A Discrete Choice Experiment on Factors Influencing Attrition and Motivation of Frontline Health Workers in Remote and Rural Areas in Nigeria

Okoroafor, Sunny C; Nwachukwu, Chukwuemeka E; Osubor, M

doi:10.21203/rs.3.rs-608253/v1

Cited by 2 publications

(13 citation statements)

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“…This finding also contradicts studies which identify provision of housing or housing allowances as incentives to work in rural or remote areas. 20 25 It may be more appropriate to invest in improving PHC facility infrastructure and supporting amenities such as access to high-quality schools to increase CHW’s motivation to reside within the community where they serve. 20 54–56 …”

Section: Discussionmentioning

confidence: 99%

“… 20 25 It may be more appropriate to invest in improving PHC facility infrastructure and supporting amenities such as access to high-quality schools to increase CHW’s motivation to reside within the community where they serve. 20 54–56 …”

Section: Discussionmentioning

confidence: 99%

“…This guided qualitative interviews and focus group discussion (FGD) among CHWs and stakeholders at state and local government levels. 20 25 In total, 13 in-depth interviews and 13 FGDs were conducted with CHWs in the study area, investigating their factors related to their practices and their views on the most important motivators and challenges. On top of this 13 FGDs were carried with other cadre of health workers and key system stakeholders to elicit their views on PHC service delivery and CHWs role in the system.…”

Section: Methodsmentioning

confidence: 99%

“…As Nigeria aims to strengthen PHC to achieve UHC and other national health sector goals, 3 effective policies that address the motivation and employment needs of all health workers are the key. 20 The importance of the CHW workforce to the future strengthening and performance of the Nigerian health system has been highlighted in the literature, yet little is known of their specific motivations. 21 22 Motivation is the ‘stimulus, incentive or motives for action towards a set goal, 23 such as the delivery of quality health services by CHWs in the context of our study.…”

Section: Introductionmentioning

confidence: 99%

“… 25 A similar study conducted in northern Nigeria among a comparable sample identified provision of basic housing, improvement of quality of the facility structures and good school for children’s education as the main motivators for taking up or continuing a rural job. 20 Other mainly descriptive studies have identified training opportunities, career progression and availability of social amenities as motivators to be retained in rural jobs. 26 A more in-depth realist evaluation study conducted among nurses, midwives, facility managers and policymakers identified five mechanisms, including ‘feeling supported’, ‘feeling valued’, ‘companionship’, ‘confidence to perform tasks’ and ‘a comfortable work environment’ to explain the motivation of PHC workers.…”

Section: Introductionmentioning

confidence: 99%

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It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria

et al. 2022

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IntroductionCommunity health workers (CHWs) constitute the majority of primary healthcare (PHC) workers in Nigeria, yet little is understood about their motivations or the most effective interventions to meet their needs to ensure quality health coverage across the country. We aimed to identify factors that would motivate CHWs for quality service delivery.MethodsA discrete-choice experiment was conducted among 300 CHWs across 44 PHC facilities in the Federal Capital Territory, Abuja Nigeria. Based on the literature review and qualitative research, five attributes, namely: salary, educational opportunities, career progression and in-service training, housing and transportation, were included in the experiment. CHWs were presented with 12 unlabelled choice sets, using tablet devices, and asked to choose which of two hypothetical jobs they would accept if offered to them, or whether they would take neither job. Mixed multinomial logistic models were used to estimate stated preferences for the attributes and the likely uptake of jobs under different policy packages was simulated.ResultsAbout 70% of the respondents were women and 39% worked as volunteers. Jobs that offered career progression were the strongest motivators among the formally employed CHWs (β=0.33) while the ‘opportunity to convert from CHW to another cadre of health workers, such as nursing’ was the most important motivator among the volunteers’ CHWs (β=0.53). CHWs also strongly preferred jobs that would offer educational opportunities, including scholarship (β=0.31) and provision of transport allowances (β=0.26). Policy scenario modelling predicted combined educational opportunities, career progression opportunities and an additional 10% of salary as incentives was the employment package that would be most appealing to CHWs.ConclusionCHWs are motivated by a mix of non-financial and financial incentives. Policy interventions that would improve motivation should be adequate to address various contexts facing different CHWs and be flexible enough to meet their differing needs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria

et al. 2022

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Barriers, promoters, and strategies for improving task shifting and task sharing implementation in Nigeria: qualitative perspectives of policymakers

Okoroafor,

Christmals

2023

Journal of Global Health Reports

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Background Nigeria developed a National Task Shifting and Sharing Policy due to protracted inequitable distribution of health workers, especially at the primary level of care, and the low stock and production rate of skilled health workforce. Following the development of Nigeria’s task shifting and sharing policy and strategy, implementation was promulgated at various levels, with States adopting and implementing the national policy. However, the policy environment for task shifting and sharing varies widely. Consequently, evidence on barriers to and factors promoting successful implementation are inconclusive. Hence, strategies for improving implementation are needed. The evidence from this study can inform the scale-up and strengthening of implementation approaches as Nigeria strives to achieve the national goals, universal health coverage and sustainable development goals. Methods An explorative, descriptive research study approach was applied with 20 key informant interviews conducted to explore the perception of policymakers on barriers and promoters of task shifting and sharing in Nigeria. In addition, strategies for improving task shifting and sharing implementation were explored. Results The barriers to effective implementation of task shifting ad sharing from our study were the persistent shortage of health workers, inter-cadre rivalry, perceived sub-optimal capacity of the beneficiary cadres, and lack of adequate equipment for delivery of needed services. The factors promoting the implementation of task shifting and sharing were the availability of adapted policies, the political will of the health sector leadership, acceptance of task shifting and sharing implementation by health workers, and the implementation of actions to improve knowledge and skills of health workers to implement shifted or shared tasks by various actors. The strategies to improve future task shifting and sharing implementation include improving staffing levels, scaling up training and periodic retraining, mentoring and supportive supervision, and improving the, use and dissemination of evidence generated. Conclusions Several factors influence the implementation of task shifting and sharing. Hence the identification and implementation of relevant strategies are pertinent in achieving set objectives and national goals. In policy and practice, therefore, a proactive exploration of the contextual understanding, barriers to implementation, enablers and learning from the performance of similar interventions is pertinent in shaping strategies for translating evidence to practice through an implementation framework. This should be done in collaboration with stakeholders to foster acceptance and participation.

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A Discrete Choice Experiment on Factors Influencing Attrition and Motivation of Frontline Health Workers in Remote and Rural Areas in Nigeria

Cited by 2 publications

References 17 publications

It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria

It is not all about salary: a discrete-choice experiment to determine community health workers’ motivation for work in Nigeria

Barriers, promoters, and strategies for improving task shifting and task sharing implementation in Nigeria: qualitative perspectives of policymakers

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