Untangling Intrinsic Motivation of Health Workers in Uganda and Malawi
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  • The sample was allocated to each district in proportion to the number of facilities (by sector) in the district. 15 public hospitals were selected with certainty to ensure the inclusion of very large health facilities in the sample; this selection was done on the basis of size distribution in each district. The sample was also constructed to allow for adequate representation of three sizes (small, medium, and large) of facilities across all sectors, and CHAM facilities both with and without SLAs in place.Uganda: 165 public sector workers and 146 PNFP workers
  • The qualitative data suggest that opportunities to learn from experienced colleagues and access skills training (e.g. on new procedures like providing vaccines or refresher courses) impact health workers’ intrinsic motivation-Sampling weights were used to account for the variation in the number of health facilities across sectors and geographic clusters-Descriptive and bivariate analyses: used meansCorrelations– describes the degree of a relationship between two variables, a value of >.5 indicates a substantive relationship and regressions- tests the significance of a relationship between two or more variables.-Confidence interval in parentheses- more narrow the CI, more reliable estimate-Range of the composite indices are 5-40 with 40 indicating highest levels of morale and motivation
  • Look at very high level of association in the private sector between religiosity and intrinsic motivation--- perhaps not what you would expect.Asterik- signifies a statistically significant relationship at the 5% level; 95% confidence that the relationship is true and not due to chance
  • Striking, statistically significant differences in professional development opportunities- overall, high levels of satisfaction with job for both sectors.-No differences in intention to stay at facility over next 12 months- 70% wish to stay
  • Statistically significant differences in adequacy of compensation but similar levels of fairness of compensation
  • Intrinsic motivators are difficult to package and export between sectors


  • 1. Untangling Intrinsic Motivation of Health Workers in Uganda and Malawi
    Ilana Ron
    Research Associate, Abt Associates
    Prepared by: Ilana Ron, Allison Goldberg, Paul Kiwanuka-Mukiibi
    June 16, 2011
  • 2. Presentation Outline
    Conventional Wisdom and Overarching Research Questions
    Brief Overview of Study Methodology
    Limitations of Study
    Results from Data Analyses
    Summary and Parting Thoughts
  • 3. Background and Conventional Wisdom
    Funded by USAID/Washington and USAID/Malawi as part of Health Systems 20/20 project
    Faith-based institutions (often Christian Health Associations) are better able to attract, retain, and motivate staff than their public counterparts
    Recent attention by donors given to a wide variety of financial and non-financial incentive schemes to improve health worker performance and motivation
  • 4. Overarching Research Questions
    What are the levels of intrinsic motivation, retention, and performance factors for health workers in public, faith-based (Christian Health), and private for-profit facilities in Malawi and Uganda?
    What are drivers of intrinsic motivation for health workers in these sectors? How might intrinsic motivation be improved?
    How important is faith as a predictor of intrinsic motivation for health workers?
  • 5. Brief Overview of Methodology
    Equal probability systematic sample selected
    Uganda: 311 health workers from 91 health facilities (all size levels) interviewed from 20 districts
    Malawi: 602 health workers from 163 health facilities from every district in Malawi interviewed; in addition, 612 clients interviewed
    Both qualitative and quantitative data collection
    Very rich dataset on intrinsic motivation; over 900 health workers from all cadres interviewed
  • 6. Limitations of Study
    Sample size in each cadre is too small to drill down into results for each cadre; results are a profile of a cadre overall
    Faith-based sector included Christian Health facilities, not Muslim facilities
    Data around intrinsic motivation, retention and job satisfaction are not matched with health outcomes; we do not know if more motivated health workers actually perform better (but we assume that they do)
  • 7. Results
  • 8. Intrinsic Motivation Factors
    Feeling of being good at the job
    Feeling of being able to successfully complete all assigned tasks
    Feeling of being proud of job and position at the facility
    Opportunities for growth and development
    Role of faith
    Daniel Pink definition: internal motivators like enjoyment of work, genuine achievement, personal growth
  • 9. Malawi: Comparison of Means on Overall Morale & Job Satisfaction and Overall Intrinsic Motivation Across Sectors
    • Average levels of overall morale & job satisfaction and overall intrinsic motivation are not substantively different across sectors
    • 10. Overall, health workers across all sectors report that they are only generally satisfied with their jobs, yet highly motivated to complete them
  • Malawi: Impact of Compensation and Faith & Religion on Intrinsic Motivation
    • Health workers’ overall level of satisfaction with compensation is not significantly associated with their overall level of intrinsic motivation. This means that compensation is not a driver of health worker motivation, except in the case of CHAM facilities without SLA (.26*).
    • 11. Strong religious values are significantly associated with health workers’ overall level of intrinsic motivation
    • 12. The importance of working in a religious environment is associated with higher levels of overall job satisfaction (but less strongly than individual religiosity)
  • Uganda: Motivation and Satisfaction Factors
  • 13. Uganda: Predictors of Intrinsic Motivation
    Strongest predictors of satisfaction and motivation:
    Adequate equipment and supplies to do job
    Professional development opportunities
    Feeling of being “good at job”
    Fair pay [*not high pay*] compared to others doing similar work
    Only predictor of satisfaction and motivation related to faith:
    Feeling that religion can help a health worker serve a client well
  • 14. Extrinsic Motivation Factors
  • 15. Malawi: Impact of Compensation and Intrinsic Motivation on Retention
    • Health workers’ overall level of satisfaction with compensation is not significantly associated with their intention to stay at the facility where they are working
    • 16. Reasons to stay at facility: convenience (e.g. house and family are nearby and transport is accessible) and the opportunity to learn from experienced colleagues
    • 17. Health workers’ intrinsic motivation is significantly associated with the decision to retain employment in the public sector.
    • 18. Intrinsic motivation is only a primary driver of retention in public sector facilities
  • Uganda: Compensation and Retention Factors
  • 19. Summary and Parting Thoughts
    Very large dataset; only a very small sub-section of results able to be presented today
    Several key themes emerging:
    Intrinsic motivation levels are largely not associated with satisfaction about compensation package
    Particularly in the public sector, intrinsic motivation is a primary driver of retention
    Biggest drivers of intrinsic motivation: professional development, opportunities for promotion, fairness of compensation
    Religiosity is an important driver of motivation but exists at the individual and workplace level in the public as well as the FBO sector
    Striking the balance between intrinsic and extrinsic motivators is key but difficult
  • 20. www.HealthSystems2020.org
    Thank you