Frontline health worker motivation in the provision of maternal and neonatal health care in Ghana

Dijk, J.W.M. van; Agyepong, Irène Akua; Gerrits, G.J.E.; Aberese-Ako, Matilda

doi:10.18174/387863

Cited by 3 publications

(7 citation statements)

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“…So mangers need to make an extra effort to exercise transformational leadership such as getting workers to perceive a common vision and purpose ( Ahmad et al 2013 ; Borkowski et al 2011 ; Bucic et al 2010 ). This will ensure that workers exercise their power positively to bring the different professional groups on board to work in the interest of achieving organizational goals ( Aberese-Ako 2016 ; Lipsky 1980 ; Pfeffer 1981 , 1992 ).…”

Section: Discussionmentioning

confidence: 99%

“…Ortner (2006) has noted the omnipresence of power in social interactions and thus consciously and unconsciously power is enacted in interactions. In the case of the hospital, studies have noted that power determines how health managers organize health care provision in health facilities, how they interact with health workers, how workers interact and collaborate with colleagues as well as their interactions with clients ( Aberese-Ako 2016 ; Pfeffer 1981 , 1992 ). Studies report that where managers lack the capacity to exercise power to meet the personal and work needs of health workers, workers lose trust in managers, which demotivates workers and contributes to anti citizenship behaviours ( Konovsky 2000 ).…”

Section: Introductionmentioning

confidence: 99%

“…Studies report that where managers lack the capacity to exercise power to meet the personal and work needs of health workers, workers lose trust in managers, which demotivates workers and contributes to anti citizenship behaviours ( Konovsky 2000 ). Workers have been noted to exhibit negative power by refusing to cooperate with colleagues to provide quality care, reporting to work late and absenteeism, which affects clinical decision making on patient care, thus compromising quality health care delivery ( Aberese-Ako 2016 ; Coombs 2003 ; Fox 1974 ).…”

Section: Introductionmentioning

confidence: 99%

“…Motivation refers to ‘…an individual’s degree of willingness to exert and maintain an effort towards organizational goals’ ( Franco et al 2004 ). Motivated workers exhibit positive attitudes that ensure that work is done efficiently and quality care provided to clients ( Aberese-Ako et al 2014 ; Aberese-Ako 2016 ; Adzei and Atinga 2012 ; Purohit and Bandyopadhyay 2014 ). Leadership style can influence job satisfaction and worker motivation ( Bonenberger et al 2014 ; Braun et al 2013 ; Dieleman et al 2006 ; Gilson 2003 ; Okello and Gilson 2015 ).…”

Section: Introductionmentioning

confidence: 99%

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Leadership styles in two Ghanaian hospitals in a challenging environment

Aberese-Ako

Agyepong

Dijk

2018

Health Policy and Planning

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Hospital managers’ power to exercise effective leadership in daily management can affect quality of care directly as well as through effects on frontline workers’ motivation. This paper explores the influence of contextual factors on hospital managers’ leadership styles and the motivation of frontline workers providing maternal and new born care in two public district hospitals in Ghana. It draws on data from an ethnographic study that involved participant observation, conversations and in-depth interviews conducted over 20 months, with frontline health workers and managers. Qualitative analysis software Nvivo 11 was used to facilitate coding, and common patterns emerging from the codes were grouped into themes. Ethical clearance was obtained from the Ghana Health Service Ethical Review Committee. Contextual factors such as institutional rules and regulations and funding constrained managers’ power, and influenced leadership styles and responses to expressed and observed needs of frontline workers and clients. The contextual constraints on mangers’ responses were a source of demotivation to both managers and frontline workers, as it hampered quality health service provision. Knowing what to do, but sometimes constrained by context, managers described ‘feeling sick’ and frustrated. On the other hand in the instances where managers’ were able to get round the constraints and respond effectively to frontline health workers and clients’ needs, they felt encouraged and motivated to work harder. Effective district hospital management and leadership is influenced by contextual factors; and not just individual manager’s knowledge and skills. Interventions to strengthen management and leadership of public sector hospitals in low- and middle-income countries like Ghana need to consider context and not just individual managers’ skills and knowledge strengthening.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Leadership styles in two Ghanaian hospitals in a challenging environment

Aberese-Ako

Agyepong

Dijk

2018

Health Policy and Planning

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“…This was a source of frustration and demotivation to health care providers, because they could not exercise power positively, since they could not fully utilize their skills and experiences in the provision of quality maternal health care. Health workers losing motivation as a result of lack of health resources to provide optimum care to clients has been reported (63)(64)(65)(66)(67).…”

Section: Effects Of Initiatives On Managers and Health Workers' Expermentioning

confidence: 99%

Managing Malaria in Pregnancy Policy Interventions in A Challenging Environment: an Ethnographic Study of two Ghanaian Administrative Regions

Aberese-Ako

Magnussen

Gyapong

et al. 2020

Preprint

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Background: Malaria in pregnancy (MiP) is an important public health problem across sub Saharan Africa. Regular use of Long-Lasting Insecticide treated bed Nets (LLINs), directly observed administration (DOT) of intermittent preventive treatment with sulphadoxine-pyrimethamine (IPTp-SP) and prompt and effective case management of MiP has constituted the package of measures for its control in Ghana in the last 20 years. Unfortunately, Ghana like other sub Saharan African countries did not achieve the reset Abuja targets of 100% of pregnant women having access to IPTp and 100% use of LLINs by 2015. Methods: This ethnographic study explored how managers dealt with existing MiP policy implementation and arrangement challenges and the consequences on clients’ access to MiP interventions, using observations with conversations, in-depth interviews and case studies in eight health facilities and twelve communities for twelve months, in two Administrative regions in Ghana. The University of Health and Allied Sciences’ Research Ethics Committee approved the study [UHAS-REC/A.I Ul 17-18]. Results: Managers addressed frequent stock outs of malaria programme drugs and supplies from the National Malaria Control Programme and delayed reimbursement from the NHIS, by instituting co-payment, rationing drugs and relaxing the DOTs policy. This ensured that facilities had funds to pay creditors, purchase drugs and supplies in order to ensure continued service delivery. Clients who could afford the cost of maternal and MiP services and those who had previously benefitted from such services were happy to access uninterrupted services. Whilst clients who could not afford the cost of services resorted to health care shopping, delaying in starting ANC and skipping scheduled ANC visits. Consequently, some clients did not receive the recommended five+ doses of SP, others did not obtain LLINs early and some did not obtain recommended treatment for MiP. Frontline workers felt frustrated and demotivated, because sometimes they could not provide comprehensive care to clients who could not afford it. Conclusion: For Ghana to achieve her goal of controlling MiP, the Ministry of Health and other supporting institutions need to ensure prompt reimbursement of funds, the supply of programme drugs and medical supplies to public, faith based and private health facilities.

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Perspectives and practices of healthcare providers and caregivers on healthcare-associated infections in the neonatal intensive care units of two hospitals in Ghana

Sunkwa-Mills

Rawal

Enweronu‐Laryea

et al. 2020

Health Policy and Planning

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Healthcare-associated infections (HAIs) remain a serious threat to patient safety worldwide, particularly in low- and middle-income countries. Reducing the burden of HAIs through the observation and enforcement of infection prevention and control (IPC) practices remains a priority. Despite growing emphasis on HAI prevention in low- and middle-income countries, limited evidence is available to improve IPC practices to reduce HAIs. This study examined the perspectives of healthcare providers (HPs) and mothers in the neonatal intensive care unit on HAIs and determined the major barriers and facilitators to promoting standard IPC practices. This study draws on data from an ethnographic study using 38 in-depth interviews, four focus group discussions and participant observation conducted among HPs and mothers in neonatal intensive care units of a secondary- and tertiary-level hospital in Ghana. The qualitative data were analysed using a grounded theory approach, and NVivo 12 to facilitate coding. HPs and mothers demonstrated a modest level of understanding about HAIs. Personal, interpersonal, community, organizational and policy-level factors interacted in complex ways to influence IPC practices. HPs sometimes considered HAI concerns to be secondary in the face of a heavy clinical workload, a lack of structured systems and the quest to protect professional authority. The positive attitudes of some HPs, and peer interactions promoted standard IPC practices. Mothers expressed interest in participation in IPC activities. It however requires systematic efforts by HPs to partner with mothers in IPC. Training and capacity building of HPs, provision of adequate resources and improving communication between HPs and mothers were recommended to improve standard IPC practices. We conclude that there is a need for institutionalizing IPC policies and strengthening strategies that acknowledge and value mothers’ roles as caregivers and partners in IPC. To ensure this, HPs should be better equipped to prioritize communication and collaboration with mothers to reduce the burden of HAIs.

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Frontline health worker motivation in the provision of maternal and neonatal health care in Ghana

Cited by 3 publications

References 126 publications

Leadership styles in two Ghanaian hospitals in a challenging environment

Leadership styles in two Ghanaian hospitals in a challenging environment

Managing Malaria in Pregnancy Policy Interventions in A Challenging Environment: an Ethnographic Study of two Ghanaian Administrative Regions

Perspectives and practices of healthcare providers and caregivers on healthcare-associated infections in the neonatal intensive care units of two hospitals in Ghana

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