems Research, 8(1), 30–38.
Mwita, K. M. (2021). The influence of work environment on employee performance in Tanzanian public hospitals. African Journal of Management, 7(2), 89–102.
Mystakidou, K., Tsilika, E., Parpa, E., & Galanos, A. (2020). Assessing quality gaps in oncology care: A SERVQUAL analysis from healthcare providers' perspective. European Journal of Oncology Nursing, *44*, Article 101703.
Nguyen, T., Le, H., & Tran, Q. (2023). Psychological contract fulfillment and nurse engagement: Evidence from rural hospitals. International Journal of Nursing Studies, 141, 104444.
Nnko, E. E., Nyang’au, S., & Odhiambo, R. (2019). Influence of workload on performance of nurses in regional hospitals in Tanzania. The Strategic Journal of Business & Change Management, 6(3), 804–815.
Park, J., Lee, H., & Kim, S. (2021). Positivist philosophy in management research: A critical review. Journal of Management Inquiry, 30(1), 10–22.
Parasuraman, A., Zeithaml, V. A., & Berry, L. L. (1988). SERVQUAL: A multiple-item scale for measuring consumer perceptions of service quality. Journal of Retailing, 64(1), 12–40.
Sibonde, A. H., & Dassah, M. O. (2021). The relationship between employee motivation and service quality: Case study of a selected municipality in the Western Cape province, South Africa. Africa’s Public Service Delivery & Performance Review, 9(1), a499.
Schaufeli, W. B., Salanova, M., González-Romá, V., & Bakker, A. B. (2002). The measurement of engagement and burnout: A two sample confirmatory factor analytic approach. Journal of Happiness studies, 3, 71-92.
Schaufeli, W. B., Salanova, M., & Bakker, A. B. (2023). The measurement of work engagement: A short review and guidelines. Frontiers in Psychology, 14, 1122331.
Swai, L. A., & Tieng’o, W. Relationship between Working Environments and Employees Performance in Local Government Authorities: A Case of Bahi District Council, Tanzania. East African Journal of Management and Business Studies (EAJMBS), 2(4), 15-22.
Theuri, M. W., Macharia, S., & Kamau, A. (2020). An assessment of the influence of the working environment on service delivery in the public health sector in Nyeri County, Kenya. Management and Economics Research Journal, 6 (1): 961199.
Thomas, D., Mnyika, K., & Kassile, T. (2022). Using cross sectional design in rural health studies: Lessons from Tanzania. African Journal of Empirical Research, 3(1), 45–58.
Twineamatsiko, A., Mugenyi, N., Kuteesa, Y. N., Atuhairwe, S., Kansiime, A., & Ninsiima, A. (2023). Factors associated with retention of health workers in remote public health centers in Northern Uganda: A cross-sectional study. Human Resources for Health, 21(1), 83.
Uwimana, P., Zarowsky, C., Hausler, H., & Jackson, D. (2021). Healthcare worker perspectives on service quality in rural primary care: A mixed-methods SERVQUAL approach. BMC Health Services Research, *21*, Article 886.https://doi.org/10.1186/s12913-021-06922-2
World Bank. (2022). Tanzania – Health sector overview. https://www.worldbank.org/en/country/tanzania/overview
World Health Organization (WHO). (2023). Primary health care on the road to universal health coverage 2023 monitoring report. https://www.who.int/publications/i/item/9789240071227
Zhang, X., Zhang, C., Gou, J., & Lee, S. Y. (2024). The influence of psychosocial work environment, personal perceived health and job crafting on nurses' well-being: A cross-sectional survey study. BMC Nursing, 23(1), 373.
Yamane, T (1967); Statistics. An Introduction Analysis, 2nd Ed., New York; Hamper and Row
Yang, C., Li, X., & Zhang, Y. (2022). Trust and social exchange in healthcare teams: Implications for quality service delivery. Healthcare Management Review, 47(4), 270–280.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Protasia Prosper, Dr. Chacha Matoka (PhD), Dr. Charles Cleophace Ngirwa (PhD)

This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution (CC-BY) 4.0 License that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.