Cross-Country Research Into Rural Health Worker Motivation - Convergence and Contrasts in Findings From Burkina Faso, Ghana and Tanzania

Strategic health workforce planning is urgently required in Sub-Saharan Africa.  Staffing shortages in remote areas impede service delivery and have ethical implications. To be effective workforce planning  needs to be informed by a detailed understanding of health worker motivation. However, the major theories of motivation all emerged in industrialized countries and their applicability to resource-constrained settings is considered limited.  

To fill this gap research was undertaken to gain a stronger grasp of the influences on health worker motivation in rural Sub-Saharan Africa. In-depth interviews  were conducted with primary level providers in Burkina Faso, Ghana and Tanzania.  The interview guideline was structured to streamline use and facilitate comparability. Experienced  researchers from the three countries met to establish a common approach to conducting the interviews,  for training on coding open-content and to undertake the initial review and coding of transcripts together to ensure inter-coder reliability.

The findings reveal there to be both common and country-specific influences that attract people to the health professions. Understandings of the terms and concepts pertaining to motivation differ strongly. Community appreciation is valued in all settings but the importance attached to the views of superiors is mixed.  The acceptability of performance management  tools is found to be limited. Factors that reinforce or erode provider motivation show commonalities across the three countries, but perceptions diverge regarding the status and remuneration of rural health work. The wish to remain a health worker is generally high, but commitment to rural workplaces fluctuates. The profiles of the providers that can most readily be recruited in remote areas vary, as do the influences on their job satisfaction and their ideas regarding incentives. Differing mixtures of financial and non-financial incentives are suggested and there are clear country preferences  as to whether incentives should be for individuals or teams.

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