The Motivation Project

There is a growing need to strengthen health systems in poor countries to help meet the Millennium Development Goals (MDGs).  The challenge is made more difficult by the demands of the AIDS crisis, migration of skilled professionals to high income countries and low morale and motivation of remaining staff. These have combined to generate a rapid worsening of availability and quality of care. Improving the retention of health workers in developing countries is critical for health system performance. Consequently, this project focused on improving understanding of how best to motivate and retain health workers. 

Motivation Project Goal and Objectives
The goal of the Motivation Project was to strengthen the evidence base for effective human resource strategies in developing countries. The project explored current capacities and contexts in three countries (Malawi, South Africa and Tanzania), evaluated local and national retention initiatives and explored in detail motivation and aspirations of health workers.

The objectives of the study were:

• To understand better the incentive and motivation environment facing health workers in district health service settings
• To assess the impact and relative importance of incentive initiatives that aim to improve recruitment, motivation and retention of health workers
• To improve the understanding of the absolute and relative power of financial and other incentives for different cadre levels

The systematic review of the literature indentified seven motivational themes, namely: financial rewards, career development, continuing education, hospital infrastructure, availability of resources and recognition/appreciation.  While these factors are undoubtedly country specific, financial incentives, career development and management issues were core factors. Nevertheless financial incentives alone are not enough to improve morale.

Component Two evaluated financial and non-financial initiatives that are being used to motivate and retain health workers. Several themes emerged across the countries and it is apparent that while financial incentives do boost motivation to a certain extent, these effects are short lived and they also lower morale for those who do not benefit. In some countries there are lots of different incentives, many of which are not complimentary and so there is a strong case for consolidation and harmonization with close attention to monitoring and evaluating the effects.

Finally a discrete choice experiment (DCE) was used to improve understanding of the relative power of financial and non-financial incentives. It was found that the relative importance of different motivational incentives differs between countries; however, training opportunities and salary are the most important overall.  Doctors and registered nurses are less motivated to work in rural areas.
All three components reinforced four main findings, namely:

1) Developing training opportunities would be a powerful motivational incentive.
2) Satisfied health workers are less motivated by financial incentives
3) Health workers, especially the higher cadres, may need to be compensated to persuade them to work in rural areas.
4) Clear communication and careful implementation is needed when using incentives so as to manage expectations.

Collaborating Partners

The Research Team

The Motivation Project was led by Prof. Charles Normand, Principal Investigator

Other Research Projects