INFLUENCES ON THE MOTIVATION, PERFORMANCE
AND JOB SATISFACTION OF PRIMARY HEALTH CARE
PROVIDERS IN RURAL TANZANIA
Prytherch, H.1, Kakoko, DCV 2., Leshabari, MT.2, Marx.M. 1, Sauerborn, R.1
1 Institute
of Public Health, University of Heidelberg, Germany
2 School of Public Health and Social Sciences, Muhimbili University of Health
and Allied Sciences, Tanzania
Introduction
• This study was conducted in the frame of the
QUALITY OF MATERNAL & NEONATAL (MNH)
CARE : BRIDING THE KNOW DO GAP
(QUALMAT) research project
• It was undertaken within work package 5
which explores the role that provider
motivation plays in the quality of such care
Background
• Improvements in MNH remain elusive in Tanzania
(MMR 790/100,000 live births, neonatal death
rate 33/1000 live births)
• Absolute shortage and mal-distribution of skilled
health workers
• Known problems re. performance and motivation
of available workforce
• Problems worst in rural areas – Lindi & Mtwara
regions in South particularly affected
Study questions
• What encourages and discourages providers
of MNH care at primary care level in rural
areas
• What is understood by the term motivation
• Which factors influence performance and job
satisfaction
Methods
• 35 in-depth interviews with primary level MNH
providers (including auxiliaries) & their managers
• Development of interview guideline led by
Tanzanian collaborators (psychologist, sociologists
and health professionals)
• Interviews conducted in Kiswahili, recorded and
transcribed into English
• NVivo9 used to support coding and analysis
Results 1
Key sources of encouragement for all the
types of providers include:
• community appreciation
• perceived government and development
partner support for MNH
• on-the-job learning
Manager appreciation does not emerge
Results 1
• Discouragements are overwhelmingly financial
in nature, but also include:
• facility understaffing & resulting, felt workload
• malfunction of the promotion system
• health and safety and security issues
Auxiliary staff particularly discouraged/
unsupported
Results 2
• Motivation “an individual’s degree of
willingness to exert and maintain an effort
towards organisational goals” (Franco et al, 2002
p.1255)
• Most respondents clear about goal of their
facility, so we might expect motivation to be
reasonable – but this was not the case
• Term often appears to be understood as a
tangible incentive
Results 3
• Performance and quality of care undermined
by lack of staff, staff assuming multiple roles
gap-filling with lower level staff
• Situation exacerbated by challenges faced by
managers of rural facilities
• Basic steps that could improve performance
appear to be overlooked
Results 4
• MNH providers and facility managers largely
report deriving a degree of job satisfaction from:
• serving the community
• importance attached to MNH work
• liking to see a job well done/feeling competent
• Possible that intrinsic rewards particularly
pronounced for MNH providers in rural facilities
Conclusions
• Influences on MNH provider motivation,
performance and satisfaction are shown to be
complex and multifaceted
• Variations in use of terms and concepts
pertaining to motivation are revealed
• Intrinsic rewards play a role in continued
provider willingness to exert an effort at work
Conclusions
Causes of discouragement can be broadly
divided into those requiring renewed policy
attention and those which could be addressed
by:
• strengthening skills of rural facility managers
• enhancing the status of their role
• increasing their support from higher levels of
the health system
Acknowledgements
• Deepest gratitude is extended to the respondents who
gave of their time to partake in these interviews
• The QUALMAT project is funded as part of the 7th
Framework Programme of the European Union grant
agreement 22982) www.qualmat.net
• Thank you for listening