Determinants of Motivation among Healthcare Workers in the East African Community between 2009–2019: A Systematic Review

Abstract

Healthcare workers are an essential element in the functionality of the health system. However, the health workforce impact on health systems tends to be overlooked. Countries within the Sub-Saharan region such as the six in the East African Community (EAC) have weak and sub-optimally functioning health systems. As countries globally aim to attain Universal Health Coverage and the Sustainable Development Goal 3, it is crucial that the significant role of the health workforce in this achievement is recognized. In this systematic review, we aimed to synthesise the determinants of motivation as reported by healthcare workers in the EAC between 2009 and 2019. A systematic search was performed using four databases, namely Cochrane library, EBSCOhost, ProQuest and PubMed. The eligible articles were selected and reviewed based on the authors’ selection criteria. A total of 30 studies were eligible for review. All six countries that are part of the EAC were represented in this systematic review. Determinants as reported by healthcare workers in six countries were synthesised. Individual-level-, organizational/structural- and societal-level determinants were reported, thus revealing the roles of the healthcare worker, health facilities and the government in terms of health systems and the community or society at large in promoting healthcare workers’ motivation. Monetary and non-monetary determinants of healthcare workers’ motivation reported are crucial for informing healthcare worker motivation policy and health workforce strengthening in East Africa.

Distance-Learning Initiatives Targeting Non-physician Anesthesia Providers in Low-Resource Environments

“…In Nepal, it is a standard practice to give daily financial allowance to government workers for attending a course, whether on-site and away from base hospital. Likewise, performance-based financial incentives are used to enhance motivation and healthcare delivery by rural health-workers in general [ 23 ]. However, as these are not yet widely practiced for distance learning, provision of allowance may increase course recruitment and decrease program attrition rates.…”

An Investigation of Healthcare Professionals’ Motivation in Public and Mission Hospitals in Meru County, Kenya

“…First, the Government of Meru County could fund experimental design studies to develop and evaluate the cost-effectiveness of alternative interventions for healthcare professionals' motivation in the context of strengthening healthcare systems. Since the present study was conducted in a rural area that is relatively endowed with a good climate and fertile volcanic soils that are conducive to agriculture, the national government ought to consider sponsoring motivation studies in the semiarid and insecure counties to identify the motivation factors that could be used to attract and retain healthcare professionals in such challenging environments [5]. Such studies would yield a comprehensive nationwide understanding of factors influencing healthcare professionals' motivation.…”

“…Kenya is among the developing countries with suboptimally functioning healthcare systems [4]. One of the main challenges contributing to weak healthcare systems in developing countries is the critical shortage of skilled healthcare professionals, which is a significant demotivator [5]. The challenges that healthcare professionals continually face deplete their motivation to stay in the Kenyan health system, as evidenced by frequent strikes by these professionals [6][7][8].…”

“…The more motivated healthcare professionals are, the better the quality of healthcare service delivery [12]. However, the opposite has been reported in several healthcare facilities in East African countries such as Kenya, necessitating the improvement of poor work environment/conditions, which is a demotivator among healthcare professionals [5].…”

Senior Managers’ Experience with Health, Happiness, and Motivation in Hospitals and the Perceived Impact on Health Systems: The Case of Meru County, Kenya

“…Quantitative studies in the Kenya assessing healthcare workers’ happiness [ 14 ], health-related quality of life [ 15 ], and motivation [ 16 , 17 , 18 , 19 ] have also been published. In 2020, systematic reviews on healthcare workers happiness globally [ 20 ] and motivation in East Africa [ 21 ] were also published. These studies and reviews revealed an existing literature gap in healthcare workers’ experience of happiness, health, and motivation in the context of health systems, especially in the African region [ 15 , 16 , 20 , 21 ].…”