HEALTHWORKERS MOTIVATION-RETENTION Dr G.Mbaruku
Motivated providers can influence performance directly & indirectly • Motivating providers may reduce the know-do gap1 • Motivated providers can mobilize social, cultural and symbolic capital to overcome work-related problems2 • Women value respectful provider attitude when choosing place of delivery3 Leonard K and Masatu M. Professionalism and the know-do gap: exploring intrinsic motivation among health workers in Tanzania. Health Econ 2010;19:1461-1477. Gross K, Pfeiffer C, Obrist B. “Workhood”-a useful concept for the analysis of health workers’ resources? An evaluation from Tanzania. BMC Health Services Research 2012; 12:55. Kruk M, Paczkowski M, Mbaruku G, de Pinho H, Galea. Women’s preferences for place of delivery in rural Tanzania: A population-based discrete choice experiment. AJPH 2009;99:1666-1672.
Shortage: skilled providers • Africa:1 million additional health workers needed to meet the MDGs • Tanzania • Nurse:Patient = 1:4,000 • Doctor:Patient=1:20,000 • Obstetrician:Patient=1:400,000 • “At current rate of training, will take >20 yrs to achieve adequate health workers” • Recent health worker strikes in Tanzania Chen L, Evans T, Anand S, et al. Human resources for health: overcoming the crisis. Lancet 2004; 364: 1984-1990. Lancet 2008.
Research question • Identify the key factors that drive provider satisfaction in primary health clinics in rural Tanzania.
Data collection • Self-administered survey • Included a 19-question index that asked providers to state their agreement: • Strongly agree, Somewhat agree, Somewhat disagree, Strongly disagree • Data collected from November 2011-April 2012 • 100 eligible providers in 24 dispensaries • 70 participated in the survey
Data analysis • Calculated descriptive statistics • Conducted principal component analysis of 19-question index • Retained 12 questions that loaded strongly
Proportion of providers who strongly agreed with the statement (n=70)
Tools to get the job done Interpersonal environment 73%: had freedom to make important decisions 67%: felt opinions were respected 12%: enough staff 3%: enough functioning equipment/infrastructure
Conclusions Tools needed for work + Positive interpersonal environment = Motivated providers
Implications • “tools of the job” are essential for patient care AND provider motivation
Future Research • Rigorous research into the associations between provider motivation and quality of care or outcomes • Assess correlation of the subscales with patient quality indicators • Assess changes of providers’ motivation overall with introduction of QI interventions