The mediating role of affective commitment in the relationship between HRM practices, satisfaction with work equipment, and turnover intentions

This research explores the factors affecting physicians' intentions to leave their jobs in Burundi, which faces a severe shortage of doctors in sub-Saharan Africa. Using data from 225 physicians in public hospitals, we analyze how perceptions of human resource management (HRM) practices—such as training, rewards, and career development—and satisfaction with work equipment influence physicians' affective commitment to their organizations and their willingness to stay. Based on social exchange theory, we propose that affective commitment acts as a mediator connecting HRM practices and working conditions to turnover intentions. Our findings support this model: affective commitment fully mediates the impact of training, rewards, and equipment satisfaction, while it partially mediates the effect of career management. Data analysis was conducted through structural equation modeling. By combining HRM practices and working conditions into a comprehensive framework, this study provides new insights into what drives physician retention in resource-limited settings and offers practical strategies for policy and healthcare practice in fragile systems.