Approaches to motivate physicians and nurses in low- and middle-income countries: a systematic literature review

Abstract

Poor health worker motivation, and the resultant shortages and geographic imbalances of providers, impedes the provision of quality care in low- and middle-income countries (LMICs). This systematic review summarizes the evidence on interventions used to motivate health workers in LMICs. A standardized keyword search strategy was employed across five databases from September 2007 -September 2017. Studies had to meet the following criteria: original study; doctors and/or nurses as target population for intervention(s); work motivation as study outcome; study design with clearly defined comparison group; categorized as either a supervision, compensation, systems support, or lifelong learning intervention; and conducted in a LMIC setting. Two independent reviewers screened 3845 titles and abstracts and, subsequently, reviewed 269 full articles. Seven studies were retained from China (n = 1), Ghana (n = 2), Iran (n = 1), Mozambique (n = 1), and Zambia (n = 2). Study data and risk of bias were extracted using a standardized form. Though work motivation was the primary study outcome, four studies did not provide an outcome definition and five studies did not describe use of a theoretical framework in the ascertainment. Four studies used a randomized trial—group design, one used a non-randomized trial—group design, one used a cross-sectional design, and one used a pretest–posttest design. All three studies that found a significant positive effect on motivational outcomes had a supervision component. Of the three studies that found no effects on motivation, two were primarily compensation interventions and the third was a systems support intervention. One study found a significant negative effect of a compensation intervention on health worker motivation. In conducting this systematic review, we found there is limited evidence on successful interventions to motivate health workers in LMICs. True effects on select categories of health workers may have been obscured given that studies included health workers with a wide range of social and professional characteristics. Robust studies that use validated and culturally appropriate tools to assess worker motivation are greatly needed in the Sustainable Development Goals era.

Impact of reliable light and electricity on job satisfaction among maternity health workers in Uganda: A cluster randomized trial

“…Qualitative data also underlined other facility challenges important to health workers, such as lack of medical supplies, equipment, space, security, and training, which are common challenges for health workers in resource-constrained settings [ 9 , 38 , 41 ]. Consistent with previous evidence [ 9 , 40 , 42 , 43 ], our findings highlight the necessity of reliable light for health facilities to improve quality of maternal and newborn care while pointing toward the importance of comprehensive interventions tailored to address multiple barriers in a health system.…”

“…In addition, sufficient light may also have signaled higher quality of care to the community, earned more respect for health workers, and made their work more rewarding, which all contribute to greater job satisfaction [ 15 , 39 ]. Given the importance of health workers’ motivation to successful guideline implementation in obstetric care in LMICs and the limited existing research on effective approaches to motivate health workers [ 9 , 40 ], our study contributes to the literature by generating rigorous and contextual evidence for cross-sectional investment in health infrastructure as a policy option for human resources for health. [ 7 ]…”

Production, Recruitment, and Retention of Health Workers in Rural Areas in the Philippines

“…18 In the systematic review of motivational factors that worked in LMICs, compensation and system support interventions were found effective in retaining HRH. 19 Some of these strategies may be adapted by the LGUs in the Philippines.…”

The regulation of healthcare professions and support workers in international context

“…These and other concerns seem to have led to a breakdown of trust at all levels between patients, providers and the regulators. This is replicated in a number of other LMICs where there are doubts about the competency of professions such as doctors and nurses [ 37 ], the enforcement of continuing professional development [ 38 ], and the provision of supportive supervision in building capacity, improving the quality of care and enhancing clinical outcomes [ 39 ]. This is exacerbated by the influence of market forces, including on the proliferation of low-quality private schools for health professionals in LMICs, which mean that regulations do not achieve their intended effect [ 40 ].…”