Motivation and retention of health workers in developing countries: a systematic review

Abstract

Background: A key constraint to achieving the MDGs is the absence of a properly trained and motivated workforce. Loss of clinical staff from low and middle-income countries is crippling already fragile health care systems. Health worker retention is critical for health system performance and a key problem is how best to motivate and retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of financial and nonfinancial incentives on motivation and retention.

Key strategies to improve systems for managing patient complaints within health facilities – what can we learn from the existing literature?

“…While there is substantial literature on determinants of behaviour of health staff [42], we found no articles that focus exclusively on staff behaviour to manage patient complaints. As for behaviour of patients, three key drivers of behaviour – opportunity, capability and motivation [43], can be targeted to improve patients’ willingness to complain, as we discuss next.…”

“…Appropriate policy and institutional frameworks are significant determinants of staff motivation, behaviour and performance [27,30,42,73]. While there is lack of studies which explore behaviours of service providers in managing patient complaints, a systematic review of factors that influence the self-reporting of incidents by health staff identified that ‘fear of punishment, uncertainty of what should be reported and how incident reports will be used and time constraints to incident reporting are common barriers to incident recognition and reporting’ [74].…”

Balancing the cost of leaving with the cost of living: drivers of long-term retention of health workers: an explorative study in three rural districts in Eastern Uganda

“…Having access to additional revenue has been found to be an effective strategy in improving health worker retention [37] although financial incentives by themselves have been found to be inadequate [38]. Males had more promotion, leadership, and training opportunities than females.…”

The future of health in Zimbabwe

“…The Zimbabwean government’s response was a partnership with Cuba to deploy hundreds of Cuban physicians within the Zimbabwean health system, together with a series of measures, such as bonding newly trained health workers and improved training [3]. With fairly strong training programs for nurses and physicians already in place, the focus should shift to retention of newly trained health professionals through fair pay and non-monetary incentives such as supportive work environments, physical safety, and leadership opportunities [31]. …”