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Workforce Management

Productivity Improvement

Although few evidence-based tools and techniques exist for measuring and improving health workforce productivity in developing countries, techniques used in developed countries show promise for use in low-resource settings.

In Zambia, Health Systems 20/20 conducted a study to determine the productivity of local health workers, as measured by the proportion of their time spent on direct patient care, nondirect care, and other areas. Based on the findings, the project facilitated a stakeholder-driven process with hospital administrators to identify and remove barriers to optimize productivity in hospitals.

Financial and Non-financial Incentives

Swaziland
In developed countries, there is significant evidence that applying incentives for improved performance also improves retention. In rural and peri-urban clinics throughout Swaziland, Health Systems 20/20 is partnering with the Ministry of Health to apply non-financial incentives for improvements in HIV/AIDS counseling and testing (HCT). When clinics reach a target HCT rate, they can select from a menu of non-financial incentives, such as minor clinic refurbishments (e.g., painting) or equipment such as a computer printer. Through case-control design, Health Systems 20/20 will demonstrate the effectiveness of these incentives on HCT performance and job satisfaction, which is believed to be an important factor in job retention.

Faith-based Institutions
Faith-based institutions are believed to be one of the most efficient mechanisms for health service delivery in sub-Saharan Africa. However, very few attempts have been made to systematically document differences in HRH intrinsic motivation and performance support factors for faith-based health workers compared to public sector health workers. To address this knowledge gap, Health Systems 20/20 conducted a study in Uganda and Malawi to answer the following key research questions:

• What are the levels of intrinsic motivation, retention, and performance factors for health workers in public, faith-based, and private for-profit facilities in Malawi and Uganda?
• What are drivers of intrinsic motivation for health workers in these sectors? How might intrinsic motivation be improved?
• How important is faith as a predictor of intrinsic motivation for health workers?

The study found that intrinsic motivation levels are largely not associated with satisfaction about compensation package. Particularly in the public sector, intrinsic motivation is a primary driver of retention. For health workers in Uganda and Malawi, the biggest drivers of intrinsic motivation are professional development, opportunities for promotion, and the perceived fairness (as opposed to absolute levels) of compensation. See a presentation of findings.