Motivation and retention of health workers in developing countries: a systematic review
Open accessAbstract
Background: A key constraint to achieving the MDGs is the absence of a properly trained and motivated workforce. Loss of clinical staff from low and middle-income countries is crippling already fragile health care systems. Health worker retention is critical for health system performance and a key problem is how best to motivate and retain health workers. The authors undertook a systematic review to consolidate existing evidence on the impact of financial and non-financial incentives on motivation and retention. Methods: Four literature databases were searched together with Google Scholar and 'Human Resources for Health' on-line journal. Grey literature studies and informational papers were also captured. The inclusion criteria were: 1) article stated clear reasons for implementing specific motivations to improve health worker motivation and/or reduce medical migration, 2) the intervention recommended can be linked to motivation and 3) the study was conducted in a developing country and 4) the study used primary data. Results: Twenty articles met the inclusion criteria. They consisted of a mixture of qualitative and quantitative studies. Seven major motivational themes were identified: financial rewards, career development, continuing education, hospital infrastructure, resource availability, hospital management and recognition/appreciation. There was some evidence to suggest that the use of initiatives to improve motivation had been effective in helping retention. There is less clear evidence on the differential response of different cadres. Conclusion: While motivational factors are undoubtedly country specific, financial incentives, career development and management issues are core factors. Nevertheless, financial incentives alone are not enough to motivate health workers. It is clear that recognition is highly influential in health worker motivation and that adequate resources and appropriate infrastructure can improve morale significantly.
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Improved frontline health worker motivation, access to knowledge and organisational support are critical non-financial incentives that contribute to frontline health worker retention.
“Improved FHW motivation, access to knowledge and organisational support are critical non-financial incentives that contribute to FHW retention [48–50].”
From Evidence on feasibility and effective use of <scp>mH</scp>ealth strategies by frontline health workers in developing countries: systematic review (2015) · cites this paper as [50]
The Results sections on Education and Hospital or clinic management identify training opportunities and management as important motivators. The Abstract Results reports some evidence that initiatives to improve motivation helped retention, but the review concerns health workers broadly, finds less clear evidence for different cadres, and does not establish these specific factors as critical to frontline health worker retention. (LLM, conf=0.84)
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- Authors
- Willis-Shattuck, M., Bidwell, P., Thomas, S., Wyness, L., Blaauw, D., & Ditlopo, P.
- Affiliations
- Trinity College Dublin (IE)
- Irish Life (Ireland) (IE)
- University of the Witwatersrand (ZA)
- Venue
- BMC Health Services Research
- Published
- 2008-12
- Volume
- 8
- Issue
- 1
- Pages
- 247-247
- ISSN
- 1472-6963 (ISSN-L)
- PMC
- PMC2612662
- OpenAlex
- W2115938495
- Cited by
- 874
- References
- 46
- Citations by year
- 2026: 36 · 2025: 41 · 2024: 41 · 2023: 44 · 2022: 53 · 2021: 70 · 2020: 53 · 2019: 58 · 2018: 49 · 2017: 75 · 2016: 70 · 2015: 67 · 2014: 62 · 2013: 42 · 2012: 51
- FWCI
- 4.08
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- BMC Health Services Research (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Queen Margaret University Publications Repository (Queen Margaret University) (acceptedVersion)
- LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Queen Margaret University Publications Repository (Queen Margaret University) (submittedVersion)
- Funders
- Irish Aid
- Topics
- Health Sciences › Health Professions › Emergency Medical Services › Global Health Workforce Issues
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
- Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
- Keywords
- health workforce retention, health worker motivation, financial incentives, non-monetary incentives, career development, continuing education, recognition and appreciation, medical migration, healthcare workers, low- and middle-income countries, health system performance
- MeSH terms
- Community Health Services, Developing Countries, Emigration and Immigration, Employee Incentive Plans, Health Workforce, Humans, Job Satisfaction, Motivation, Personnel Loyalty, Global Health
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