Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study
Background: Lack of an adequate and well-performing health workforce has emerged as the biggest barrier to scaling up health services provision in sub-Saharan Africa. As the global community commits to the Sustainable Development Goals and universal health coverage, health workforce challenges are c...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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Taylor & Francis Group
2016-10-01
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| Series: | Global Health Action |
| Subjects: | |
| Online Access: | http://www.globalhealthaction.net/index.php/gha/article/view/32404/pdf_299 |
| _version_ | 1818518624748437504 |
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| author | Gifty Apiung Aninanya Natasha Howard John E. Williams Benjamin Apam Helen Prytherch Svetla Loukanova Eunice Karanja Kamara Easmon Otupiri |
| author_facet | Gifty Apiung Aninanya Natasha Howard John E. Williams Benjamin Apam Helen Prytherch Svetla Loukanova Eunice Karanja Kamara Easmon Otupiri |
| author_sort | Gifty Apiung Aninanya |
| collection | DOAJ |
| description | Background: Lack of an adequate and well-performing health workforce has emerged as the biggest barrier to scaling up health services provision in sub-Saharan Africa. As the global community commits to the Sustainable Development Goals and universal health coverage, health workforce challenges are critical. In northern Ghana, performance-based incentives (PBIs) were introduced to improve health worker motivation and service quality. Objective: The goal of this study was to determine the impact of PBIs on maternal health worker motivation in two districts in northern Ghana. Design: A quasi-experimental study design with pre- and post-intervention measurement was used. PBIs were implemented for 2 years in six health facilities in Kassena-Nankana District with six health facilities in Builsa District serving as comparison sites. Fifty pre- and post-intervention structured interviews and 66 post-intervention in-depth interviews were conducted with health workers. Motivation was assessed using constructs for job satisfaction, pride, intrinsic motivation, timelines/attendance, and organisational commitment. Quantitative data were analysed to determine changes in motivation between intervention and comparison facilities pre- and post-intervention using STATA™ version 13. Qualitative data were analysed thematically using NVivo 10 to explore possible reasons for quantitative findings. Results: PBIs were associated with slightly improved maternal health worker motivation. Mean values for overall motivation between intervention and comparison health workers were 0.6 versus 0.7 at baseline and 0.8 versus 0.7 at end line, respectively. Differences at baseline and end line were 0.1 (p=0.40 and p=0.50 respectively), with an overall 0.01 difference in difference (p=0.90). Qualitative interviews indicated that PBIs encouraged health workers to work harder and be more punctual, increasing reported pride and job satisfaction. Conclusions: The results contribute evidence on the effects of PBIs on motivational constructs among maternal health workers in primary care facilities in northern Ghana. PBIs appeared to improve motivation, but not dramatically, and the long-term and unintended effects of their introduction require additional study. |
| first_indexed | 2024-12-11T01:12:42Z |
| format | Article |
| id | doaj.art-6a3ddc08b4dc40abaaa678f087e51771 |
| institution | Directory Open Access Journal |
| issn | 1654-9880 |
| language | English |
| last_indexed | 2024-12-11T01:12:42Z |
| publishDate | 2016-10-01 |
| publisher | Taylor & Francis Group |
| record_format | Article |
| series | Global Health Action |
| spelling | doaj.art-6a3ddc08b4dc40abaaa678f087e517712022-12-22T01:25:59ZengTaylor & Francis GroupGlobal Health Action1654-98802016-10-019011010.3402/gha.v9.3240432404Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental studyGifty Apiung Aninanya0Natasha Howard1John E. Williams2Benjamin Apam3Helen Prytherch4Svetla Loukanova5Eunice Karanja Kamara6Easmon Otupiri7 School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK Navrongo Health Research Centre, Navrongo, Ghana Department of Statistics, Bolgatanga Polytechnic, Bolgatanga, Ghana Swiss Tropical and Public Health Institute, University of Basel, Basel, Switzerland Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany Department of Philosophy, Religion and Theology, Moi University, The Eldoret, Kenya School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, GhanaBackground: Lack of an adequate and well-performing health workforce has emerged as the biggest barrier to scaling up health services provision in sub-Saharan Africa. As the global community commits to the Sustainable Development Goals and universal health coverage, health workforce challenges are critical. In northern Ghana, performance-based incentives (PBIs) were introduced to improve health worker motivation and service quality. Objective: The goal of this study was to determine the impact of PBIs on maternal health worker motivation in two districts in northern Ghana. Design: A quasi-experimental study design with pre- and post-intervention measurement was used. PBIs were implemented for 2 years in six health facilities in Kassena-Nankana District with six health facilities in Builsa District serving as comparison sites. Fifty pre- and post-intervention structured interviews and 66 post-intervention in-depth interviews were conducted with health workers. Motivation was assessed using constructs for job satisfaction, pride, intrinsic motivation, timelines/attendance, and organisational commitment. Quantitative data were analysed to determine changes in motivation between intervention and comparison facilities pre- and post-intervention using STATA™ version 13. Qualitative data were analysed thematically using NVivo 10 to explore possible reasons for quantitative findings. Results: PBIs were associated with slightly improved maternal health worker motivation. Mean values for overall motivation between intervention and comparison health workers were 0.6 versus 0.7 at baseline and 0.8 versus 0.7 at end line, respectively. Differences at baseline and end line were 0.1 (p=0.40 and p=0.50 respectively), with an overall 0.01 difference in difference (p=0.90). Qualitative interviews indicated that PBIs encouraged health workers to work harder and be more punctual, increasing reported pride and job satisfaction. Conclusions: The results contribute evidence on the effects of PBIs on motivational constructs among maternal health workers in primary care facilities in northern Ghana. PBIs appeared to improve motivation, but not dramatically, and the long-term and unintended effects of their introduction require additional study.http://www.globalhealthaction.net/index.php/gha/article/view/32404/pdf_299Ghanaperformance-based incentivesmotivationconstructs of motivationhealth worker |
| spellingShingle | Gifty Apiung Aninanya Natasha Howard John E. Williams Benjamin Apam Helen Prytherch Svetla Loukanova Eunice Karanja Kamara Easmon Otupiri Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study Global Health Action Ghana performance-based incentives motivation constructs of motivation health worker |
| title | Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study |
| title_full | Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study |
| title_fullStr | Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study |
| title_full_unstemmed | Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study |
| title_short | Can performance-based incentives improve motivation of nurses and midwives in primary facilities in northern Ghana? A quasi-experimental study |
| title_sort | can performance based incentives improve motivation of nurses and midwives in primary facilities in northern ghana a quasi experimental study |
| topic | Ghana performance-based incentives motivation constructs of motivation health worker |
| url | http://www.globalhealthaction.net/index.php/gha/article/view/32404/pdf_299 |
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