Motivation and Satisfaction Among Community Health Workers in Morogoro Region, Tanzania: Nuanced Needs and Varied Ambitions

In 2012, the Ministry of Health and Social Welfare (MOHSW), Tanzania, approved national guidelines and training materials for community health workers (CHWs) in integrated maternal, newborn and child health (Integrated MNCH), with CHWs trained and deployed across five districts of Morogoro Region soon after. To inform future scale up, this study assessed motivation and satisfaction among these CHWs. [from abstract]

Improving Benchmarks for Key Health Service Delivery Areas: Evaluation of Demonstration Sites Interventions

The main objective of the evaluation was to conduct a review of the support given by the Capacity Kenya Project at the selected demonstration sites and their contribution to the health worker productivity and/or retention. [from introduction]

Incentives for non-physician health professionals to work in the rural and remote areas of Mozambique—a discrete choice experiment for eliciting job preferences

Successfully motivating and retaining health workers is critical for the effective performance of health systems. In Mozambique, a shortage of health care professionals and low levels of staff motivation in rural and remote areas pose challenges to the provision of equitable health care delivery.

Wage-Setting in the Hospital Sector

This paper examines wage setting mechanisms for health workers in hospitals across eight different OECD countries. It describes similarities and differences and how fixed or fluid these approaches have been in recent years through health system reforms, labour market dynamics and economic pressures. [from abstract]

Assessment of Non-Financial Incentives for Volunteer Community Health Workers – The Case of Wukro District, Tigray, Ethiopia

Volunteer community health workers (VCHW) are health care providers who are trained but do not
have any professional certification. They are intended to fill the gap for unmet curative, preventative, and health promotion health needs of communities. This study aims to investigate the non-financial incentives for VCHWs and factors affecting their motivation. [from abstract]

Pay for Performance: An Analysis of the Context of Implementation In A Pilot Project in Tanzania

Pay for performance schemes are increasingly being implemented in low income countries to improve health service coverage and quality. This paper describes the context within which a pay for performance programme was introduced in Tanzania and discusses the potential for pay for performance to address health system constraints to meeting targets. [from abstract]

Establishing Sustainable Performance-Based Incentive Schemes: Views of Rural Health Workers from Qualitative Research in Three Sub-Saharan African Countries

Performance-based incentives (PBIs) are currently receiving attention as a strategy for improving the quality of care that health providers deliver. Experiences from several African countries have shown that PBIs can trigger improvements, particularly in the area of maternal and neonatal health. The involvement of health workers in deciding how their performance should be measured is recommended. Only limited information is available about how such schemes can be made sustainable. [from introduction]

Why Do Some Physicians in Portuguese-Speaking African Countries Work Exclusively for the Private Sector? Findings From a Mixed-Methods Study

Despite the growing interest in the private health sector in low- and middle-income countries, little is known about physicians working outside the public sector. The paper’s objective is to contribute to the understanding of such physicians, ultimately informing the policies regulating the medical profession in low- and middle-income countries. [adapted from abstract]

An Investigation of Staff Turnover at a Private Healthcare Provider in the Kavango Region, Namibia

The study sought to investigate the factors contributing to the high turnover of clinical staff at two Catholic Health Services (CHS) hospitals of Andara and Nyangana in the Kavango region of Namibia. The conceptual framework, factors related to the decision to stay in or leave rural and remote areas, was adapted from Henderson and Tulloch (2008) and guided this study. [from abstract]

Context Analysis: Close-to-Community Providers in Mozambique

This report combines findings from a desk review,a mapping of [Close-to-Community] CTC providers and data collected during qualitative explorations carried out in two selected districts of Maputo Province as part of the context analysis. [from introduction]

Which Incentive Package Will Retain Regionalized Health Personnel in Burkina Faso: A Discrete Choice Experiment

The objective of the study was to identify a package for attracting and retaining health workers in underserved areas. [from abstract]

Should I stay or should I go? The Impact of Working Time and Wages on Retention in the Health Workforce

Inspired by the observation that providing care is based on the duration of practices, tasks and processes (issues of time) rather than exchange values (wages), this paper focuses on the influence of working-time characteristics and wages on an employee’s intention to stay. [from abstract]

Pay-for-Performance, Motivation and Final Output in the Health Sector: Experimental Evidence from the Democratic Republic of Congo

The pap er studies the effects of a financing mechanism for the health sector in which governmental payment to health facilities is contingent up on the number of patients for some predetermined health services, as opposed to a fixed payment. [from abstract]

Using Incentives to Attract Nurses to Remote Areas of Tanzania: A Contingent Valuation Study

This article analyses (1) how financial incentives (salary top-ups) and non-financial incentives (housing and education) affect nurses’ willingness to work in remote areas of Tanzania and (2) how the magnitude of the incentives needed to attract health workers varies with the nurses’ geographic origin and their intrinsic motivation. [from abstract]

Rural Allied Health Scholarships: Do They Make a Difference?

Specifically this study aimed to examine the profile of the QHRSS-AH recipients from 2000 to 2010 including graduate recruitment outcomes and retention within the scholarship program. It also explored the influence of the QHRSS-AH on early career practice location decisions and the features of the scheme that influenced motivation to be involved as either a scholarship holder or manager, perceived barriers to employment of scholarship holders in rural or remote services, experiences of scholarship holders as new graduates in rural and remote services and views on support requirements.

Performance-Based Financing as a Health System Reform: Mapping the Key Dimensions for Monitoring and Evaluation

This paper presents a framework for assessing the interactions between performance-based financing (meaning performance-based incentives are earned by service providers) and health systems, focusing on low and middle income countries in order to develop a framework for monitoring and evaluating health system reforms in general. [adapted from author]

Annotated Literature Review: African Actors, Global Health Governance and Performance-Based Funding

This review highlights the key strengths and weaknesses associated with performance-based funding (PBF) schemes in their use in low- and middle-income countries. It illustrates the theoretical thinking behind PBF implementation. It also seeks to draw out analysis of the role of African actors in global health diplomacy and decision-making surrounding PBF. [from summary]

Getting Doctors into the Bush: General Practitioners' Preferences for Rural Location

The aim of this study is to examine the preferences of general practitioners (GPs) for rural location using a discrete choice experiment to estimate the probabilities of moving to a rural area, and the size of financial incentives GPs would require to move there. [adapted from abstract]

Migration of South African Health Workers: The Extent to Which Financial Considerations Influence Internal Flows and External Movements

This study investigates the causes of migration focusing on the role of salaries and benefits. Health professionals from public, private and non-governmental health facilities located in selected peri-urban and urban areas in KwaZulu-Natal, South Africa were surveyed about their current positions and attitudes toward migration. [from abstract]

Protocol for the Evaluation of a Pay for Performance Programme in Pwani Region in Tanzania: A Controlled Before and After Study

This protocol outlines a controlled before and after study that will examine the effect of a pay-for-performance incentive program on quality, coverage, and cost of targeted maternal and newborn healthcare services and selected non-targeted services at facilities in Tanzania. [adapted from abstract]

How to Recruit and Retain Health Workers in Rural and Remote Areas in Developing Countries

This paper aims to outline the magnitude of unequal health workforce distribution in the developing countries; summarize the evidence on the factors that contribute to these imbalances; present a systematic set of policy interventions that are being implemented to address the problem of recruitment and retention of health workers in rural and remote regions of developing countries; and introduce the Discrete Choice Experiment to elicit health workers’ preferences and factors likely to increase uptake of a rural or remote job. [adapted from abstract]

Why Would I Go There? Motivating Workers to Take and Keep Jobs in Rural Areas

Given the complexity of the social, professional and economic factors that influence motivation, this article addresses how institutions make rural job postings more attractive and how they can identify what kinds of incentive packages can attract and motivate young, bright graduates to serve the areas of their country that are most in need. [adapted from author]

Differences in Preferences for Rural Job Postings between Nursing Students and Practicing Nurses: Evidence from a Discrete Choice Experiment in Lao People's Democratic Republic

A discrete choice experiment was conducted to investigate preferences for job characteristics among nursing students and practicing nurses to determine how these groups vary in their respective preferences and to understand whether differing policies may be appropriate for each group. [from abstract]

Policy Implementation and Financial Incentives for Nurses in South Africa: A Case Study on the Occupation Specific Dispensation

The article draws on a policy implementation framework to analyse the implementation of occupation-specific dispensation (OSD), a financial incentive strategy to attract, motivate, and retain health professionals in the public health sector, and seeks to determine whether the manner in which OSD was implemented caused unintended negative consequences. [from author]

Factors that Influence Midwifery Students in Ghana When Deciding Where to Practice: A Discrete Choice Experiment

This quantitative research study used a computerized structured survey containing a discrete choice experiment (DCE) to quantify the importance of different incentives and policies to encourage service to deprived, rural and remote areas by upper-year midwifery students following graduation. [from abstract]

Innovative Pay-for -Performance (P4P) Strategy for Improving Malaria Management in Rural Kenya: Protocol for a Cluster Randomized Controlled Trial

The authors describe the design of a cluster-randomized controlled study to investigate the role of sustainable institutional incentives to improve management of malaria in peripheral health facilities. This study will demonstrate whether facility-based rather than individual incentives are compelling enough to change provider behavior and whether these incentives lead to cost savings as a result of targeted drug consumption. [from author]

Understanding the Factors Influencing Health-Worker Employment Decisions in South Africa

This paper explores the nonfinancial factors that influence health workers’ choice of employer (public, private or nongovernmental organization) or their choice of work location (urban, rural or overseas). [adapted from author]

Motivation and Incentives of Rural Maternal and Neonatal Health Care Providers: A Comparison of Qualitative Findings from Burkina Faso, Ghana and Tanzania

This study explores the role of provider motivation in the quality of maternal and neonatal care. The main research questions were: which factors motivated these respondents to join the health professions; what is understood by the term motivation; what influences their motivation, job satisfaction and the quality of their care; and which incentives do these providers themselves suggest. [adapted from author]

Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs

This chapter surveys experience with performance pay in developing country health programs focusing on four key conceptual issues: what to reward, who to reward, how to reward, and what unintended consequences might performance incentives create. [adapted from abstract]

Australia: The Practice Incentives Program (PIP)

The authors evaluate Autstralia’s Practice Incentives Program which aims to encourage continuing improvements in general practice through financial incentives to support quality care, and improve access and health outcomes for patients. [from introduction]