Motivation and incentives of rural maternal and neonatal health care providers: a comparison of qualitative findings from Burkina Faso, Ghana and Tanzania

Abstract

BackgroundIn Burkina Faso, Ghana and Tanzania strong efforts are being made to improve the quality of maternal and neonatal health (MNH) care. However, progress is impeded by challenges, especially in the area of human resources. All three countries are striving not only to scale up the number of available health staff, but also to improve performance by raising skill levels and enhancing provider motivation.MethodsIn-depth interviews were used to explore MNH provider views about motivation and incentives at primary care level in rural Burkina Faso, Ghana and Tanzania. Interviews were held with 25 MNH providers, 8 facility and district managers, and 2 policy-makers in each country.ResultsAcross the three countries some differences were found in the reasons why people became health workers. Commitment to remaining a health worker was generally high. The readiness to remain at a rural facility was far less, although in all settings there were some providers that were willing to stay. In Burkina Faso it appeared to be particularly difficult to recruit female MNH providers to rural areas. There were indications that MNH providers in all the settings sometimes failed to treat their patients well. This was shown to be interlinked with differences in how the term ‘motivation’ was understood, and in the views held about remuneration and the status of rural health work. Job satisfaction was shown to be quite high, and was particularly linked to community appreciation. With some important exceptions, there was a strong level of agreement regarding the financial and non-financial incentives that were suggested by these providers, but there were clear country preferences as to whether incentives should be for individuals or teams.ConclusionsUnderstandings of the terms and concepts pertaining to motivation differed between the three countries. The findings from Burkina Faso underline the importance of gender-sensitive health workforce planning. The training that all levels of MNH providers receive in professional ethics, and the way this is reinforced in practice require closer attention. The differences in the findings across the three settings underscore the importance of in-depth country-level research to tailor the development of incentives schemes.

Implementation of free maternal and child healthcare policies: assessment of influence of context and institutional capacity of health facilities in South-east Nigeria

“…Similarly, shortage of appropriate qualified health workers, worse in remote areas, constrained provision of maternal, neonatal and child health services in the Lao People’s Democratic Republic and three African countries, where health workers had preference for urban posts [19,36]. Though presence of SURE-P staff improved the availability of health workers, postings and transfers of health workers to less busy or urban health facilities limit responsiveness of health facilities and contribute to declining quality of care.…”

“…Use of service charters to curb informal payments to service providers [9], active health facility committees (HFCs) including financial management [10–12], timely payment of providers [13], regular and uninterrupted drug supply [13], availability of clear guidelines on use of user fee replacement grants [14], an effective staff sanction framework, which reduces health worker absenteeism [15], have enabled health facilities to effectively implement free healthcare policies. In contrast, barriers to health facilities implementing free healthcare policies include weak decentralization [10,16–18]; poor supervision and monitoring [19,20]; weak referral systems [17]; absence of written implementation guidelines [14,21]; shortage of staff and inconsistent recording and reporting [10,20]; low social accountability and community involvement [9,22–24]; delayed payment of providers [12,21,25]; lack of adequate drug stock [17,18,24,26–31]; mistrust between providers and patients [19,32–34]; absenteeism [10,15,20]; poorly motivated health workers [18,24]; lack of financial incentives [35]; preference for urban postings [19,36]; funding inadequacy in health facilities [16]; inadequate physical infrastructure [18,24,36]; unavailability of guidelines for use of user fee replacement fund [37] and unclear procedures for targeting beneficiaries [3]. …”

Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso

“…In 2010, the proportion of women delivering in a health facility in rural Burkina Faso was estimated at 61.5% [47]. In rural areas, obstacles to maternal care access remain numerous, and include social, geographical and economic barriers, shortages of skilled health staff, lack of information on sexual and reproductive health, the cost of medical treatment, and negative perceptions of quality of care [48–52]. …”

Retention of qualified healthcare workers in rural Senegal: lessons learned from a qualitative study

“…It can ease the feeling of inequity among healthcare workers in rural areas, especially to prevent healthcare workers from 'feeling forgotten' 25,26 . Knowing what type of healthcare workers are currently working where, with which skill, and for how long, the MoH can develop, implement or monitor the appropriate human resource strategy for production, recruitment, deployment, and retention to meet the healthcare needs in the country.…”