Non-Financial Incentives

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It discusses the human resources for health situation in Tanzania in general, and specific findings from the Lake zone in terms of health workers in church health institutions. The author proposes options for a motivation package to address the issues of retention for these workers.

A preliminary report of a small-scale study of health worker motivation in South Africa exploring the links between motivation and performance, and the relevance of workplace trust as an influence over motivation. In general, health workers appear to give less emphasis to trust in colleagues as an influence over motivation, and much great emphasis to trust in manager/supervisor and trust in employing organization. The initial findings suggest that: health care provision is affected by health worker motivation and performance problems; there is potential to strengthen motivation and performance through changed management practices; the way in which management decisions are implemented is a critical influence over the impact of any decision on motivation; and management action needs to recognize the perceived risk and powerlessness expressed by many health workers, and seek to tackle these perceptions.

A study exploring the influence of workplace trust over health worker performance at primary care level was undertaken in Tanzania and South Africa in 2003. The main factors identified by respondents as underlying poor health worker performance and motivation in the public sector were: staff shortages and low salaries; poor working conditions; favoritism and lack of transparency in human resource management practices; limited supervision and monitoring; weak disciplinary procedures; limited and slow opportunities for promotion; differential salary levels; rigid employment management policies; slow decision-making across the public service; and conflicting lines of accountability at district level.

There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non-financial incentives. This study assesses the role of non-financial incentives for motivation in two cases, in Benin and Kenya. [abstract]

Health worker motivation has the potential to have a large impact on health systems performance, yet little is known about the key determinants and outcomes of motivation in developing and transition countries. This study, conducted in Jordan and Georgia focused on the individual determinants and outcomes of the worker’s motivational process. A wide range of psychometric scales was used to assess individual differences, perceived contextual factors and motivational outcomes (feelings, thoughts and behaviors). Although the two countries have very different cultural and socio-economic environments, many similarities existed among key determinants between the two countries.

To provide good quality health care services, it is important to develop strategies influencing staff motivation for better performance. An exploratory qualitative research was carried out among health workers in two provinces in North Viet Nam so as to identify entry points for developing strategies that improve staff performance in rural areas. [from abstract]

This paper provides an overview of evidence of the effects of incentives on the performance and motivation of independent health professionals and health workers.

A growing body of evidence suggests that the quality of a health system depends greatly on highly motivated health workers who are satisfied with their jobs, and therefore stay at their stations and work. This paper reviewed evidence from published and grey literature on the use of non-financial incentives for health worker retention in sixteen countries in east and southern Africa. [adapted from author]

GTZ’s stake in Human Resources for Health is based on the fact that human resource development is a core function of technical cooperation. The following paper sketches out the concepts of non-financial incentives and quality management and its potential role in motivating staff. It then presents some preliminary results from a multicountry study on the role of non-financial incentives to increase staff motivation, undertaken by GTZ in collaboration with its partner countries. [from author]

This video clip is 8 minutes and 45 seconds and discusses Uganda’s pay reforms and other incentive for health personnel to address the brain drain issue. It also has information on other incentives and programs such as government sponsored grants to health institutions to promote research and the retention of health educators.


You must have access to a media player to see the video. Download instructions are available from the WHO Best Practices in Human Resources for Health Development website.