Retention

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It discusses the human resources for health situation in Tanzania in general, and specific findings from the Lake zone in terms of health workers in church health institutions. The author proposes options for a motivation package to address the issues of retention for these workers.

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It outlines FBO health services in Kenya and sources of and financial support for them. It also discusses the exodus of health workers from church health facilities, the reasons behind this migration and how this problem is being addressed.

This presentation was given as part of the Christian Health Association’s Conference: CHAs at a Crossroad Towards Achieving Health Millennium Development Goals. It discusses church health institutions and the HR crisis, including staffing levels and attrition; the national response, and details the many efforts of the CHAZ response such as the CHAZ Health Workers’ Retention Scheme.

The effective provision of health services in poor countries is severely hampered by lack of staff. A frequently cited reason for staff shortages is brain drain or moving to greener pastures. Although international migration of health personnel has been occurring since before the 1970s, this has been further facilitated by the recent globalisatioIl of markets and the development offree trade agreements. A summary of an international review was done, to place the South African situation within the international context, and understand the various factors that influence migration. [from executiv

This study evaluates an intervention to raise healthcare provider morale and retention. Two different incentives-cash and a trophy, awarded to facilities rather than individuals-were tested in two districts. The program was implemented district-wide. Health centers and other small health facilities competed for the awards and were scored on the basis of management system indicators. Interviews with staff in both districts measured the effect of the awards on staff motivation and satisfaction. [publisher’s description]

This report on the Consultation on AIDS and Human Resources for Health, WHO, Geneva, 11-12 May, 2006 outlines the Treat, Train Retain plan to address AIDS and HRH. The plan comprises three sets of elements: a package of HIV treatment, prevention, care and support services for health workers in countries affected by HIV (Treat); measures to empower health workers to deliver universal access to HIV/AIDS services (Train); and strategies to retain health workers in the public health system, including financial and other incentives and strategies to improve pay and working conditions and manage the migration of health care workers (Retain).

A seven-point framework was used to analyze retention strategies in four countries: Uganda, the United Kingdom, Canada, and Thailand. This framework draws upon available country data and includes GDP and investment in health, mix of private/public investment, international migration, health policy frameworks, countrywide strategies, provincial/regional strategies, and professional associations/regulatory bodies. Comparison of the countries demonstrated that progress has been made in nurse retention. [from executive summary]

Rewards are important in attracting, motivating and retaining the most qualified employees, and nurses are no exception to this rule. This makes the establishment of an efficient reward system for nurses a true challenge for every hospital manager. A reward does not necessarily have a financial connotation: non-financial rewards may matter too, or may even be more important. Therefore, the present study examines nurses’ reward perceptions, in order to identify potential reward options. [abstract]

The NSW Department of Health is responsible for managing nurse supply. It needs to identify the extent and nature of shortages and develop ways to attract, retain and best manage nurses working in public hospitals. This audit looks at how nurses are managed in four of our public hospitals and examines how the Department has responded to expected nurse shortages. It also highlights actions that have helped reduce the number of nurses leaving hospitals. [from foreword]

The availability of medical human resource supply is a growing concern for rural and remote communities in many countries. In the last decade, various telehealth experiences in Canada have highlighted the potential impact of this technology on professional practice. The purpose of this study was to explore physicians’ and managers’ perceptions regarding the potential of telehealth to support recruitment and retention of physicians in remote and rural regions. [abstract]

This paper describes the specific policy measures that the Zimbabwean government has recently implemented to try to improve health sector performance, and promote higher levels of motivation amongst public sector health care workers. The overall reform package is to include financial reforms (user fees and social insurance), strengthening of health management, liberalization and regulation of the private health sector, decentralization, and contracting out. Unfortunately, the process of reform implementation in Zimbabwe and the government’s poor communication with workers, combined with a conflict between local cultures and the measures being implemented, has undermined the potentially positive effect of reforms on health worker motivation.

This paper reports the experiences of primary care reform in the Zhezkazgan region of Kazakhstan. After the collapse of the Soviet regime, Kazakhstan undertook a radical program of reform to restructure the health sector, making primary care the centerpiece of their health reform agenda. The reforms included the creation of independent family group practices financed on a capitation basis directly from the Ministry of Health, allowing free choice of primary care providers through open enrollment, and creating a non-governmental primary care physician association. This program has had remarkable success in improving motivation among primary health care workers.

A conceptual framework of motivation processes is presented and used to identify strategies and options for the measurement of health worker motivation in developing countries. Measures of motivation are broadly organized into determinant and consequent categories, and determinants are further distinguished in terms of measures that influence worker–organization goal congruence (“will do” motivation) and those directed toward goal striving (“can do” motivation).

Problems related to health worker motivation are remarkably pervasive, but to-date little attention has been paid to them in developing and transition countries. Basic tools to measure the determinants and consequences of motivation have not been adapted to contexts outside the industrialized world. This paper assesses the feasibility of transferring psychometric tools, typically used in industrialized countries to measure motivational processes, to other contexts. The paper draws upon two field studies conducted in two hospitals in the Republic of Georgia and two hospitals in the Hashemite Kingdom of Jordan.

This paper offers a conceptual framework for considering the many layers of influences upon health worker motivation. It suggests that worker motivation is influenced not only by specific incentive schemes targeted at workers, but also by the whole range of health sector reforms which potentially affect organizational culture, reporting structures, channels of accountability, etc.

This study was implemented as part of the EQUINET theme work on Human Resources for Health coordinated by Health systems Trust. The study set out to explore and describe the influence of conditions of service on the movement and retention of the health professionals in Namibia. It is a qualitative study targeting mainly professional nurses, doctors, social workers and health inspectors at both operational and managerial levels, in public and private sectors. [from executive summary]

Provider payment methods are important to consider any time a government or a payor wants to improve the efficiency and the quality of health services with the use of its funds. Changes in provider payment methods are often pivotal to broader health reform measures to contain costs and use existing resources effectively, and also to improve quality of care and equitable financial access to care. [author’s description]

Incentives that affect worker performance may be modified by system change. Attention to both financial and non-financial incentives can make health care delivery more effective. [author’s description]

The goal of this project was to assist health system managers and policy makers develop policies and strategies to recruit and retain human resources in the homecare sector and have a satisfied, healthy workforce. Researchers worked in partnership with the agencies and the unions representing workers in the agencies to examine the effects of work and work environments on homecare workers’ emotional, mental, and physical health and intention to leave their workplaces. [executive summary]

These job satisfaction surveys are tools intended to gain feedback from providers who have stayed in their positions, providers who have changed jobs and managers in district and facility level health centers in order to measure satisfaction with working conditions.

The response to AIDS depends largely on people who are themselves getting sick and dying. This is why there is now a need for more targeted interventions to support these health workers, enable them to deliver good care and keep them in their positions. [author’s description]

The shortage of health workers with the right expertise and experience has reached crisis levels in many developing countries. The ability of health services to deliver care depends on the knowledge, skills and motivation of health workers. Without enough skilled staff in the right place at the right time health systems cannot function effectively and populations are left without the treatment and support they need. [author’s description]

As part of the High-Level Forum on the Health Millennium Development Goals, this issue paper discusses improving health workforce performance as a key factor in meeting MDGs. The required scaling up of interventions towards the MDGs depends on effective health services delivery systems (HSDS). The availability, the skills, the attitudes, motivation, and behaviors of health workers are key to well-functioning HSDS. [adapted from author]

This resolution, enacted by the Department of Health in South Africa, details the management and conditions of an allowance designed to attract and retain health workers in rural areas.

To tackle problems of staff shortage and maldistribution, in 2003 the Government of the Republic of Zambia in partnership with the Royal Netherlands Government embarked on a Pilot Zambian Health Workers Retention Scheme (ZHWRS) for health professionals. The scheme had as first objective to replace the Dutch doctors, working under the bilateral agreement between Zambia and the Netherlands. A regular review process was included as part of the scheme. This report is from the Midterm review that took place in January 2005. [from introduction]

In the era of cost containment, managers are constantly pursuing increased organizational performance and productivity by aiming at the obvious target, i.e. the workforce. The health care sector, in which production processes are more complicated compared to other industries, is not an exception. In light of recent legislation in Greece in which efficiency improvement and achievement of specific performance targets are identified as undisputable health system goals, the purpose of this study was to develop a reliable and valid instrument for investigating the attitudes of Greek physicians, nurses and administrative personnel towards job-related aspects, and the extent to which these motivate them to improve performance and increase productivity.

This presentation was part of the Planning, Developing and Supporting the Health Workforce: Human Resources for Health Action Workshop. It briefly discusses the background and some issues for consideration about Malawi’s plan to retain and recruit health workers.


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To support good performance, health care workers need clear job expectations, up-to-date knowledge and skills, adequate equipment and supplies, constructive feedback and a caring supervisor (Luoma and Crigler, 2002). Workers also need motivation, especially when some of the other factors that support good performance are lacking. Indeed, highly motivated individuals can often overcome obstacles such as poor working conditions, personal safety concerns and inadequate equipment. Given the current challenges related to human resources for health (HRH) in most developing countries (Joint Learning Initiative, 2004), helping workers to be as productive as possible in the face of such obstacles can be an important outcome of increased motivation.

This paper discusses human capital outflow from Africa from a developmental perspective. The focus is on the high skill content of African emigration to industrial countries, its impact on development in the region, and the challenges faced by institutions of higher learning to help the region deal with this problem. This paper further takes up the issue of African brain drain in the context of relevant changes taking place globally: globalization, movement towards a knowledge-based economy, and global demographic trends. [adapted from author]

This report presents a review of issues in the regional policy context that are of relevance to the retention of human resources for the health sector (HRH) within the region, based on a rapid appraisal in selected countries and at regional level. This work specifically focussed on the actions needed to stem the flow of international migration by encouraging the retention of health staff within countries. A particular concern raised across countries is staff retention in the public and rural services that preferentially serve the poorest populations. Importantly, policy documents and national