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Measuring the motivation of health workers in the DRC

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Rishma maini

Publié dans : Santé
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Measuring the motivation of health workers in the DRC

  1. 1. Rishma Maini, Josephine Borghi, Natasha Palmer, David Hotchkiss Measuring the motivation of health workers in the DRC
  2. 2. Background: The DRC • Poor provision of basic services • Public sector health workers often not paid by government • Donors implementing PBF (performance based financing) programmes for short periods • Little known about health worker motivation in the DRC
  3. 3. Programme changes • Red zones – PBF programme was operating (now stopped) • Green zones – workers were never exposed to PBF
  4. 4. Aims • To measure the determinants and outcomes of motivation in health workers in the DRC • To compare any differences between workers who used to work in a PBF programme (red zones) with health workers who had never worked in a PBF programme (green zones).
  5. 5. Methods DATA COLLECTION • Health worker motivation survey administered in red and green zones, and outside of those zones. • 46 questions on determinants and 16 items on outcomes of motivation (13 constructs) answered using Likert scales ANALYSIS OF QUANTITATIVE DATA • Cronbach’s alpha on pre-defined constructs • Exploratory factor analysis on entire scale • OLS regression model to identify relationships between independent health worker and health facility variables and scores for latent constructs and overall motivation.
  6. 6. CHARACTERISTIC PROPORTION OF WORKERS (n=430) SEX Male 69% Female 31% AGE <30 years 11.2% 30-44 years 59.5% 45-60 years 26.1% >60 years 3.3% POSITION Doctor 0.9% Nurse 89.5% Laboratory worker 1.2% Pharmacy worker 1.4% Traditional birth attendant 2.8% Auxiliaries, medical and nursing assistants 4.2% Sample characteristics
  7. 7. Predefined constructs Construct Cronbach’s alpha Determinants Financial 0.6 Management 0.5 Job description 0.6 Workload 0.7 Training 0.7 Resources 0.6 Work harmony/relationships 0.6 Pride 0.7 Self-efficacy 0.5 Outcomes Timeliness/attendance 0.5 Conscientiousness 0.7 Commitment 0.1 Satisfaction 0.4 Determinants 0.8 Outcomes 0.6 Overall scale 0.8
  8. 8. Latent factors overall scale Intrinsic Extrinsic Individual factors (Competence and autonomy) Opportunities Job tasks /characteristics Working environment /relationships Financial factors Number of items 11 5 8 6 6 % of variance explained 30.3% 23.2% 22.8% 20.6% 20.1% Cronbach’s alpha 0.8 0.7 0.7 0.7 0.5 Cronbach’s alpha full scale 0.8 KMO test 0.8 (middling)
  9. 9. OLS regression Dependent variables: Overall motivation score Scores for constructs of motivation Independent variables: Health worker: Age, gender, health worker position/cadre, education, number of financial dependents, and years worked in position. Health facility: Urban-rural facility, reference or health centre, distance from village, number of services, total personnel, population catchment, and whether in previous PBF-supported zone or not .
  10. 10. OLS regression Mean score for overall motivation weighted by construct and clustered by health facility Explanatory variables β (SE) Full model Reduced model Years in position -0.002 (0.003) Population served 0.000 (0.000) Total personnel -0.006 (0.021) Urban (vs rural) -0.039 (0.069) Number of services 0.031 (0.020) Distance of facility from village -0.004 (0.004) Reference heath centre (vs heath centre) 0.131 (0.084) Nurse (versus other positions) 0.089 (0.064) Age 0.002 (0.002) Male (vs female) 0.058 (0.042) Number of dependents 0.006 (0.004) 0.008 (0.004)* University (vs school education) 0.025 (0.042) PBF removed -0.165 (0.053)** -0.162 (0.047)** Constant 2.546 (0.445)*** 3.458 (0.039)*** Pseudo R2 0.11 0.06 Number observations (n) 348 348 *P≤0.05 **p≤0.01 ***p≤0.001
  11. 11. Strengths and Limitations Strengths Factor analysis widely used method to study the dimensionality of a set of variables High power of data reduction – focus on core elements and not redundant attributes Yielded a parsimonious scale Limitations Factor analysis only as good as the data allows Inclusion of enough questions to start with Multiple motivational frameworks in the literature Could not establish causality around PBF payment removal and motivation
  12. 12. Summary Revealed dimensions relevant to motivation of workers in the DRC Intrinsic and extrinsic motivation framework Results indicate potential consequences of donors exiting from PBF programmes Future research Repeated field testing of needed - confirmatory factor analysis