Understanding the Complex Drivers of Intrinsic Motivation for Health Workers in Malawi
Malawi suffers from an acute human resources for health crisis, and in 2003, it was estimated that fewer than 4,000 doctors, nurses, and midwives were serving a population of approximately 12 million (Manafa et al., 2009). In response, the Government of Malawi implemented an Emergency Human Resources Programme (EHRP) to increase the number of health workers employed in the Ministry of Health and Christian Health Association of Malawi (CHAM) sectors. On many levels, the EHRP was a success and across 11 priority cadres, the total number of health workers increased by 53 percent, from 5,453 in 2004 to 8,369 in 2009.
However, the EHRP relied heavily on financial incentives including salary top-ups and did not systematically employ nonfinancial incentives in health facilities. Increasingly, human resource management efforts recognize that the intrinsic motivation of health workers is associated with higher levels of retention and service delivery performance. However, there are few nationally representative studies that measure and determine the predictors of intrinsic motivation across the entire health system, including for public, private for-profit, and faith-based health workers.
The USAID-funded Health Systems 20/20 project conducted a nationally representative study in Malawi and employed both qualitative and quantitative data collection methods to assess statistically significant drivers of intrinsic motivation. 602 health workers of every cadre were interviewed, and 612 randomly sampled clients were interviewed in Malawi to match client perceptions of health care services with health worker motivation levels. Every district in Malawi was sampled and included in data collection. In order to account for the variation in the number of health facilities included in the sample across sectors and geographic clusters, sample weights were computed.
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