The Relative Importance of Different Motivational Determinants for Different Categories of Health...

The Relative Importance of Different Motivational Determinants for Different Categories of Health Workers in South

Africa, Tanzania And Malawi

Charles Normand

Trinity College Dublin

for the Motivation Project Team

Rationale & Objectives

• Well-defined list of factors influencing the motivation of health workers– But no data on the relative importance of different

motivational incentives– Little known about preferences of different

categories of health workers in different countries

• Use a Discrete Choice Experiment (DCE) to measure the relative importance of different motivational incentives to different categories of health workers in South Africa, Tanzania and Malawi

Methods

• Discrete choice experiment (DCE)– Quantify relative importance of different

motivational attributes on respondent choices– Survey of health professionals in each country– Stratified cluster sample– Self-administered questionnaire

• Preparatory work– Literature review, Country case studies, Several

iterations of design, Pilot studies

• Used SAS program to generate optimal D-efficient design

Question 1 : Which of these two public sector jobs would you find more motivating?

Job A Job B

Location of job The health facility is located in a remote rural

area with no infrastructure and no access to social amenities such as shops and schools.

The health facility is located in a major city with excellent infrastructure and excellent access to social amenities such as shops and schools.

Total monthly take home pay including all allowances

50% more than you currently earn. 75% more than you currently earn.

Staffing levels

40% of the professional health workers posts in the facility are filled. 80% of the professional health workers posts in

the facility are filled.

Availability of essential drugs and equipment to provide patient care

90% of essential drugs and equipment are available. 50% of essential drugs and equipment are

available.

Opportunities for further training You will not be able to undertake further training

to upgrade your professional qualifications. You will be able to undertake further training to upgrade your professional qualifications.

Opportunities for promotion

You will be eligible for promotion to the next job grade in 5 years time. You will be eligible for promotion to the next job

grade in 2 years time.

Recognition from your manager Your work is rarely acknowledged or appreciated

by your manager. Your work is frequently acknowledged and appreciated by your manager.

Respect from the local community You are not respected by the local community for

the work that you do. You are respected by the local community for the work that you do.

Which job would be more motivating? Job A Job B

8 different incentives

16 choice sets

DCE Questionnaire

Focus on Motivation

Generic designTwo choices

DCE Results

DCE Ranking – By Country

2.39

1.89

1.88

1.86

1.72

1.50

1.47

1.34

1.28

1.26

1.24

1.23

75% Salary increase

Training opportunities

Large town

50% Salary increase

Main city

Respect from local community

Small town

25% Salary increase

Availability of drugs & equipment

Recognition from manager

Promotion opportunities

Staffing levels

South Africa

1.49

1.24

1.23

1.21

1.21

1.19

1.19

1.16

1.10

1.08

1.05

1.01


Main city

Large town

Small town


50% Salary increase

75% Salary increase




Staffing levels

25% Salary increase

Tanzania

5.02

2.64

2.02

1.76

1.52

1.51

1.48

1.43

1.35

1.30

1.18

1.14


75% Salary increase

50% Salary increase

Large town


Main city

Small town


25% Salary increase



Staffing levels

Malawi

5.79

3.51

2.56

2.49

1.89

1.87

1.46

1.45

1.36

1.35

1.16

1.15


75% Salary increase

Large town

50% Salary increase

Small town

Main city




25% Salary increase


Staffing levels

ML: Allied HW

7.39

2.68

2.22

1.99

1.89

1.64

1.58

1.50

1.40

1.32

1.12

1.10


75% Salary increase

Large town

50% Salary increase

Main city

Small town



25% Salary increase



Staffing levels

ML: Med Asst, CO

6.84

2.96

2.85

1.97

1.91

1.80

1.76

1.69

1.58

1.40

1.34

1.23


75% Salary increase

Large town

50% Salary increase

Main city

Small town




25% Salary increase


Staffing levels

ML: Registered Nurse

DCE Rank – By HW in Malawi

4.02

2.62

2.00

1.50

1.44

1.39

1.32

1.30

1.25

1.24

1.20

1.16


75% Salary increase

50% Salary increase



Large town

Small town

25% Salary increase

Main city



Staffing levels

ML: Aux, Nurse MW, EN

Statistically Significant Interactions: Malawi

Male <30 yrs Single ChildrenCompared to EN

SatisfiedRN CO Allied

Small town + +Large town + + + +Main city – + + + +25% Salary increase

50% Salary increase +75% Salary increase + + –Staffing levels


Training opportunities + +Promotion opportunities +Recognition from manager + +Respect from local community – +

Conclusions

• The relative importance of different motivational incentives differs between countries.

• Training opportunities and salary are the most important motivational incentives.

• Doctors and registered nurses are less motivated to work in rural areas.

• Satisfied health workers are less motivated by financial incentives.

• South African health workers have high levels of dissatisfaction and low organisational commitment.

Policy Recommendations• Developing training opportunities would be a

powerful motivational incentive.

• Health workers will need to be compensated to persuade them to work in rural areas.

• Need to pay more attention to building respect from managers and local community.

• Regular staff satisfaction surveys should be part of HR management information systems.

The End

Thank you for your attention

The Relative Importance of Different Motivational Determinants for Different Categories of Health...

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