Healthworkers’ motivation in low- and middle-income countries: A systematic review of the literature
Main Article Content
Abstract
Healthcare systems in low- and middle-income countries (LMICs) face a double burden of workforce challenges: low availability of healthworkers, and poor performance of many in post. Knowledge of what motivates healthworkers in their work may help address both challenges. To understand developments in this area, a systematic review of f literature was conducted. From an initial 4341 papers, 73 met the review’s inclusion criteria, encompassing a mix of focuses, methodologies, and geographical areas. Five themes are identified by healthworkers in the studies reviewed as influencing their motivation: working conditions (54 studies), financial incentives (46 studies), social incentives (37 studies), career development (31 studies) and living conditions (28 studies). As in previous reviews, there is a lack of evidence on the effectiveness of interventions for improving the availability, performance and motivation of healthworkers. A number of areas for further research are highlighted such as: developing effective interventions, understanding the role of context, and analysing the cost-effectiveness of different approaches to attracting and motivating healthworkers.
Article Details
How to Cite
VLAEV, Ivo et al.
Healthworkers’ motivation in low- and middle-income countries: A systematic review of the literature.
Medical Research Archives, [S.l.], v. 5, n. 8, aug. 2017.
ISSN 2375-1924.
Available at: <https://esmed.org/MRA/mra/article/view/1423>. Date accessed: 15 nov. 2024.
Keywords
healthcare, health workforce, motivation, performance, quality, retention
Section
Research Articles
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
References
Adzei, F. A. & Atinga, R. A. (2012). Motivation and retention of health workers in Ghana's
district hospitals: Addressing the critical issues. Journal of Health Organization and Management, 26(4), 467-485.
Agyepong, I. A., Anafi, P., Asiamah, E., Ansah, E. K., Ashon, D. A., & Narh-Dometey, C.
(2004). Health worker (internal customer) satisfaction and motivation in the public sector in Ghana. The International Journal of Health Planning and Management, 19(4), 319-336.
Alameddine, M., Saleh, S., El-Jardali, F., Dimassi, H., & Mourad, Y. (2012). The retention of
health human resources in primary healthcare centers in Lebanon: A national survey. BMC Health Services Research, 12(1), 419.
Antwi, J. & Phillips, D.C. (2012). Wages and health worker retention: Evidence from public
sector wage reforms in Ghana. Journal of Development Economics, 102, 101-105.
Ashmore, J. (2013). 'Going private': A qualitative comparison of medical specialists' job
satisfaction in the public and private sectors of South Africa. Human Resources for Health, 11, 1.
Brock, J. M., Lange, A. & Leonard, K. L. (2012). Generosity norms and intrinsic motivation
in health care provision: evidence from the laboratory and the field. Europe, European Bank for Reconstruction and Redevelopment.
Campbell, C., Scott, K., Madenhire, C., Nyamukapa, C., & Gregson, S. (2011). Sources of
motivation and frustration among healthcare workers administering antiretroviral treatment for HIV in rural Zimbabwe. AIDS Care, 23(7), 797-802.
Chandler, C. I. R., Chonya, S., Mtei, F., Reyburn, H., & Whitty, C. J. M. (2009). Motivation,
money and respect: A mixed-method study of Tanzanian non-physician clinicians. Social Science & Medicine, 68(11), 2078-2088.
Chhea, C., Warren, N., & Manderson, L. (2010). Health worker effectiveness and retention in
rural Cambodia. Rural Remote Health, 10(3), 1391.
Chopra, M., Lawn, J. E., Sanders, D., Barron, P., Karim, S. S. A., Bradshaw, D., Jewkes, R.,
Karim, Q. A., Flisher, A. J., Mayosi, B. M., Tollman, S. M., Churchyard, G. J., & Coovadia, H. (2009). Achieving the health Millennium Development Goals for South Africa: Challenges and priorities. The Lancet, 374(9694), 1023-1031.
Chopra, M., Munro, S., Lavis, J. N., Vist, G., & Bennett, S. (2008). Effects of policy options
for human resources for health: An analysis of systematic reviews. The Lancet, 371, 9613, 668-674.
Das, J. & Hammer, J. (2005). Which doctor? Combining vignettes and item response to
measure clinical competence. Journal of Development Economics, 78(2), 348-383.
Das, J., Hammer, J., & Leonard, K. (2008). The quality of medical advice in low-income
countries. The Journal of Economic Perspectives, 22(2), 93-114.
Delobelle, P., Rawlinson, J. L., Ntuli, S., Malatsi, I., Decock, R., & Depoorter, A. M. (2011).
Job satisfaction and turnover intent of primary healthcare nurses in rural South Africa: A questionnaire survey. Journal of Advanced Nursing, 67(2), 371-383.
Dieleman, M., Kane, S., Zwanikken, P., & Gerretsen, B. (2011). Realist review and synthesis
of retention studies for health workers in rural and remote areas. Geneva, World Health Organization.
Dieleman, M., Cuong, P., Anh, L., & Martineau, T. (2003). Identifying factors for job
motivation of rural health workers in North Viet Nam. Human Resources for Health, 1(1), 10.
Dieleman, M., Gerretsen, B., & van der Wilt, G. J. (2009). Human resource management
interventions to improve health workers' performance in low and middle income countries: a realist review. Health Research Policy and Systems, 7(1), 7.
Dieleman, M., Toonen, J., Toure, H., & Martineau, T. (2006). The match between motivation
and performance management of health sector workers in Mali. Human Resources for Health, 4(1), 2.
Dolea, C., Stormont, L., Shaw, D., Zurn, P., & Braichet, J. (2009). Increasing access to health
workers in remote and rural areas through improved retention. Background Paper for the First Expert Consultations on Developing Global Recommendations on Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention. Geneva, WHO.
Dolea, C., Stormont, L., & Braichet, J. (2010). Evaluated strategies to increase attraction and
retention of health workers in remote and rural areas. Bulletin of the World Health Organization, 88(5), 379-385.
Ebuehi, O. & Campbell, P. (2011). Attraction and retention of qualified health workers to
rural areas in Nigeria: a case study of four LGAs in Ogun State, Nigeria. Rural and Remote Health, 11(1), 1515.
Efendi, F. (2012). Health worker recruitment and deployment in remote areas of Indonesia.
Rural and Remote Health, 12, 2008.
Franco, L. M., Bennett, S., & Kanfer, R. (2002). Health sector reform and public sector
health worker motivation: a conceptual framework. Social Science & Medicine, 54(8), 1255-1266.
Franco, L. M., Bennett, S., Kanfer, R., & Stubblebine, P. (2004). Determinants and
consequences of health worker motivation in hospitals in Jordan and Georgia. Social Science & Medicine, 58(2), 343-355.
Fritzen, S. (2007). Strategic management of the health workforce in developing countries:
what have we learned? Human Resources for Health, 5(1), 4.
Hagopian, A., Zuyderduin, A., Kyobutungi, N., & Yumkella, F. (2009). Job satisfaction and
morale in the Ugandan health workforce. Health Affairs, 28(5), w863-w875.
Hanson, K. & Jack, W. (2008). Health Worker Preferences for Job Attributes in Ethiopia:
Results from a Discrete Choice Experiment. Health Systems for Outcomes, the World Bank.
Hanson, K. & Jack, W. (2010). Incentives could induce Ethiopian doctors and nurses to
work in rural settings. Health Affairs, 29(8), 1452-1460.
Jack, H., Canavan, M., Ofori-Atta, A., Taylor, L., & Bradley, E. (2013). Recruitment and
retention of mental health workers in Ghana. PloS One, 8(2), e57940.
Jayasuriya, R., Whittaker, M., Halim, G., & Matineau, T. (2012). Rural health workers and
their work environment: The role of inter-personal factors on job satisfaction of nurses in rural Papua New Guinea. BMC Health Services Research, 12(1), 156.
Kekana, H., Du Rand, E., & Van Wyk, N. (2007). Job satisfaction of registered nurses in a
community hospital in the Limpopo Province in South Africa. Curationis, 30(2), 24-35.
Kinfu, Y., Dal Poz, M. R., Mercer, H., & Evans, D. B. (2009). The health worker
shortage in Africa: Are enough physicians and nurses being trained? Bulletin of the World
Health Organization, 87, 225-230.
Klopper, H. C., Coetzee, S. K., Pretorius, R., & Bester, P. (2012). Practice environment, job
satisfaction and burnout of critical care nurses in South Africa. Journal of Nursing Management, 20(5), 685-695.
Kotzee, T. & Couper, I. (2006). What interventions do South African qualified doctors think
will retain them in rural hospitals of the Limpopo province of South Africa. Rural Remote Health, 6(3), 581.
Lehmann, U., Dieleman, M., & Martineau, T. (2008). Staffing remote rural areas in middle-
and low-income countries: A literature review of attraction and retention. BMC Health Services Research, 8(1), 19.
Leonard, K. L. & Masatu, M. C. (2010). Professionalism and the know-do gap: Exploring
intrinsic motivation among health workers in Tanzania. Health Economics, 19(12), 1461-1477.
Leonard, K. L., Masatu, M. C., & Vialou, A. (2007). Getting doctors to do their best.
Journal of Human Resources, 42(3), 682-700.
Leonard, K. L. & Masatu, M. C. (2005). The use of direct clinician observation and vignettes
for health services quality evaluation in developing countries. Social Science & Medicine, 61(9), 1944-1951.
Leshabari, M. T., Muhondwa, E., Mwangu, M., & Mbembati, N. (2008). Motivation of health
care workers in Tanzania: A case study of Muhimbili National Hospital. East African Journal of Public Health, 5(1), 32-37.
Lievens, T., Serneels, P., Garabino, S., Quartey, P., Appiah, E., Herbst, C., Lemiere, C.,
Soucat, A., Rose, L., & Saleh, K. (2011). Creating incentives to work in Ghana: Results from a qualitative health worker study. Health, Nutrition and Population (HNP) Discussion Paper, November, World Bank, Washington, DC.
Lephoko, C., Bezuidenhout, M., & Roos, J. (2006). Organisational climate as a cause of
job dissatisfaction among nursing staff in selected hospitals within the Mpumalanga Province. Curationis, 29(4), 28-36.
Luboga, S., Hagopian, A., Ndiku, J., Bancroft, E., & McQuide, P. (2011). Satisfaction,
motivation, and intent to stay among Ugandan physicians: A survey from 18 national hospitals. The International Journal of Health Planning and Management, 26(1), 2-17.
Mæstad, O., Torsvik, G., & Aakvik, A. (2010). Overworked? On the relationship between
workload and health worker performance. Journal of Health Economics, 29(5), 686-698.
Malik, A., Yamamoto, S., Souares, A., Malik, Z., & Sauerborn, R. (2010). Motivational
determinants among physicians in Lahore, Pakistan. BMC Health Services Research, 10(1), 201.
Mangham, L. J. & Hanson, K. (2008). Employment preferences of public sector nurses in
Malawi: Results from a discrete choice experiment. Tropical Medicine & International Health, 13(12), 1433-1441.
Manongi, R., Marchant, T., & Bygbjerg, I. C. (2006). Improving motivation among primary
health care workers in Tanzania: A health worker perspective. Human Resources for Health, 4(1), 6.
Mathauer, I. & Imhoff, I. (2006). Health worker motivation in Africa: The role of non-
financial incentives and human resource management tools. Human Resources for Health, 4(1), 24.
Mbilinyi, D., Daniel, M., & Lie, G.T. (2011). Health worker motivation in the context of
HIV care and treatment challenges in Mbeya Region, Tanzania: A qualitative study. BMC Health Services Research, 11(1), 266.
Mbindyo, P., Gilson, L., Blaauw, D., & English, M. (2009). Contextual influences on health
worker motivation in district hospitals in Kenya. Implementation Science, 4(1), 43.
McAuliffe, E., Manafa, O., Maseko, F., Bowie, C., & White, E. (2009). Understanding job
satisfaction amongst mid-level cadres in Malawi: The contribution of organisational justice. Reproductive Health Matters, 17(33), 80-90.
Mokoka, K., Ehlers, V., & Oosthuizen, M. (2011). Factors influencing the retention of
registered nurses in the Gauteng Province of South Africa. Curationis, 34(1), E1-9.
Mullei, K., Mudhune, S., Wafula, J., Masamo, E., English, M., Goodman, C., Lagarde, M., &
Blaauw, D. (2010). Attracting and retaining health workers in rural areas: Investigating nurses’ views on rural posts and policy interventions. BMC Health Services Research, 10, Suppl 1, S1.
Oman, K. M., Moulds, R., & Usher, K. (2009). Professional satisfaction and dissatisfaction
among Fiji specialist trainees: What are the implications for preventing migration? Qualitative Health Research, 19(9), 1246-1258.
Peabody, J., Shimkhada, R., Quimbo, S., Florentino, J., Bacate, M., McCulloch, C. E., &
Solon, O. (2011). Financial incentives and measurement improved physicians’ quality of care in the Philippines. Health Affairs, 30(4), 773-781.
Penn-Kekana, L., Blaauw, D., Tint, K., Monareng, D., & Chege, J. (2005). Nursing staff
dynamics and implications for maternal health provision in public health facilities in the context of HIV/AIDS. Frontiers in Reproductive Health, Population Council.
Peters, D., Chakraborty, S., Mahapatra, P., & Steinhardt, L. (2010). Job satisfaction and
motivation of health workers in public and private sectors: Cross-sectional analysis from two Indian states. Human Resources for Health, 8(1), 27.
Petticrew, M. & Roberts, H. (2008). Systematic reviews in the social sciences: A practical
guide. Wiley.
Pietersen, C. (2005). Job satisfaction of hospital nursing staff. SA Journal of Human
Resource Management, 3(2), 19-25.
Pillay, R. (2009). Work satisfaction of professional nurses in South Africa: A comparative
analysis of the public and private sectors. Human Resources for Health, 7(1), 15.
Prytherch, H., Kakoko, D. C. V., Leshabari, M. T., Sauerborn, R., & Marx, M. (2012). Maternal
and new born healthcare providers in rural Tanzania: In-depth interviews exploring influences on motivation, performance and job satisfaction. Rural and Remote Health, 12, 2072.
Prytherch, H., Kagone, M., Aninanya, G., Williams, J., Kakoko, D. C. V., Leshabari, M., Ye,
M., Marx, M., & Sauerborn, R. (2013). Motivation and incentives of rural maternal and neonatal health care providers: A comparison of qualitative findings from Burkina Faso, Ghana and Tanzania. BMC Health Services Research, 13(1), 149.
Rao, K. D. (2012). How to attract health workers to rural areas? Findings from a discrete
choice experiment in India. BMC Proceedings, 6, Suppl 5, O1.
Razee, H., Whittaker, M., Jayasuriya, R., Yap, L., & Brentnall, L. (2012). Listening to the
rural health workers in Papua New Guinea: The social factors that influence their motivation to work. Social Science & Medicine, 75(5), 828-835.
Reuter, H. & Couper, I. (2007). Influences on the choice of health professionals to practice
in rural areas. South African Medical Journal, 97(11), 1082-1086.
Robyn, P., Barnighausen, T., Souares, A., Savadogo, G., Bicaba, B., Sie, A., & Sauerborn, R.
(2012). Health worker preferences for community-based health insurance payment mechanisms: A discrete choice experiment. BMC Health Services Research, 12(1), 159.
Rockers, P., Jaskiewicz, W., Kruk, M., Phathammavong, O., Vangkonevilay, P., Paphassarang, C.,
Phachanh, I., Wurts, L., & Tulenko, K. (2013). Differences in preferences for rural job postings between nursing students and practicing nurses: Evidence from a discrete choice experiment in Lao People's Democratic Republic. Human Resources for Health, 11(1), 22.
Rowe, A. K., de Savigny, D., Lanata, C. F., & Victora, C. G. (2005). How can we achieve
and maintain high-quality performance of health workers in low-resource settings? The Lancet, 366(9490), 1026-1035.
Sheikh, A., Naqvi, S. H., Sheikh, K., Naqvi, S. H., & Bandukda, M. (2012a). Physician
migration at its roots: A study on the factors contributing towards a career choice abroad among students at a medical school in Pakistan. Globalization and Health, 15(8), 43.
Sheikh, K., Rajkumari, B., Jain, K., Rao, K., Patanwar, P., Gupta, G., Antony, K. R., &
Sundararaman, T. (2012b). Location and vocation: Why some government doctors stay on in rural Chhattisgarh, India. International Health, 4(3), 192-199.
Sipsma, H., Curry, L., Kakoma, J., Linnander, E., & Bradley, E. (2012). Identifying
characteristics associated with performing recommended practices in maternal and newborn care among health facilities in Rwanda: A cross-sectional study. Human Resources for Health, 10(1), 13.
Snow, R., Asabir, K., Mutumba, M., Koomson, E., Gyan, K., Dzodzomenyo, M., Kruk, M.,
& Kwansah, J. (2011). Key factors leading to reduced recruitment and retention of health professionals in remote areas of Ghana: A qualitative study and proposed policy solutions. Human Resources for Health, 9(1), 13.
Songstad, N.G., Lindkvist, I., Moland, K.M., Chimhutu, V., & Blystad, A. (2012a).
Assessing performance enhancing tools: experiences with the open performance review and appraisal system (OPRAS) and expectations towards payment for performance (P4P) in the public health sector in Tanzania. Globalization and Health, 8(1), 1-13.
Songstad, N. G., Moland, K. M., Massay, D. A., & Blystad, A. (2012b). Why do health
workers in rural Tanzania prefer public sector employment? BMC Health Services Research, 12(1), 92.
Stringhini, S., Thomas, S., Bidwell, P., Mtui, T., & Mwisongo, A. (2009). Understanding
informal payments in health care: Motivation of health workers in Tanzania. Human Resources for Health, 7(1), 53.
Uys, L., Minnaar, A., Reid, S., & Naidoo, J. (2004). The perceptions of nurses in a district
health system in KwaZulu-Natal of their supervision, self-esteem and job satisfaction. Curationis, 27(2), 50-56.
van der Doef, M., Mbazzi, F. B., & Verhoeven, C. (2012). Job conditions, job satisfaction,
somatic complaints and burnout among East African nurses. Journal of Clinical Nursing, 21(11-12), 1763-1775.
Vujicic, M. (2010a). Policy options to attract nurses to rural Liberia: evidence from a
discrete choice experiment. Washington, DC, World Bank.
Vujicic, M., Alfano, M., Shengalia, B., & Witter, S. (2010b). Attracting doctors and medical
students to rural Vietnam: insights from a discrete choice experiment. Washington, DC, HNP Discussion Paper. World Bank.
WHO. (2010). Increasing access to health workers in remote and rural areas through
improved retention: global policy recommendations. , World Health Organization.
WHO. (2007). Everybody's business - strengthening health systems to improve health
outcomes: WHO's framework for action. Geneva: World Health Organization.
WHO. (2006). Working together for health: The World Health Report 2006. Geneva: World
Health Organisation.
Willis-Shattuck, M., Bidwell, P., Thomas, S., Wyness, L., Blaauw, D., & Ditlopo, P. (2008).
Motivation and retention of health workers in developing countries: A systematic review. BMC Health Services Research, 8(1), 247.
Wilson, N., Couper, I., De Vries, E., Reid, S., Fish, T., & Marais, B. (2009). A critical review
of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health, 9(2), 1060.
Witter, S., Ha, B. T. T., Shengalia, B., & Vujicic, M. (2011a). Understanding the ‘four
directions of travel’: Qualitative research into the factors affecting recruitment and retention of doctors in rural Vietnam. Human Resources for Health, 9(1), 1-14.
Witter, S., Zulfiqur, T., Javeed, S., Khan, A., & Bari, A. (2011b). Paying health workers for
performance in Battagram district, Pakistan. Human Resources for Health, 9(1), 23.
World Bank. (2010). Africa Development Indicators 2010: Silent and lethal, how quiet
corruption undermines Africa's development efforts. Washington DC, The World Bank.
Zinnen, V., Paul, E., Mwisongo, A., Nyato, D., & Robert, A. (2012). Motivation of human
resources for health: A case study at rural district level in Tanzania. The International Journal of Health Planning and Management, 27(4), 327-347.
Zurn, P., Codjia, L., Sall, F. L., & Braichet, J. (2010). How to recruit and retain health
workers in underserved areas: the Senegalese experience. Bulletin of the World Health Organization, 88(5), 386-389.
district hospitals: Addressing the critical issues. Journal of Health Organization and Management, 26(4), 467-485.
Agyepong, I. A., Anafi, P., Asiamah, E., Ansah, E. K., Ashon, D. A., & Narh-Dometey, C.
(2004). Health worker (internal customer) satisfaction and motivation in the public sector in Ghana. The International Journal of Health Planning and Management, 19(4), 319-336.
Alameddine, M., Saleh, S., El-Jardali, F., Dimassi, H., & Mourad, Y. (2012). The retention of
health human resources in primary healthcare centers in Lebanon: A national survey. BMC Health Services Research, 12(1), 419.
Antwi, J. & Phillips, D.C. (2012). Wages and health worker retention: Evidence from public
sector wage reforms in Ghana. Journal of Development Economics, 102, 101-105.
Ashmore, J. (2013). 'Going private': A qualitative comparison of medical specialists' job
satisfaction in the public and private sectors of South Africa. Human Resources for Health, 11, 1.
Brock, J. M., Lange, A. & Leonard, K. L. (2012). Generosity norms and intrinsic motivation
in health care provision: evidence from the laboratory and the field. Europe, European Bank for Reconstruction and Redevelopment.
Campbell, C., Scott, K., Madenhire, C., Nyamukapa, C., & Gregson, S. (2011). Sources of
motivation and frustration among healthcare workers administering antiretroviral treatment for HIV in rural Zimbabwe. AIDS Care, 23(7), 797-802.
Chandler, C. I. R., Chonya, S., Mtei, F., Reyburn, H., & Whitty, C. J. M. (2009). Motivation,
money and respect: A mixed-method study of Tanzanian non-physician clinicians. Social Science & Medicine, 68(11), 2078-2088.
Chhea, C., Warren, N., & Manderson, L. (2010). Health worker effectiveness and retention in
rural Cambodia. Rural Remote Health, 10(3), 1391.
Chopra, M., Lawn, J. E., Sanders, D., Barron, P., Karim, S. S. A., Bradshaw, D., Jewkes, R.,
Karim, Q. A., Flisher, A. J., Mayosi, B. M., Tollman, S. M., Churchyard, G. J., & Coovadia, H. (2009). Achieving the health Millennium Development Goals for South Africa: Challenges and priorities. The Lancet, 374(9694), 1023-1031.
Chopra, M., Munro, S., Lavis, J. N., Vist, G., & Bennett, S. (2008). Effects of policy options
for human resources for health: An analysis of systematic reviews. The Lancet, 371, 9613, 668-674.
Das, J. & Hammer, J. (2005). Which doctor? Combining vignettes and item response to
measure clinical competence. Journal of Development Economics, 78(2), 348-383.
Das, J., Hammer, J., & Leonard, K. (2008). The quality of medical advice in low-income
countries. The Journal of Economic Perspectives, 22(2), 93-114.
Delobelle, P., Rawlinson, J. L., Ntuli, S., Malatsi, I., Decock, R., & Depoorter, A. M. (2011).
Job satisfaction and turnover intent of primary healthcare nurses in rural South Africa: A questionnaire survey. Journal of Advanced Nursing, 67(2), 371-383.
Dieleman, M., Kane, S., Zwanikken, P., & Gerretsen, B. (2011). Realist review and synthesis
of retention studies for health workers in rural and remote areas. Geneva, World Health Organization.
Dieleman, M., Cuong, P., Anh, L., & Martineau, T. (2003). Identifying factors for job
motivation of rural health workers in North Viet Nam. Human Resources for Health, 1(1), 10.
Dieleman, M., Gerretsen, B., & van der Wilt, G. J. (2009). Human resource management
interventions to improve health workers' performance in low and middle income countries: a realist review. Health Research Policy and Systems, 7(1), 7.
Dieleman, M., Toonen, J., Toure, H., & Martineau, T. (2006). The match between motivation
and performance management of health sector workers in Mali. Human Resources for Health, 4(1), 2.
Dolea, C., Stormont, L., Shaw, D., Zurn, P., & Braichet, J. (2009). Increasing access to health
workers in remote and rural areas through improved retention. Background Paper for the First Expert Consultations on Developing Global Recommendations on Increasing Access to Health Workers in Remote and Rural Areas through Improved Retention. Geneva, WHO.
Dolea, C., Stormont, L., & Braichet, J. (2010). Evaluated strategies to increase attraction and
retention of health workers in remote and rural areas. Bulletin of the World Health Organization, 88(5), 379-385.
Ebuehi, O. & Campbell, P. (2011). Attraction and retention of qualified health workers to
rural areas in Nigeria: a case study of four LGAs in Ogun State, Nigeria. Rural and Remote Health, 11(1), 1515.
Efendi, F. (2012). Health worker recruitment and deployment in remote areas of Indonesia.
Rural and Remote Health, 12, 2008.
Franco, L. M., Bennett, S., & Kanfer, R. (2002). Health sector reform and public sector
health worker motivation: a conceptual framework. Social Science & Medicine, 54(8), 1255-1266.
Franco, L. M., Bennett, S., Kanfer, R., & Stubblebine, P. (2004). Determinants and
consequences of health worker motivation in hospitals in Jordan and Georgia. Social Science & Medicine, 58(2), 343-355.
Fritzen, S. (2007). Strategic management of the health workforce in developing countries:
what have we learned? Human Resources for Health, 5(1), 4.
Hagopian, A., Zuyderduin, A., Kyobutungi, N., & Yumkella, F. (2009). Job satisfaction and
morale in the Ugandan health workforce. Health Affairs, 28(5), w863-w875.
Hanson, K. & Jack, W. (2008). Health Worker Preferences for Job Attributes in Ethiopia:
Results from a Discrete Choice Experiment. Health Systems for Outcomes, the World Bank.
Hanson, K. & Jack, W. (2010). Incentives could induce Ethiopian doctors and nurses to
work in rural settings. Health Affairs, 29(8), 1452-1460.
Jack, H., Canavan, M., Ofori-Atta, A., Taylor, L., & Bradley, E. (2013). Recruitment and
retention of mental health workers in Ghana. PloS One, 8(2), e57940.
Jayasuriya, R., Whittaker, M., Halim, G., & Matineau, T. (2012). Rural health workers and
their work environment: The role of inter-personal factors on job satisfaction of nurses in rural Papua New Guinea. BMC Health Services Research, 12(1), 156.
Kekana, H., Du Rand, E., & Van Wyk, N. (2007). Job satisfaction of registered nurses in a
community hospital in the Limpopo Province in South Africa. Curationis, 30(2), 24-35.
Kinfu, Y., Dal Poz, M. R., Mercer, H., & Evans, D. B. (2009). The health worker
shortage in Africa: Are enough physicians and nurses being trained? Bulletin of the World
Health Organization, 87, 225-230.
Klopper, H. C., Coetzee, S. K., Pretorius, R., & Bester, P. (2012). Practice environment, job
satisfaction and burnout of critical care nurses in South Africa. Journal of Nursing Management, 20(5), 685-695.
Kotzee, T. & Couper, I. (2006). What interventions do South African qualified doctors think
will retain them in rural hospitals of the Limpopo province of South Africa. Rural Remote Health, 6(3), 581.
Lehmann, U., Dieleman, M., & Martineau, T. (2008). Staffing remote rural areas in middle-
and low-income countries: A literature review of attraction and retention. BMC Health Services Research, 8(1), 19.
Leonard, K. L. & Masatu, M. C. (2010). Professionalism and the know-do gap: Exploring
intrinsic motivation among health workers in Tanzania. Health Economics, 19(12), 1461-1477.
Leonard, K. L., Masatu, M. C., & Vialou, A. (2007). Getting doctors to do their best.
Journal of Human Resources, 42(3), 682-700.
Leonard, K. L. & Masatu, M. C. (2005). The use of direct clinician observation and vignettes
for health services quality evaluation in developing countries. Social Science & Medicine, 61(9), 1944-1951.
Leshabari, M. T., Muhondwa, E., Mwangu, M., & Mbembati, N. (2008). Motivation of health
care workers in Tanzania: A case study of Muhimbili National Hospital. East African Journal of Public Health, 5(1), 32-37.
Lievens, T., Serneels, P., Garabino, S., Quartey, P., Appiah, E., Herbst, C., Lemiere, C.,
Soucat, A., Rose, L., & Saleh, K. (2011). Creating incentives to work in Ghana: Results from a qualitative health worker study. Health, Nutrition and Population (HNP) Discussion Paper, November, World Bank, Washington, DC.
Lephoko, C., Bezuidenhout, M., & Roos, J. (2006). Organisational climate as a cause of
job dissatisfaction among nursing staff in selected hospitals within the Mpumalanga Province. Curationis, 29(4), 28-36.
Luboga, S., Hagopian, A., Ndiku, J., Bancroft, E., & McQuide, P. (2011). Satisfaction,
motivation, and intent to stay among Ugandan physicians: A survey from 18 national hospitals. The International Journal of Health Planning and Management, 26(1), 2-17.
Mæstad, O., Torsvik, G., & Aakvik, A. (2010). Overworked? On the relationship between
workload and health worker performance. Journal of Health Economics, 29(5), 686-698.
Malik, A., Yamamoto, S., Souares, A., Malik, Z., & Sauerborn, R. (2010). Motivational
determinants among physicians in Lahore, Pakistan. BMC Health Services Research, 10(1), 201.
Mangham, L. J. & Hanson, K. (2008). Employment preferences of public sector nurses in
Malawi: Results from a discrete choice experiment. Tropical Medicine & International Health, 13(12), 1433-1441.
Manongi, R., Marchant, T., & Bygbjerg, I. C. (2006). Improving motivation among primary
health care workers in Tanzania: A health worker perspective. Human Resources for Health, 4(1), 6.
Mathauer, I. & Imhoff, I. (2006). Health worker motivation in Africa: The role of non-
financial incentives and human resource management tools. Human Resources for Health, 4(1), 24.
Mbilinyi, D., Daniel, M., & Lie, G.T. (2011). Health worker motivation in the context of
HIV care and treatment challenges in Mbeya Region, Tanzania: A qualitative study. BMC Health Services Research, 11(1), 266.
Mbindyo, P., Gilson, L., Blaauw, D., & English, M. (2009). Contextual influences on health
worker motivation in district hospitals in Kenya. Implementation Science, 4(1), 43.
McAuliffe, E., Manafa, O., Maseko, F., Bowie, C., & White, E. (2009). Understanding job
satisfaction amongst mid-level cadres in Malawi: The contribution of organisational justice. Reproductive Health Matters, 17(33), 80-90.
Mokoka, K., Ehlers, V., & Oosthuizen, M. (2011). Factors influencing the retention of
registered nurses in the Gauteng Province of South Africa. Curationis, 34(1), E1-9.
Mullei, K., Mudhune, S., Wafula, J., Masamo, E., English, M., Goodman, C., Lagarde, M., &
Blaauw, D. (2010). Attracting and retaining health workers in rural areas: Investigating nurses’ views on rural posts and policy interventions. BMC Health Services Research, 10, Suppl 1, S1.
Oman, K. M., Moulds, R., & Usher, K. (2009). Professional satisfaction and dissatisfaction
among Fiji specialist trainees: What are the implications for preventing migration? Qualitative Health Research, 19(9), 1246-1258.
Peabody, J., Shimkhada, R., Quimbo, S., Florentino, J., Bacate, M., McCulloch, C. E., &
Solon, O. (2011). Financial incentives and measurement improved physicians’ quality of care in the Philippines. Health Affairs, 30(4), 773-781.
Penn-Kekana, L., Blaauw, D., Tint, K., Monareng, D., & Chege, J. (2005). Nursing staff
dynamics and implications for maternal health provision in public health facilities in the context of HIV/AIDS. Frontiers in Reproductive Health, Population Council.
Peters, D., Chakraborty, S., Mahapatra, P., & Steinhardt, L. (2010). Job satisfaction and
motivation of health workers in public and private sectors: Cross-sectional analysis from two Indian states. Human Resources for Health, 8(1), 27.
Petticrew, M. & Roberts, H. (2008). Systematic reviews in the social sciences: A practical
guide. Wiley.
Pietersen, C. (2005). Job satisfaction of hospital nursing staff. SA Journal of Human
Resource Management, 3(2), 19-25.
Pillay, R. (2009). Work satisfaction of professional nurses in South Africa: A comparative
analysis of the public and private sectors. Human Resources for Health, 7(1), 15.
Prytherch, H., Kakoko, D. C. V., Leshabari, M. T., Sauerborn, R., & Marx, M. (2012). Maternal
and new born healthcare providers in rural Tanzania: In-depth interviews exploring influences on motivation, performance and job satisfaction. Rural and Remote Health, 12, 2072.
Prytherch, H., Kagone, M., Aninanya, G., Williams, J., Kakoko, D. C. V., Leshabari, M., Ye,
M., Marx, M., & Sauerborn, R. (2013). Motivation and incentives of rural maternal and neonatal health care providers: A comparison of qualitative findings from Burkina Faso, Ghana and Tanzania. BMC Health Services Research, 13(1), 149.
Rao, K. D. (2012). How to attract health workers to rural areas? Findings from a discrete
choice experiment in India. BMC Proceedings, 6, Suppl 5, O1.
Razee, H., Whittaker, M., Jayasuriya, R., Yap, L., & Brentnall, L. (2012). Listening to the
rural health workers in Papua New Guinea: The social factors that influence their motivation to work. Social Science & Medicine, 75(5), 828-835.
Reuter, H. & Couper, I. (2007). Influences on the choice of health professionals to practice
in rural areas. South African Medical Journal, 97(11), 1082-1086.
Robyn, P., Barnighausen, T., Souares, A., Savadogo, G., Bicaba, B., Sie, A., & Sauerborn, R.
(2012). Health worker preferences for community-based health insurance payment mechanisms: A discrete choice experiment. BMC Health Services Research, 12(1), 159.
Rockers, P., Jaskiewicz, W., Kruk, M., Phathammavong, O., Vangkonevilay, P., Paphassarang, C.,
Phachanh, I., Wurts, L., & Tulenko, K. (2013). Differences in preferences for rural job postings between nursing students and practicing nurses: Evidence from a discrete choice experiment in Lao People's Democratic Republic. Human Resources for Health, 11(1), 22.
Rowe, A. K., de Savigny, D., Lanata, C. F., & Victora, C. G. (2005). How can we achieve
and maintain high-quality performance of health workers in low-resource settings? The Lancet, 366(9490), 1026-1035.
Sheikh, A., Naqvi, S. H., Sheikh, K., Naqvi, S. H., & Bandukda, M. (2012a). Physician
migration at its roots: A study on the factors contributing towards a career choice abroad among students at a medical school in Pakistan. Globalization and Health, 15(8), 43.
Sheikh, K., Rajkumari, B., Jain, K., Rao, K., Patanwar, P., Gupta, G., Antony, K. R., &
Sundararaman, T. (2012b). Location and vocation: Why some government doctors stay on in rural Chhattisgarh, India. International Health, 4(3), 192-199.
Sipsma, H., Curry, L., Kakoma, J., Linnander, E., & Bradley, E. (2012). Identifying
characteristics associated with performing recommended practices in maternal and newborn care among health facilities in Rwanda: A cross-sectional study. Human Resources for Health, 10(1), 13.
Snow, R., Asabir, K., Mutumba, M., Koomson, E., Gyan, K., Dzodzomenyo, M., Kruk, M.,
& Kwansah, J. (2011). Key factors leading to reduced recruitment and retention of health professionals in remote areas of Ghana: A qualitative study and proposed policy solutions. Human Resources for Health, 9(1), 13.
Songstad, N.G., Lindkvist, I., Moland, K.M., Chimhutu, V., & Blystad, A. (2012a).
Assessing performance enhancing tools: experiences with the open performance review and appraisal system (OPRAS) and expectations towards payment for performance (P4P) in the public health sector in Tanzania. Globalization and Health, 8(1), 1-13.
Songstad, N. G., Moland, K. M., Massay, D. A., & Blystad, A. (2012b). Why do health
workers in rural Tanzania prefer public sector employment? BMC Health Services Research, 12(1), 92.
Stringhini, S., Thomas, S., Bidwell, P., Mtui, T., & Mwisongo, A. (2009). Understanding
informal payments in health care: Motivation of health workers in Tanzania. Human Resources for Health, 7(1), 53.
Uys, L., Minnaar, A., Reid, S., & Naidoo, J. (2004). The perceptions of nurses in a district
health system in KwaZulu-Natal of their supervision, self-esteem and job satisfaction. Curationis, 27(2), 50-56.
van der Doef, M., Mbazzi, F. B., & Verhoeven, C. (2012). Job conditions, job satisfaction,
somatic complaints and burnout among East African nurses. Journal of Clinical Nursing, 21(11-12), 1763-1775.
Vujicic, M. (2010a). Policy options to attract nurses to rural Liberia: evidence from a
discrete choice experiment. Washington, DC, World Bank.
Vujicic, M., Alfano, M., Shengalia, B., & Witter, S. (2010b). Attracting doctors and medical
students to rural Vietnam: insights from a discrete choice experiment. Washington, DC, HNP Discussion Paper. World Bank.
WHO. (2010). Increasing access to health workers in remote and rural areas through
improved retention: global policy recommendations. , World Health Organization.
WHO. (2007). Everybody's business - strengthening health systems to improve health
outcomes: WHO's framework for action. Geneva: World Health Organization.
WHO. (2006). Working together for health: The World Health Report 2006. Geneva: World
Health Organisation.
Willis-Shattuck, M., Bidwell, P., Thomas, S., Wyness, L., Blaauw, D., & Ditlopo, P. (2008).
Motivation and retention of health workers in developing countries: A systematic review. BMC Health Services Research, 8(1), 247.
Wilson, N., Couper, I., De Vries, E., Reid, S., Fish, T., & Marais, B. (2009). A critical review
of interventions to redress the inequitable distribution of healthcare professionals to rural and remote areas. Rural Remote Health, 9(2), 1060.
Witter, S., Ha, B. T. T., Shengalia, B., & Vujicic, M. (2011a). Understanding the ‘four
directions of travel’: Qualitative research into the factors affecting recruitment and retention of doctors in rural Vietnam. Human Resources for Health, 9(1), 1-14.
Witter, S., Zulfiqur, T., Javeed, S., Khan, A., & Bari, A. (2011b). Paying health workers for
performance in Battagram district, Pakistan. Human Resources for Health, 9(1), 23.
World Bank. (2010). Africa Development Indicators 2010: Silent and lethal, how quiet
corruption undermines Africa's development efforts. Washington DC, The World Bank.
Zinnen, V., Paul, E., Mwisongo, A., Nyato, D., & Robert, A. (2012). Motivation of human
resources for health: A case study at rural district level in Tanzania. The International Journal of Health Planning and Management, 27(4), 327-347.
Zurn, P., Codjia, L., Sall, F. L., & Braichet, J. (2010). How to recruit and retain health
workers in underserved areas: the Senegalese experience. Bulletin of the World Health Organization, 88(5), 386-389.