Motivation

This paper examines the employment preferences of public sector registered nurses working in Malawi and identifies the range and relative importance of the factors that affect their motivation. The research was designed in the light of the Malawi government’s programme to address the shortage of health workers, which is based on salary top-ups as a means of increasing employee motivation and reducing high rates of attrition. This policy has been adopted despite relatively little quantitative exploration into the employment preferences of health workers in developing countries. This study aims to provide a clearer picture of the preferences of registered nurses about different aspects of their employment, and the factors that might persuade them to continue in the profession within their home country.

This paper examines the experience with using various incentives to motivate and retain community health workers (CHWs) serving primarily as volunteers in child health and nutrition programs in developing countries.

Health professionals face the duality of the professional and the organizational systems, each of which has its own distinct values, principles and expectations. This study presents organizational and professional commitment concepts and their relations in the context of the health sector. [adapted from introduction]

This issue outlines the connections between work climate, employee motivation, and performance. It describes how managers can assess the climate in their work group and shows how they can use the results to make changes in leadership and management practices that will motivate their group to do the best work possible and improve results. [editor’s description]

This paper represents the second phase of a larger study examining health worker motivation in two hospitals in Tbilisi, Georgia. The overall objective of the 360 degree assessment was to begin to identify the major organizational, situational, and individual factors associated with health worker motivation, and to better understand how major constituencies (i.e., managers, supervisors, workers, and patients) perceive the hospital/work environment. Specific objectives of this study component were to: assess congruence between managers, supervisors and workers on perceptions of hospital goals; compare perceptions of hospital and worker characteristics among types of workers (physician, nurse, other) and levels of respondents (managers, supervisors, workers, patients); and identify possible factors for stimulating good performance and possible interventions for enhancing motivation.

In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity.

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.

Problems related to health worker motivation are remarkably pervasive, but to-date little attention has been paid to them in developing and transition countries. Basic tools to measure the determinants and consequences of motivation have not been adapted to contexts outside the industrialized world. This paper assesses the feasibility of transferring psychometric tools, typically used in industrialized countries to measure motivational processes, to other contexts. The paper draws upon two field studies conducted in two hospitals in the Republic of Georgia and two hospitals in the Hashemite Kingdom of Jordan.

Using incentives and disincentives to direct individuals’ energies and behaviour is common practice in all work settings, of which the health care system is no exception. The range and influence of economic incentives/disincentives affecting community nurses are the subject of this discussion paper. The tendency by nurses to disregard, and in many cases, deny a direct impact of economic incentives/disincentives on their motivation and professional conduct is of particular interest. The goal of recent research was to determine if economic incentives/disincentives in community nursing exist, whether they have a perceivable impact and in what areas.

With the recognition that public hospitals are often productively inefficient, reforms have taken place worldwide to increase their administrative autonomy and financial responsibility. Reforms in China have been some of the most radical: the government budget for public hospitals was fixed, and hospitals had to rely on charges to fill their financing gap. Accompanying these changes was the widespread introduction of performance-related pay for hospital doctors, termed the “bonus” system. While the policy objective was to improve productivity and cost recovery, it is likely that the incentive to increase the quantity of care provided would operate regardless of whether the care was medically necessary.

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.

Over the last five years, international development organizations began to modify and adapt the conventional Performance Improvement Model for use in low-resource settings. This model outlines the five key factors believed to influence performance outcomes: job expectations, performance feedback, environment and tools, motivation and incentives, and knowledge and skills. This study presents a unique exploration of how the factors affect the performance of primary reproductive health providers (nurse-midwives) in two regions of Armenia. [from abstract]

This pilot study focused on self-identified factors of nursing students who expressed an interest in rural practice post-graduation. The sample included students from the USA and Canada, who were enrolled in graduate and undergraduate programs of nursing, and were attending an international rural nursing conference. [From abstract]

By measuring the ability and actual practice of a sample of clinicians in Tanzania and examining the terms of employment for these clinicians, we show that both ability and motivation are important to quality.

The human resource (HR) problem in the health sector in sub-Saharan Africa has worsened to an extent that it has reached crisis proportions in some countries. Although the gravity of the problem varies across the continent, the situation in some of the countries is so grave that urgent action is needed. A complex set of factors has contributed to this problem, some exogenous, such as the austere fiscal measures introduced by structural adjustment, often resulting in cutbacks in the number of health workers. But endogenous factors are also to blame, including misdirected human resource and training policies, weak institutions, and possibly even inappropriate structures. Section I of the paper lays out the key features of the HR crisis as gathered from a review of available data and reports and interviews with health program managers, health officers and project task managers in east and southern Africa. Section II of the paper gathers a few good practices and mechanisms that have been tried to ease the HR problems in the region. It highlights some opportunities for reform and cites the continuing challenges and risks. [adapted from author]

Ghana, a low income developing country, is undergoing health sector reforms aimed at achieving greater equity of access to services, improved efficiencies in resource utilization, development of wider linkages with communities and other partners, as well as improved quality of health services. These reforms have strong influences on, and are influenced by, issues of human resources development, deployment and motivation. Some of the human resources issues debated under the reforms include issues of distribution of personnel, reprofiling of staff types and skill mixes including delegation of some essential skills.

It is becoming increasing important that policymakers be aware of health worker motivation and it’s impact on health sector performance. Health care delivery is highly labor-intensive, and service quality, efficiency, and equity are all directly mediated by workers’ willingness to apply themselves to their tasks. While resource availability and worker competencies are essential, decision makers should know that they are not sufficient in themselves to ensure desired worker performance. Worker performance is also dependent on workers’ level of motivation stimulating them to come to work regularly, work diligently, and be flexible and willing to carry out the necessary tasks.

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]

This paper represents the first phase of a larger study examining health worker motivation in two hospitals in Tbilisi, Georgia. The paper analyzes the context within which health workers are located and describes historic trends in the position of health workers and the current efforts to reform the health sector. It also provides a detailed analysis of work conditions and organizational features of the two study hospitals. [from 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.

This issue focuses on the health workforce and contains the articles: Could health worker migration bring benefits to Malawi?; Removal of childbirth delivery fees: the impact on health workers in Ghana; Regulation of dual job-holding public sector doctors in Peru; Health worker responses to health sector reforms; and Motivating Tanzanian primary health care workers. [adapted from author]

This report summarizes findings from Phase 2 of a two-phase case study to determine why certain reproductive healthcare facilities in low-resource settings perform better than others. The study examined the characteristics, behaviors, and coping strategies of high-performing reproductive healthcare facilities in Kenya, exploring elements of resilience and factors influencing performance. The study investigated the applicability of a performance improvement (PI) model that hypothesizes that both individual and organizational performance are influenced by seven performance factors: job expectations; motivation; knowledge and skills; performance feedback; infrastructure, equipment, and supplies; leadership and management systems; and client and community focus.

Staff shortages could harm the provision and quality of health care in Uganda and therefore staff retention and motivation are crucial. Understanding the impact of HIV/AIDS on staff contributes to designing appropriate retention and motivation strategies. This research aimed to identify the influence of HIV/AIDS on staff working in general hospitals at district level in rural areas and to explore support required and offered to deal with HIV/AIDS in the workplace. Results from interviews and surveys show that HIV/AIDS is an important contextual factor that impacts working conditions in various ways.

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 describes the specific policy measures that the Zimbabwean government has recently implemented to try to improve health sector performance, and promote higher levels of motivation amongst public sector health care workers. The overall reform package is to include financial reforms (user fees and social insurance), strengthening of health management, liberalization and regulation of the private health sector, decentralization, and contracting out. Unfortunately, the process of reform implementation in Zimbabwe and the government’s poor communication with workers, combined with a conflict between local cultures and the measures being implemented, has undermined the potentially positive effect of reforms on health worker motivation.

This report was commissioned to describe experiences and to provide lessons learnt with respect to interventions to retain staff and improve their productivity, competence and responsiveness. [from summary]

As part of the High-Level Forum on the Health Millennium Development Goals, this issue paper discusses improving health workforce performance as a key factor in meeting MDGs. The required scaling up of interventions towards the MDGs depends on effective health services delivery systems (HSDS). The availability, the skills, the attitudes, motivation, and behaviors of health workers are key to well-functioning HSDS. [adapted from author]

The aim of this study was to explore the experiences of health workers working in the primary health care facilities in Kilimanjaro Region, Tanzania, in terms of their motivation to work, satisfaction and frustration, and to identify areas for sustainable improvement to the services they provide.

In Tanzania access to urban and rural primary health care is relatively widespread, yet there is evidence of considerable bypassing of services; questions have been raised about how to improve functionality.