Afarand Scholarly Publishing Institute Health Education and Health Promotion 2588-5715 14 1 2026 01 01 Organizational Determinants of Health Worker Performance in a Decentralized Health System: The Selective Mediating Role of Quality of Work Life 28591 EN M. Yuda Pratama I. Yustina N. Nurmaini Z. Zulkarnain G. Silaban E. Mutiara N.L. Lubis S. Sumardiyono Journal Article 2026 02 02 Aims: to analyze whether QWL (Quality of Work Life) consistently mediates organizational commitment, healthy work environment, motivational climate, career development, and health worker job performance in decentralized primary care systems.                 <br>Materials & Methods This paper adopted an explanatory quantitative research study approach, referring to the validated metrics measured organizational commitment, workplace quality, motivation, career progression, QWL, and job performance involved 320 Aceh, Indonesia, local government primary health care workers. Indirect and direct variable links were examined using PLS-SEM. <br>Findings QWL significantly mediates the effects of inspiring environment and career development on work performance (β = 0.272; p = 0.001), but not organizational commitment or health. Many organizational elements affect work performance without QWL. Finally, QWL cannot explain all organizational and job scenarios. Psychological and structural factors impact decentralized health system employee performance, requiring workforce management beyond QWL growth.<br>Conclusion: Work-life quality boosts health professionals' performance in decentralized health systems, although its mediating effect varies by organization. QWL selectively mediated motivating environment and career growth on work performance, but not organizational commitment or health.<br>  https://hehp.modares.ac.ir/article_28591_6e117946c3865270453226df079b8d5f.pdf