Motivation and incentives of rural maternal and neonatal health care providers: a comparison of qualitative findings from Burkina Faso, Ghana and Tanzania
Open accessAbstract
BACKGROUND: In Burkina Faso, Ghana and Tanzania strong efforts are being made to improve the quality of maternal and neonatal health (MNH) care. However, progress is impeded by challenges, especially in the area of human resources. All three countries are striving not only to scale up the number of available health staff, but also to improve performance by raising skill levels and enhancing provider motivation. METHODS: In-depth interviews were used to explore MNH provider views about motivation and incentives at primary care level in rural Burkina Faso, Ghana and Tanzania. Interviews were held with 25 MNH providers, 8 facility and district managers, and 2 policy-makers in each country. RESULTS: Across the three countries some differences were found in the reasons why people became health workers. Commitment to remaining a health worker was generally high. The readiness to remain at a rural facility was far less, although in all settings there were some providers that were willing to stay. In Burkina Faso it appeared to be particularly difficult to recruit female MNH providers to rural areas. There were indications that MNH providers in all the settings sometimes failed to treat their patients well. This was shown to be interlinked with differences in how the term 'motivation' was understood, and in the views held about remuneration and the status of rural health work. Job satisfaction was shown to be quite high, and was particularly linked to community appreciation. With some important exceptions, there was a strong level of agreement regarding the financial and non-financial incentives that were suggested by these providers, but there were clear country preferences as to whether incentives should be for individuals or teams. CONCLUSIONS: Understandings of the terms and concepts pertaining to motivation differed between the three countries. The findings from Burkina Faso underline the importance of gender-sensitive health workforce planning. The training that all levels of MNH providers receive in professional ethics, and the way this is reinforced in practice require closer attention. The differences in the findings across the three settings underscore the importance of in-depth country-level research to tailor the development of incentives schemes.
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In rural Burkina Faso, obstacles to maternal care access remain numerous, including social, geographical and economic barriers, shortages of skilled health staff, lack of information on sexual and reproductive health, cost of medical treatment, and negative perceptions of quality of care.
“In rural areas, obstacles to maternal care access remain numerous, and include social, geographical and economic barriers, shortages of skilled health staff, lack of information on sexual and reproductive health, the cost of medical treatment, and negative perceptions of quality of care [48–52].”
From Situating mobile health: a qualitative study of mHealth expectations in the rural health district of Nouna, Burkina Faso (2017) · cites this paper as [52]
Social isolation was reported by midwifery personnel in different contexts.
“Social isolation was reported by midwifery personnel in different contexts [29, 32, 35, 37–40].”
From What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective (2016) · cites this paper as [40]
In Afghanistan and Burkina Faso, midwives cited not speaking the local language as a reason for social isolation from their assigned communities.
“In studies from Afghanistan and Burkina Faso, midwives cited not speaking the local language as another reason for social isolation from their assigned communities [39, 40].”
From What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective (2016) · cites this paper as [40]
In Burkina Faso, midwifery personnel indicated that quality of care could be affected by the financial stress incurred when they had to take out loans to support themselves.
“In Burkina Faso, midwifery personnel indicated that quality of care could be effected by the financial stress incurred when they had to take out loans to support themselves [40].”
From What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective (2016) · cites this paper as [40]
Providers did not adopt the expression 'moral distress' but expressed corresponding feelings of guilt, anger, depersonalization and demoralization that fit the definition.
“Whilst the expression ‘moral distress’ was not adopted by providers, they did express corresponding feelings of guilt, anger, depersonalization and demoralization that fit the definition [29, 40, 45, 53, 72].”
From What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective (2016) · cites this paper as [40]
Inefficient or absent transport with impassable or dangerous roads is a recurrent barrier to providing quality midwifery care in both urban and remote areas.
“Inefficient or absent transport with impassable or dangerous roads was also a recurrent barrier to providing quality midwifery care in both urban and remote areas [38, 40, 51].”
From What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective (2016) · cites this paper as [40]
The long-term impact of burnout and moral distress is poor retention of maternity staff.
“The long term impact of burn out and moral distress is poor retention of maternity staff [30, 40, 50].”
From What Prevents Quality Midwifery Care? A Systematic Mapping of Barriers in Low and Middle Income Countries from the Provider Perspective (2016) · cites this paper as [40]
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Self-citation
- Authors
- Prytherch, H., Kagoné, M., Aninanya, G. A., Williams, J. E., Kakoko, D. C., Leshabari, M. T., Yé, M., Marx, M., & Sauerborn, R.
- Affiliations
- Heidelberg University (DE)
- Centre de Recherche en Santé de Nouna (BF)
- Navrongo Health Research Centre (GH)
- Muhimbili University of Health and Allied Sciences (TZ)
- Corresponding author
- Prytherch, Helen
- Kagoné, Moubassira
- Aninanya, Gifty A
- Williams, John E
- Kakoko, Deodatus CV
- Leshabari, Melkidezek T
- Yé, Maurice
- Marx, Michael
- Sauerborn, Rainer
- ORCID
- Venue
- BMC Health Services Research
- Published
- 2013-04-25
- Volume
- 13
- Issue
- 1
- Pages
- 149-149
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC3648439
- OpenAlex
- W2109198904
- Cited by
- 83
- References
- 38
- Citations by year
- 2026: 3 · 2025: 3 · 2024: 5 · 2023: 6 · 2022: 7 · 2021: 10 · 2020: 4 · 2019: 9 · 2018: 9 · 2017: 5 · 2016: 9 · 2015: 4 · 2014: 8 · 2012: 1
- FWCI
- 10.89
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- IHI Repository (acceptedVersion)
- Greater South Information System
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- health worker motivation, financial incentives, rural health workforce, provider retention, job satisfaction, remuneration, professional ethics training, primary care, Burkina Faso, Ghana, Tanzania
- MeSH terms
- Adult, Attitude of Health Personnel, Burkina Faso, Cross-Cultural Comparison, Female, Ghana, Health Personnel, Humans, Interviews as Topic, Male, Maternal-Child Health Centers, Motivation, Primary Health Care, Salaries and Fringe Benefits, Tanzania, Rural Health Services, Young Adult
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