The reciprocity concept is the foundation of many significant social contracts, including employment agreements. A trustworthy social exchange and individual well-being depend on a fair distribution of the expenses and benefits of participating in cooperative activities. In contrast, failure to reciprocate when there is a large cost and little reward results in significant negative feelings and related stress reactions. The effort-reward imbalance model was created with a specific emphasis on the workplace in order to pinpoint instances of failed reciprocity in social contracts. Job stress has been found to have a considerable negative influence on both employee performance and the standard of care provided to patients. Research on the ERI model in Pakistan revealed a paucity of literature, but many other nations are now concentrating on resolving the problems employees have with the effort-reward balance. Therefore, this study aims to investigate the impacts of effort-reward imbalance (ERI) on job stress and work performance, the influence of job stress on work performance, and the direct and indirect effects of ERI on work performance through job stress in the healthcare sector of Sindh Pakistan. This study is quantitative and employs a cross-study design with an analytical observational study. Total, 400 healthcare professionals (medical, nursing, and non-medical) that participated in the survey were the respondents. The data was analyzed using path analysis and the Chi-square test. The findings indicated that job satisfaction and productivity were significantly correlated with ERI.
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