Prytherch, H. 1 , Kakoko, DCV 2 ., Leshabari , MT. 2 , Marx.M . 1 , Sauerborn , R. 1

1. INFLUENCES ON THE MOTIVATION, PERFORMANCE AND JOB SATISFACTION OF PRIMARY HEALTH CARE PROVIDERS IN RURAL TANZANIA Prytherch, H.1, Kakoko, DCV2., Leshabari, MT.2, Marx.M. 1, Sauerborn, R.1 1 Institute of Public Health, University of Heidelberg, Germany 2 School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Tanzania

2. Introduction • This study was conducted in the frame of the QUALITY OF MATERNAL & NEONATAL (MNH) CARE : BRIDING THE KNOW DO GAP (QUALMAT) research project • It was undertaken within work package 5 which explores the role that provider motivation plays in the quality of such care

3. Background • Improvements in MNH remain elusive in Tanzania (MMR 790/100,000 live births, neonatal death rate 33/1000 live births) • Absolute shortage and mal-distribution of skilled health workers • Known problems re. performance and motivation of available workforce • Problems worst in rural areas – Lindi & Mtwara regions in South particularly affected

4. Study questions • What encourages and discourages providers of MNH care at primary care level in rural areas • What is understood by the term motivation • Which factors influence performance and job satisfaction

5. Methods • 35 in-depth interviews with primary level MNH providers (including auxiliaries) & their managers • Development of interview guideline led by Tanzanian collaborators (psychologist, sociologists and health professionals) • Interviews conducted in Kiswahili, recorded and transcribed into English • NVivo9 used to support coding and analysis

6. Results 1 Key sources of encouragement for all the types of providers include: • community appreciation • perceived government and development partner support for MNH • on-the-job learning • Manager appreciation does not emerge

7. Results 1 • Discouragements are overwhelmingly financial in nature, but also include: • facility understaffing & resulting, felt workload • malfunction of the promotion system • health and safety and security issues • Auxiliary staff particularly discouraged/ unsupported

8. Results 2 • Motivation “an individual’s degree of willingness to exert and maintain an effort towards organisational goals” (Franco et al, 2002 p.1255) • Most respondents clear about goal of their facility, so we might expect motivation to be reasonable – but this was not the case • Term often appears to be understood as a tangible incentive

9. Results 3 • Performance and quality of care undermined by lack of staff, staff assuming multiple roles gap-filling with lower level staff • Situation exacerbated by challenges faced by managers of rural facilities • Basic steps that could improve performance appear to be overlooked

10. Results 4 • MNH providers and facility managers largely report deriving a degree of job satisfaction from: • serving the community • importance attached to MNH work • liking to see a job well done/feeling competent • Possible that intrinsic rewards particularly pronounced for MNH providers in rural facilities

11. Conclusions • Influences on MNH provider motivation, performance and satisfaction are shown to be complex and multifaceted • Variations in use of terms and concepts pertaining to motivation are revealed • Intrinsic rewards play a role in continued provider willingness to exert an effort at work

12. Conclusions Causes of discouragement can be broadly divided into those requiring renewed policy attention and those which could be addressed by: • strengthening skills of rural facility managers • enhancing the status of their role • increasing their support from higher levels of the health system

13. Acknowledgements • Deepest gratitude is extended to the respondents who gave of their time to partake in these interviews • The QUALMAT project is funded as part of the 7th Framework Programme of the European Union grant agreement 22982) www.qualmat.net • Thank you for listening