Institute of Public Health, University of Heidelberg, Im Neuenheimer Feld 324, Heidelberg, 69120, Germany.
BMC Health Serv Res. 2013 Apr 25;13:149. doi: 10.1186/1472-6963-13-149.
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.
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.
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.
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.
在布基纳法索、加纳和坦桑尼亚，正在做出巨大努力以提高孕产妇和新生儿健康（MNH）护理的质量。然而，进展受到了挑战，尤其是在人力资源领域。这三个国家不仅在努力增加现有的卫生工作人员数量，还通过提高技能水平和增强提供者的积极性来提高绩效。
使用深入访谈探讨了农村布基纳法索、加纳和坦桑尼亚的 MNH 提供者对初级保健水平的激励措施和激励措施的看法。在每个国家，都对 25 名 MNH 提供者、8 名设施和区管理人员以及 2 名政策制定者进行了访谈。
在这三个国家，人们成为卫生工作者的原因存在一些差异。对成为卫生工作者的承诺普遍较高。愿意留在农村机构的意愿要低得多，尽管在所有环境中，都有一些愿意留下来的提供者。在布基纳法索，似乎特别难以招募女性 MNH 提供者到农村地区。有迹象表明，所有环境中的 MNH 提供者有时未能很好地对待他们的患者。这与对“激励”一词的理解差异以及对薪酬和农村卫生工作的地位的看法有关。工作满意度很高，与社区的赞赏密切相关。除了一些重要的例外，这些提供者都强烈认同所建议的财务和非财务激励措施，但在激励措施应该针对个人还是团队方面，存在明显的国别偏好。
对激励措施相关术语和概念的理解在三个国家之间存在差异。布基纳法索的研究结果强调了制定对性别敏感的卫生人力规划的重要性。所有 MNH 提供者接受的职业道德培训以及在实践中对这方面的强化需要给予更多关注。这三个国家的研究结果存在差异，这突显了深入的国家一级研究的重要性，以制定适合激励措施计划。
