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Health sector reform and public sector health worker motivation: a conceptual framework

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  • Franco, Lynne Miller
  • Bennett, Sara
  • Kanfer, Ruth
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    Abstract

    Motivation in the work context can be defined as an individual's degree of willingness to exert and maintain an effort towards organizational goals. Health sector performance is critically dependent on worker motivation, with service quality, efficiency, and equity, all directly mediated by workers' willingness to apply themselves to their tasks. Resource availability and worker competence are essential but not sufficient to ensure desired worker performance. While financial incentives may be important determinants of worker motivation, they alone cannot and have not resolved all worker motivation problems. Worker motivation is a complex process and crosses many disciplinary boundaries, including economics, psychology, organizational development, human resource management, and sociology. This paper discusses the many layers of influences upon health worker motivation: the internal individual-level determinants, determinants that operate at organizational (work context) level, and determinants stemming from interactions with the broader societal culture. Worker motivation will be affected by health sector reforms which potentially affect organizational culture, reporting structures, human resource management, channels of accountability, types of interactions with clients and communities, etc. The conceptual model described in this paper clarifies ways in which worker motivation is influenced and how health sector reform can positively affect worker motivation. Among others, health sector policy makers can better facilitate goal congruence (between workers and the organizations they work for) and improved worker motivation by considering the following in their design and implementation of health sector reforms: addressing multiple channels for worker motivation, recognizing the importance of communication and leadership for reforms, identifying organizational and cultural values that might facilitate or impede implementation of reforms, and understanding that reforms may have differential impacts on various cadres of health workers.

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    Bibliographic Info

    Article provided by Elsevier in its journal Social Science & Medicine.

    Volume (Year): 54 (2002)
    Issue (Month): 8 (April)
    Pages: 1255-1266

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    Handle: RePEc:eee:socmed:v:54:y:2002:i:8:p:1255-1266

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    Related research

    Keywords: Health sector reform Health workers Worker motivation;

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    Cited by:
    1. Magnus Lindelow & Pieter Serneels & Teigist Lemma, 2005. "The Performance of Health Workers in Ethiopia Results from Qualitative Research," CSAE Working Paper Series 2005-06, Centre for the Study of African Economies, University of Oxford.
    2. Magrath, Priscilla & Nichter, Mark, 2012. "Paying for performance and the social relations of health care provision: An anthropological perspective," Social Science & Medicine, Elsevier, vol. 75(10), pages 1778-1785.
    3. Barr, Abigail & Lindelow, Magnus & Serneels, Pieter, 2009. "Corruption in public service delivery: An experimental analysis," Journal of Economic Behavior & Organization, Elsevier, vol. 72(1), pages 225-239, October.
    4. Abigail Barr & Magnus Lindelow & Pieter Serneels, 2003. "To serve the community or oneself: the public servant's dilemma," CSAE Working Paper Series 2003-11, Centre for the Study of African Economies, University of Oxford.
    5. Abigail Barr & Magnus Lindelow, 2005. "Intrinsic motivations on the development frontline: Do they exist? Do they endure?," Economics Series Working Papers GPRG-WPS-033, University of Oxford, Department of Economics.
    6. Pieter Serneels & Magnus Lindelow & José Garcia Montalvo & Abigail Barr, 2006. "For public service or money: Understanding geographical imbalances in the health workforce in Ethiopia," Economics Working Papers 989, Department of Economics and Business, Universitat Pompeu Fabra.
    7. Serneels, Pieter & Lindelow, Magnus & Garcia-Montalvo, Jose & Barr, Abigail, 2005. "For public service or money : understanding geographical imbalances in the health workforce," Policy Research Working Paper Series 3686, The World Bank.
    8. Lange, Siri & Mwisongo, Aziza & Mæstad, Ottar, 2014. "Why don't clinicians adhere more consistently to guidelines for the Integrated Management of Childhood Illness (IMCI)?," Social Science & Medicine, Elsevier, vol. 104(C), pages 56-63.
    9. Lewis, Maureen & Pettersson, Gunilla, 2009. "Governance in health care delivery : raising performance," Policy Research Working Paper Series 5074, The World Bank.
    10. Julie Rayner & Alan Lawton & Helen Williams, 2012. "Organizational Citizenship Behavior and the Public Service Ethos: Whither the Organization?," Journal of Business Ethics, Springer, vol. 106(2), pages 117-130, March.
    11. Christopher H. Herbst & Monique Vledder & Karen Campbell & Mirja Sjöblom & Agnes Soucat, 2011. "The Human Resources for Health Crisis in Zambia : An Outcome of Health Worker Entry, Exit, and Performance within the National Health Labor Market," World Bank Publications, The World Bank, number 5938, October.
    12. Pieter Serneels & Abigail Barr, 2005. "Understanding Geographical Imbalances in the Health Workforce," Economics Series Working Papers GPRG-WPS-018, University of Oxford, Department of Economics.
    13. Pinto, Rogério M. & da Silva, Sueli Bulhões & Soriano, Rafaela, 2012. "Community Health Workers in Brazil’s Unified Health System: A framework of their praxis and contributions to patient health behaviors," Social Science & Medicine, Elsevier, vol. 74(6), pages 940-947.
    14. Garcia-Prado, Ariadna, 2005. "Sweetening the carrot : motivating public physicians for better performance," Policy Research Working Paper Series 3772, The World Bank.
    15. Grant Miller & Kimberly Singer Babiarz, 2013. "Pay-for-Performance Incentives in Low- and Middle-Income Country Health Programs," NBER Working Papers 18932, National Bureau of Economic Research, Inc.
    16. Razee, Husna & Whittaker, Maxine & Jayasuriya, Rohan & Yap, Lorraine & Brentnall, Lee, 2012. "Listening to the rural health workers in Papua New Guinea – The social factors that influence their motivation to work," Social Science & Medicine, Elsevier, vol. 75(5), pages 828-835.

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