Performance management systems among physiotherapists in public rehabilitation centers in Bangladesh: A cross-sectional study of the health workforce

Health workforce performance is central to service quality, yet little empirical work has examined how performance management systems operate for physiotherapists in rehabilitation services in low- and middle-income settings. This cross-sectional study assessed the current state, perceived effectiveness, and process gaps of performance management systems among physiotherapists working in public rehabilitation centers in Dhaka, Bangladesh. A pretested semi-structured questionnaire was administered to 105 physiotherapists between September and October 2025. Descriptive statistics were used to summarize participant characteristics and performance management indicators. Wilson 95% confidence intervals were estimated for key proportions. A nine-item exploratory performance management system maturity score was constructed from process indicators. Fisher exact tests with Cramer's V were used to examine associations with perceived system effectiveness, and exploratory logistic regression estimated odds ratios for effective or moderately effective performance management. The mean age of respondents was 31.6 years, 56 of 105 were male, and 85 of 105 had graduate or postgraduate qualifications. Formal performance management systems were reported by 102 of 105 respondents (97.1%, 95% CI 91.9-99.0). Standardized appraisal timing and method, assessment form use, performance planning, and formal evaluation systems were each reported by about 60-70% of participants. Reward-performance linkage was perceived as motivating by 97 of 105 respondents (92.4%, 95% CI 85.7-96.1). Overall, 81 of 105 respondents (77.1%, 95% CI 68.2-84.1) rated the system as effective or moderately effective. Training recipient category was associated with perceived effectiveness (Fisher exact p=0.0035; Cramer's V=0.363), as was perceived appropriateness of the process (p=0.0323; Cramer's V=0.258). The maturity score was not independently associated with perceived effectiveness in exploratory regression. Public rehabilitation centers in Dhaka appear to have formal performance management systems, but the systems are only moderately developed. Strengthening training coverage, transparent evaluation criteria, routine feedback, and formal system review may improve staff confidence in performance management processes.