DR. MADIHA MASOOD, SADIA MUSTAFA, RABIA TARIQ, ALINA KHALIQ
DOI: https://doi.org/Purpose: This study examines how physicians and nurses working in Pakistan’s public primary health care system experience psychological empowerment to engage in managerial activities alongside their routine clinical duties. The study responds to the growing expectation that clinicians in low- and middle-income countries perform administrative and coordination tasks without formal managerial appointments.
Design/methodology/approach: A qualitative interview-based design was employed. Data were collected in 2024 from five government primary health care facilities (Basic Health Units and Rural Health Centers) across two districts of Punjab, Pakistan. A total of 52 semi-structured interviews were conducted with physicians, nurses, and senior nursing supervisors. Data were analyzed using a thematic approach guided by the psychological empowerment framework.
Findings: The findings reveal context-specific themes of psychological empowerment. Nurses’ engagement in managerial work was strongly dependent on structural permission, senior endorsement, and informal authority derived from experience. Physicians experienced autonomy and impact largely through professional status but demonstrated low perceived competence and motivation for managerial tasks. Unlike findings from high-income contexts, managerial work in Pakistan was often associated with compliance, reporting obligations, and accountability pressures rather than development-oriented activities. Managerial work was perceived as meaningful primarily when it reduced clinical overload or improved patient flow, but it remained secondary to clinical care for both professional groups.
Practical implications: Health system reforms in Pakistan should strengthen nurses’ structural empowerment through formal delegation and training while reframing managerial tasks for physicians as supportive rather than competing with clinical work.
Originality: This study offers indigenous empirical evidence on clinicians’ psychological empowerment for managerial work in Pakistan, extending empowerment theory to a resource-constrained, hierarchical health care context.
