Charles Normand Trinity College Dublin for the Motivation Project Team The Relative Importance of Different Motivational Determinants for Different Categories of Health Workers in South Africa, Tanzania And Malawi Charles Normand Trinity College Dublin for the Motivation Project Team

Rationale & Objectives Well-defined list of factors influencing the motivation of health workers But no data on the relative importance of different motivational incentives Little known about preferences of different categories of health workers in different countries Use a Discrete Choice Experiment (DCE) to measure the relative importance of different motivational incentives to different categories of health workers in South Africa, Tanzania and Malawi

Methods Discrete choice experiment (DCE) Preparatory work Quantify relative importance of different motivational attributes on respondent choices Survey of health professionals in each country Stratified cluster sample Self-administered questionnaire Preparatory work Literature review, Country case studies, Several iterations of design, Pilot studies Used SAS program to generate optimal D-efficient design

DCE Questionnaire Generic design Two choices 8 different incentives 16 choice sets Focus on Motivation

DCE Results

DCE Ranking – By Country

DCE Rank – By HW in Malawi

Statistically Significant Interactions: Malawi Male <30 yrs Single Children Compared to EN Satisfied RN CO Allied Small town + Large town Main city – 25% Salary increase 50% Salary increase 75% Salary increase Staffing levels Availability of drugs & equipment Training opportunities Promotion opportunities Recognition from manager Respect from local community

Conclusions The relative importance of different motivational incentives differs between countries. Training opportunities and salary are the most important motivational incentives. Doctors and registered nurses are less motivated to work in rural areas. Satisfied health workers are less motivated by financial incentives. South African health workers have high levels of dissatisfaction and low organisational commitment.

Policy Recommendations Developing training opportunities would be a powerful motivational incentive. Health workers will need to be compensated to persuade them to work in rural areas. Need to pay more attention to building respect from managers and local community. Regular staff satisfaction surveys should be part of HR management information systems.

The End Thank you for your attention