Untangling Intrinsic Motivation of Health Workers in Uganda and Malawi

1. Untangling Intrinsic Motivation of Health Workers in Uganda and Malawi Ilana Ron Research Associate, Abt Associates Prepared by: Ilana Ron, Allison Goldberg, Paul Kiwanuka-Mukiibi June 16, 2011

2. Presentation Outline • Conventional Wisdom and Overarching Research Questions • Brief Overview of Study Methodology • Limitations of Study • Results from Data Analyses • Summary and Parting Thoughts

3. Background and Conventional Wisdom • Funded by USAID/Washington and USAID/Malawi as part of Health Systems 20/20 project • Faith-based institutions (often Christian Health Associations) are better able to attract, retain, and motivate staff than their public counterparts • Recent attention by donors given to a wide variety of financial and non-financial incentive schemes to improve health worker performance and motivation

4. Overarching Research Questions • What are the levels of intrinsic motivation, retention, and performance factors for health workers in public, faith-based (Christian Health), 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?

5. Brief Overview of Methodology • Equal probability systematic sample selected • Uganda: 311 health workers from 91 health facilities (all size levels) interviewed from 20 districts • Malawi: 602 health workers from 163 health facilities from every district in Malawi interviewed; in addition, 612 clients interviewed • Both qualitative and quantitative data collection • Very rich dataset on intrinsic motivation; over 900 health workers from all cadres interviewed

6. Limitations of Study • Sample size in each cadre is too small to drill down into results for each cadre; results are a profile of a cadre overall • Faith-based sector included Christian Health facilities, not Muslim facilities • Data around intrinsic motivation, retention and job satisfaction are not matched with health outcomes; we do not know if more motivated health workers actually perform better (but we assume that they do)

7. Results

8. Intrinsic Motivation Factors • Feeling of being good at the job • Feeling of being able to successfully complete all assigned tasks • Feeling of being proud of job and position at the facility • Opportunities for growth and development • Role of faith • Daniel Pink definition: internal motivators like enjoyment of work, genuine achievement, personal growth

9. Malawi: Comparison of Means on Overall Morale & Job Satisfaction and Overall Intrinsic Motivation Across Sectors • Average levels of overall morale & job satisfaction and overall intrinsic motivation are not substantively different across sectors • Overall, health workers across all sectors report that they are only generally satisfied with their jobs, yet highly motivated to complete them

10. Malawi: Impact of Compensation and Faith & Religion on Intrinsic Motivation • Health workers’ overall level of satisfaction with compensation is not significantly associated with their overall level of intrinsic motivation. This means that compensation is not a driver of health worker motivation, except in the case of CHAM facilities without SLA (.26*). • Strong religious values are significantly associated with health workers’ overall level of intrinsic motivation • The importance of working in a religious environment is associated with higher levels of overall job satisfaction (but less strongly than individual religiosity)

11. Uganda: Motivation and Satisfaction Factors

12. Uganda: Predictors of Intrinsic Motivation • Strongest predictors of satisfaction and motivation: • Adequate equipment and supplies to do job • Professional development opportunities • Feeling of being “good at job” • Fair pay [*not high pay*] compared to others doing similar work • Only predictor of satisfaction and motivation related to faith: • Feeling that religion can help a health worker serve a client well

13. Extrinsic Motivation Factors • Compensation • Benefits

14. Malawi: Impact of Compensation and Intrinsic Motivation on Retention • Health workers’ overall level of satisfaction with compensation is not significantly associated with their intention to stay at the facility where they are working • Reasons to stay at facility: convenience (e.g. house and family are nearby and transport is accessible) and the opportunity to learn from experienced colleagues • Health workers’ intrinsic motivation is significantly associated with the decision to retain employment in the public sector. • Intrinsic motivation is only a primary driver of retention in public sector facilities

15. Uganda: Compensation and Retention Factors

16. Summary and Parting Thoughts • Very large dataset; only a very small sub-section of results able to be presented today • Several key themes emerging: • 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 • Biggest drivers of intrinsic motivation: professional development, opportunities for promotion, fairness of compensation • Religiosity is an important driver of motivation but exists at the individual and workplace level in the public as well as the FBO sector • Striking the balance between intrinsic and extrinsic motivators is key but difficult

17. Thank you www.HealthSystems2020.org