Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts

Abstract

BackgroundSince its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts.MethodsInterviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively.ResultsIn both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water, electricity and cups for clients to use while taking doses under direct observed therapy than their public facility counterparts. Employees in public HFs more acknowledged availability of clinical officers, nurses and midwives than their private facility counterparts. More results are presented and discussed.ConclusionThe study shows conditions related to staffing levels, health infrastructure and essential supplies being among the key determinants or drivers of frontline HWs' motivation to deliver ANC services in both private and public HFs. Efforts of the government to meet the maternal health related Millennium Development Goals and targets for specific interventions need to address challenges related to HWs' motivation to perform their duties at their work-places.

Challenges in day-to-day midwifery practice; a qualitative study from a regional referral hospital in Dar es Salaam, Tanzania

“…Other factors of importance were personal struggles, shortage of staff, equipment availability, and unawareness and challenges in society. The feeling of demoralization and lack of motivation is in line with findings from other studies conducted in the region [15–17]. Positive support from supervisors have been demonstrated to be of importance for the quality of services that health workers are able to deliver [18].…”

Knowledge and perceptions of antenatal services need and delivery and reasons for seeking such services among women in Tanzania: Implications for utilization and coverage of intermittent presumptive treatment of malaria in pregnancy in two districts

“…Therefore, answers collected based on opinions given by respondents through word of mouth without other mechanisms being used to confirm them need to be treated cautiously (Asenso-Okyere et al, 1999). However, these latter findings/evidence are validated by reports from the frontline HWs in the present study who confessed to have occasionally found themselves too busy with heavy workload at HFs to deliver the required health messages or keep individual clients' records for the services delivered in the appropriate official registers or personal HF cards (Mubyazi et al, 2012;Mubyazi et al, 2014a).…”

“…Inclusion of mothers of little children and pregnant women found at village level was targeted to capture feedback from those who might not be using the ANC services during their pregnancy period for various reasons, and their views would be compared with those from the pregnant women who coincidently were found visiting the ANC clinics at the selected study HFs. The HWs involved in the interviews included those who delivered services to ANC clients, and their overall samples and type of cadres have been documented in previous publications (Mubyazi et al, 2012;Mubyazi et al, 2014a).…”

“…The term 'current ANC users' as applied throughout the present paper is taken to refer to Women who were currently pregnant on date (of study) while the term 'recent ANC users' refers to women who had given birth within the last twenty four months period prior to the present study. Information from the recent and current ANC users was , supplementary data with informal (personal) communication with frontline HWs who were found at same ANC clinics selected for investigating pregnant women (Mubyazi et al, 2012), as well as some intertemporal observations made at the selected clinics (Mubyazi et al, 2014a).…”

Coverage and efficacy of intermittent preventive treatment with sulphadoxine pyrimethamine against malaria in pregnancy in Côte d¿Ivoire five years after its implementation

“…Stock outs of SP, absence of cups and clean drinking water for taking SP by DOT [17], unclear guidelines [21] or confusion among health workers regarding the guidelines [24] and other related health facility factors [15,25] are factors which hamper delivery of IPTp.…”