Burnout among primary healthcare workers in poorer countries is 'substantial' and putting patients' safety at risk, according to new Keele research published in the influential Bulletin of the World Health Organization.

Burnout is defined as a form of chronic occupational stress consisting of three dimensions - exhaustion; depersonalisation or cynicism; and feelings of inefficacy. The consequences of burnout are significantly associated with reduced patient safety and quality of care. It also has a significant impact on physical and mental health and is linked to increased rates of sick leave and staff turnover, which creates problems in countries where understaffing and insufficient resources is already a critical issue.

While the burden of burnout in high income countries (HICs) is well established, less is known about the effect it has in low and middle-income countries (LMICs). To assess the impact, the researchers reviewed 60 studies investigating burnout among more than 61,000 primary healthcare professionals from 20 countries*.

They found more than half of staff reported moderate or high levels of emotional exhaustion, and more than a third felt depersonalised and lacked empathy. The majority of the findings were reported before the coronavirus pandemic, with health services across the world facing unprecedented pressures over the last two years.

Heavy workloads, including overtime, shift-work, and patient load, together with working a second job, were significantly associated with high levels of burnout in the studies reviewed. Other factors were conflict, exposure to violence at work, and inadequate personal protective equipment, rest breaks, or vacation time.

Publishing their findings, the researchers say significant knowledge gaps still exist on the impact of burnout in low and middle-income countries. They say it is vital to identify measures to protect staff, such as more support and regular rest breaks, and have called for an international consensus on the definition of burnout to improve future reporting and research across all countries.

Lead author Dr Tanya Wright, from Keele University’s School of Medicine, said: "The well-being of primary healthcare professionals is a vital part of building the strong and resilient healthcare systems necessary to achieve universal health coverage. Our research is important in highlighting not only the high prevalence of burnout among primary healthcare professionals in low- and middle-income countries, but also the complete lack of data for many low-income and lower-middle income countries.

"Not only is the risk of burnout in these lower resource settings potentially higher, but the organisational and economic consequences of burnout may have a much greater impact in these countries, and it is vital that further research is done to better determine the burden of burnout.

"We hope that our research will lead firstly to a greater awareness of the impact of burnout and the need for further research in these countries, and secondly to studies focused on enhancing our understanding of burnout in these countries, and developing appropriate interventions to mitigate, and even prevent burnout."

*Brazil, Mexico, and Cuba from the WHO Region of the Americas; China from the Western Pacific Region; Turkey, Serbia, Bosnia and Herzegovina, Bulgaria, and the Russian Federation from the Europe Region; Iran, Iraq, West Bank and Gaza, and Egypt from the Eastern Mediterranean Region; Thailand and India from the South East Asia Region; South Africa, Zambia, Uganda, Ethiopia, and Cameroon from the Africa Region.