There is a serious human resource crisis in the health sector in developing countries, particularly in Africa. One of the challenges is the low motivation of health workers. Experience and the evidence suggest that any comprehensive strategy to maximize health worker motivation in a developing country context has to involve a mix of financial and non financial incentives. This study assesses the role of non-financial incentives for motivation in Benin and Kenya.
Human Resources
Health worker motivation in Africa: The role of non-financial incentives and human resource management tools
Mathauer I, Imhoff I: Human Resources for Health 4:24, 29 August 2006
Health worker satisfaction and motivation: An empirical study of incomes, allowances and working conditions in Zambia
Gow J, George G, Mwamba S, Ingombe L and Mutinta G: International Journal of Business and Management 7(10): 37-48, May 2012
In this study, researchers in Zambia examined the relationship between health worker incomes and their satisfaction and motivation. Cross-sectional data collection was undertaken using both quantitative and qualitative methods. Data was collected in three regions that represent extremes in overall remuneration and benefits. Lusaka represented the favourable area while Monze and Nyimba represented less favourable areas for study in Zambia. The researchers found that there are hefty disparities between different health workers. There are also enormous salary differentials for the same workers between the public and private sectors. These salary differentials explain the experience of public-to-private migration of health workers as well as casual private sector work by public sector health workers, they argue. In addition, there are negligible efforts by government to reduce the benefits gaps among key public health cadres. The low incomes received by public health workers in Zambia have many negative implications: it begets absenteeism, results in low output, poor quality health care, and the departure of health workers to the private sector and overseas.
Health worker scarcity in AIDS-ridden countries highlighted
A new study to be published in the Lancet has, for the first time, quantified the dangerous scarcity of healthcare workers in countries with climbing rates of HIV, tuberculosis and malaria. The report, 'Human Resources for Health: Overcoming the Crisis', says health workers from developing countries are lured by better salaries and safer working conditions in urban areas or richer countries, creating the so-called "brain-drain".
Health worker shortage is major obstacle to universal treatment
Oxfam press release, 15 August 2006
Representatives of Oxfam International, Physicians for Human Rights and Health GAP today called the critical shortage of health workers in developing countries "a major challenge to meeting the promise of universal access to treatment." They demanded massive new investment from government to train and retain health workers. "Campaigns to fulfill the right to health have brought anti-retroviral medicines to hundreds of thousands of people. But without the health workers and health systems to administer these medicines, that right remains unrealized for millions more," said Leonard Rubenstein, JD, Executive Director of Physicians for Human Rights.
Health Worker Shortage Limits Access To HIV/AIDS Treatment In Southern Africa
Medicens Sans Frontiers, 30 May 2007
A shortage of health care workers is paralysing the health system in Lesotho, Malawi, Mozambique and South Africa, and threatens the lives of millions, particularly in rural areas, warns Medecins Sans Frontieres. A new report by the organisation, launched in Johannesburg, shows that only South Africa has met the World Health Organisation (WHO) target for an adequate supply of health care workers: 74.3 doctors, 393 nurses and 468 health providers per 100,000 people.
Health worker shortages and global justice
O’Brien P and Gostin LO: Milbank Memorial Fund, 2011
The human resource crisis affects developed and developing countries, but the global poor suffer disproportionately, not only because they have a much smaller workforce but also because their needs are so much greater, according to this paper. Of the 57 countries with critical shortages, 36 are in Africa. Africa has 25% of the world’s disease burden, but only 3% of the world’s health workers and 1% of the economic resources. The causes of the human resource shortages are multifaceted and complex, but not so complex that they cannot be understood and acted upon, the authors argue. They make several recommendations. The United States (US) administration, using an “all-of-government” approach, should develop a strategic plan to address the global health worker shortage. The US government should also reform US global health assistance programmes to increase health workforce capacity in partner countries, as well as increase financial assistance for global health workforce capacity development. Finally, Congress should empower the Department of Health and Human Services or another appropriate agency to regulate the recruiters of foreign-trained health workers.
Health worker shortages: Policy neglect equivalent to 'institutional manslaughter’
Sankore R: Pambazuka News, 25 September 2008
African leaders lack the foresight and political will required to ensure sustainable health development, financing and universal primary health care. By underlining the effects of institutional under-funding and the brain drain, the author contends that policy neglect is the equivalent of ‘institutional manslaughter’. Africa’s critical health workforce shortage is arguably the most serious obstacle to implementing global and African health frameworks and universal primary health care across the continent and governments must improve health workforce working conditions. The proper, moral and sustainable solution is to ensure that more developed countries invest in training of adequate numbers of their own health workforce, and that less-developed countries demonstrate full political commitment to training and retaining their health workers –with the support of more-developed countries, where necessary.
Health workers at the core of the health system: Framework and research issues
Anand S, Bärnighausen T Health Policy (2011), 25 October 2011
This paper presents a framework for the health system with health workers at the core. The authors reviewed existing health-system frameworks and the role they assign to health workers, finding that earlier frameworks either do not include health workers as a central feature of system functioning or treat them as one among several components of equal importance. As every function of the health system is either undertaken by or mediated through the health worker, the authors argue that the health worker should be placed at the centr of the health system. They describe six research issues on the health workforce: metrics to measure the capacity of a health system to deliver healthcare; the contribution of public- vs private-sector health workers in meeting healthcare needs and demands; the appropriate size, composition and distribution of the health workforce; approaches to achieving health-worker requirements; the adoption and adaption of treatments by health workers; and the training of health workers for horizontally vs vertically structured health systems.
Health Workers for All and All for Health Workers
The Kampala Declaration and Agenda for Global Action, Global Health Workforce Alliance
The participants at the first Global Forum on Human Resources for Health in Kampala, 2-7 March 2008, representing a diverse group of governments, multilateral, bilateral and academic institutions, civil society, the private sector, and health workers' professional associations and unions called on governments to provide the stewardship to resolve the health worker crisis, involving all relevant stakeholders and providing political momentum to the process.
Health workers remain unprotected in Kenya
IRIN News: 17 May 2011
While Kenyan health workers treating tuberculosis patients are working without masks, government officials say problems with the supply chain and funding shortages are the main reason for the lack of protective gear. Health personnel cannot stop treating or offering services to patients even without these commodities and during that time, they risk getting infected by the very patients they treat. According to Joseph Sitienei, head of the National Leprosy and TB Control Programme, sometimes health facilities delay in requesting these much-needed materials and only do so when they completely run out. However, he pointed to increased funding to the health sector recently, which held promise that the situation would improve. He noted that the government is streamlining procurement and supply of commodities including protective gear to health facilities. In contrast, local NGOs say corruption within the health system is to blame for the haphazard availability of medical supplies, with drugs often 'disappearing' from government health facilities and sold to private pharmacies by government pharmacists.