Managing and Motivating tion of medical practitioners who were present at their assigned post. Nationwide they found a 26% absenteeism rate in rural health centres, with considerable regional variation. In the poorer areas, with single doctor clinics, this rises to 74% absenteeism. Thus, even when health facilities are staffed, the staff may not be present. In Tanzania, time and motion studies found overall productiv- ity in public health facilities to be only 57%, with a mere 37% of staff time spent on patient care (Kurowski, Abdulla, & Mills, 2003). Further, skills among health personnel may be inadequate in terms of making an accurate diagnosis and fol- lowing through with appropriate treatment; skill levels and skill mix may be inappropriate, while application within the job can also be quite poor (McPake et al., 1999; World Bank, 2004). Ferrinho and Lerberghe (2003) have argued that poorly paid health service employees have developed a number of "coping strategies" to "compensate" for utilises our research data from two sub-Saharan African countries to examine health workers' perceptions of their work environment, including their relationships with managers and co-workers. Data from surveys and focus groups with health workers demonstrate the impact of the work environment on burnout levels, de-motivation and retention. THE RESEARCH CONTEXT Two sub-Saharan African countries, Malawi and Lesotho, were selected in which to explore these issues. Malawi is one of the poorest countries in the region and has poor health indicators. Life expectancy has fallen in the last decade to 42 years and has been attributed to HIV/AIDS. The maternal mortality rate is 1,800 per 100,000 live births, while the infant mortality rate is 92.1