Health worker motivation in Africa: the role of non-financial incentives and human resource management tools

Abstract

Background: 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. Methods:The study design entailed semi-structured qualitative interviews with doctors and nurses from public, private and NGO facilities in rural areas. The selection of health professionals was the result of a layered sampling process. In Benin 62 interviews with health professionals were carried out; in Kenya 37 were obtained. Results from individual interviews were backed up with information from focus group discussions. For further contextual information, interviews with civil servants in the Ministry of Health and at the district level were carried out. The interview material was coded and quantitative data was analysed with SPSS software. Results and discussion:The study shows that health workers overall are strongly guided by their professional conscience and similar aspects related to professional ethos. In fact, many health workers are demotivated and frustrated precisely because they are unable to satisfy their professional conscience and impeded in pursuing their vocation due to lack of means and supplies and due to inadequate or inappropriately applied human resources management (HRM) tools. The paper also indicates that even some HRM tools that are applied may adversely affect the motivation of health workers. Conclusion:The findings confirm the starting hypothesis that non-financial incentives and HRM tools play an important role with respect to increasing motivation of health professionals. Adequate HRM tools can uphold and strengthen the professional ethos of doctors and nurses. This entails acknowledging their professionalism and addressing professional goals such as recognition, career development and further qualification. It must be the aim of human resources management/quality management (HRM/QM) to develop the work environment so that health workers are enabled to meet their personal and the organizational goals.

Mobile instant messaging for rural community health workers: a case from Malawi

“…This is of particular value in settings where the management of health workers is inhibited by geographical distances and lack of transport, a phenomenon which is typical for many global health contexts [24,25]. In addition, the use of MIM to visualise and acknowledge performance (beyond exclusive control and monitoring purposes), which has been revealed in this study, is relevant in view of the widely acknowledged lack of supervision tools and practices that facilitate recognition and feedback mechanisms in global health work [24,26,27]. …”

Professional skills development in a resource-poor setting: the case of pharmacy in Malawi

“…In what is known as the 'know-do' gap that deeply frustrates many development partners, it is hoped that these recalcitrant public officers would one day wake up to do what they know they are supposed to do. There have been divided opinions about what solutions there are to eventually uproot such 'culture' that almost characterises the African public service: does the problem come from 'bad' governance, lack of skills for human resource management, or simply a cultural difference (Fiszbein et al, 2011;Mathauer and Imhoff, 2006;Blunt and Jones, 1997)? Interestingly, or rather paradoxically, these debates seem not to find their way into the HRH discourse.…”

“…The mantra is to train the 'right' cadres of health workers with the 'right' skills in order to deliver the 'right' services to the 'right' population at the 'right' time and the 'right' place (Birch, 2002). In the research arena, there has thus been launched a search for the 'holy grail' of the 'right' model for health planning-where we see the mushrooming of a myriad of strategic plans/tools for improving accuracy in predicting 'human resources for health' (HRH) needs (Hirschhorn et al, 2006;Van Damme et al, 2007;Nyoni et al, 2006); identifying skills/competencies gaps to deliver health services (Waako et al, 2009); and exploring the feasibility of numerous incentives to encourage in-country retention Mathauer and Imhoff, 2006;Witter et al, 2011). The dominance of the human capital approach is therefore apparent through conceptualisation of HRH as a capital for health-as an asset to be built, improved and safeguarded.…”

Understanding job satisfaction amongst mid-level cadres in Malawi: the contribution of organisational justice

“…14 Maternal health nurses, for example, ranked improved working environments and conditions (such as good facility management and adequate equipment) as high as or higher than financial incentives in one study. 15 Most African countries have focused on producing more expensive (less cost-effective) cadres of health workers relative to their disease burden and to what they can afford. Some experts have pointed out that as much as two-thirds of Africa's disease burden could be addressed by community health nurses.…”