Table 1 Description of predictor variables and their data sources

Staff Burnout

A continuous variable at the clinic level to measure the level of burnout on a standardized scale experienced by the staff at the clinic.

Healthcare worker survey about staff motivation and health seeking behavior (Kruse et al. [9])

For each clinic burnout was defined as the median of the individual responses to the following question in the healthcare worker survey: “Q-32 Using your own definition of ‘burnout,’ please circle ONE of the following:

1. I have no symptoms of burnout.

2. Sometimes I am under stress, but I don’t feel burned out.

3. I am definitely burning out and have occasional symptoms of burnout.

4. The symptoms of burnout that I’m experiencing won’t go away.

5. I feel completely burned out. I am at the point where I need to make some changes or seek some sort of help.

Staff experience

A continuous variable at the clinic level to measure the work experience of healthcare workers at the facility.

Healthcare worker survey about staff motivation and health seeking behavior (Kruse et al. [9])

For each clinic experience was defined as the median of the individual responses to the following question in the healthcare worker survey:

“Q-7 Amount of time in your current position (write the number of months and/or years):

______ MONTHS ______ YEARS”

Staff absenteeism

A continuous variable at the clinic level to measure the extent of absenteeism

Healthcare worker survey about staff motivation and health seeking behavior (Kruse et al. [9])

Individual responses to the following 4 questions in the healthcare worker survey were summed to determine each worker’s total number of days absent. For each clinic absenteeism was defined as the median of these individual summed responses:

“Q-12 Have you been away from work because of funerals”

“Q-13 Have you been away from work because you were ill”

“Q-14 Have you been away from work because a family member was ill”

“Q-15 How much leave (local and accumulated) have you taken in the last 12 months”

Staff Turnover?

Q9 from the HCW

How many healthcare workers in your department have left their position in the last 2 years

Clinic age

A continuous variable at the clinic level to measure the time since initiation of ART program at a particular health facility

Electronic medical record data

Staffing ratio

A continuous variable at the clinic level for each month in calendar year 2007 to measure the number of patient visits per shift.

CIDRZ overtime payment data

This was calculated by dividing the total number of patient visits in a month by the total number of FTE shifts paid for in that month.

Electronic medical record data

Physical space

A continuous variable to measure the availability of physical space.

Facility architectural plans

This was calculated by dividing the floor area of each facility measured in sq. meters divided by average daily visits to the facility

Electronic medical record data