The challenges of developing an instrument to assess health provider motivation at primary care level in rural Burkina Faso, Ghana and Tanzania

Abstract

BackgroundThe quality of health care depends on the competence and motivation of the health workers that provide it. In the West, several tools exist to measure worker motivation, and some have been applied to the health sector. However, none have been validated for use in sub-Saharan Africa. The complexity of such tools has also led to concerns about their application at primary care level.ObjectiveTo develop a common instrument to monitor any changes in maternal and neonatal health (MNH) care provider motivation resulting from the introduction of pilot interventions in rural, primary level facilities in Ghana, Burkina Faso, and Tanzania.DesignInitially, a conceptual framework was developed. Based upon this, a literature review and preliminary qualitative research, an English-language instrument was developed and validated in an iterative process with experts from the three countries involved. The instrument was then piloted in Ghana. Reliability testing and exploratory factor analysis were used to produce a final, parsimonious version.Results and discussionThis paper describes the actual process of developing the instrument. Consequently, the concepts and items that did not perform well psychometrically at pre-test are first presented and discussed. The final version of the instrument, which comprises 42 items for self-assessment and eight for peer-assessment, is then shown. This is followed by a presentation and discussion of the findings from first use of the instrument with MNH providers from 12 rural, primary level facilities in each of the three countries.ConclusionsIt is possible to undertake work of this nature at primary health care level, particularly if the instruments are kept as straightforward as possible and well introduced. However, their development requires very lengthy preparatory periods. The effort needed to adapt such instruments for use in different countries within the region of sub-Saharan Africa should not be underestimated.

Analyzing the Determinants of Health Worker Performance

“…They conclude that a short list of simple questions can provide significant information on the motivation of health workers across a wide variety of settings. Prytherch et al (2012) test similar instruments and come to a similar conclusion: complexity and nuance are not useful in such surveys. Out of a list of 23 statements (table 8.2), they suggest a reduced list of nine questions in three domains (marked by a plus sign in table 8.2): organizational commitment, job satisfaction, and conscientiousness.…”

“…Low effort may, for instance, involve spending more time than necessary per task (time inefficiency). Prytherch et al 2012. Note: The plus sign (+) signifies a way to reduce the list of 23 statements to nine questions in three domains: organizational commitment, job satisfaction, and conscientiousness.…”

Attitudes of health care professionals towards Mutual Health Organizations: evidence from two regions in the Northwest Province of Cameroon

“…There are several studies on general aspects of HCPs in industrial countries and even some in so-called developing countries (Fischer and Lun 2008;Maestad and Torsvik 2008;Mutizwa-Mangiza 1998;Prytherch et al 2012). Studies that focus systematically on aspects of HCPs in the context of MHOs are sparse: Criel et al indicated, through semi-structured interviews with 16 HCPs in GuineaConakry, difficulties between MHOs and HCPs.…”

Sociocultural and individual determinants for motivation of sexual and reproductive health workers in Papua New Guinea and their implications for male circumcision as an HIV prevention strategy

“…HW motivation may also be influenced by the disproportionate funding, resourcing, infrastructure and historical focus on HIV that have been described in some contexts [27]. Motivation of HWs in developing countries to engage in recently introduced programmes and practices has also been highlighted in the literature to be an important component of programme success [28,29]. Given the complexity of rolling out adult MC programmes that has already been described in Africa, understanding HW motivation in the context of sexual reproductive health services and application to MC programme roll-out is important for policy development.…”