IFGH 2012: The Implementation Challenges of Improving Motivation Through Better Financial Incentives in South Africa, Malawi and Tanzania

January 30, 2012

Authors:Bidwell P.1*, Thomas S.1, Ditlopo P.2, Chirwa M.3, Revill P.1

Author Affiliations:1Centre for  Global Health, Trinity College Dublin, Ireland, 2CCentre for Health Policy, University of the Witwatersrand, South Africa, 3Department of Community Health, College of Medicine, Malawi

Option 2– Lessons from the field; project and programme evaluations; and syntheses or analyses Presented as – Oral Presentation


Boosting financial incentives are one of the most popular strategies to increase motivation and retention and address the human resource for health crisis. Nevertheless, it important to review the way in which such initiatives are implemented and this may affect both the development of the policy and its reception. The Motivation Project evaluated incentive initiatives that are currently being implemented in South Africa, Malawi and Tanzania to improve health worker motivation and retention. Both financial and non-financial initiatives were identified within each project country. The Project results found that despite increased financial incentives health workers are still not satisfied with their remuneration


Hogwood and Gunn’s ten step policy implementation model was used to explore issues and identify areas which may have constrained the success of the salary increase policies. The model outlines conditions for ideal implementation and this framework was utilized in order to reflect on the experiences of the three countries and draw lessons for implementing policies to increase motivation through financial incentives in similar settings.

Lessons learned:

There are some common weaknesses of policy implementation across all the countries. First, there were problems around communication and coordination. In addition, initiatives to boost financial incentives were conducted in an atmosphere of poor relations between government and health workers. Such resentment may be a strong external constraint to impede the success of policies.

Next steps:

In particular it is important to manage expectations with financial incentive policies, through clear rationale, very clear communication and careful timing. It appears that none of the countries forecast how the situation would develop and no country was prepared for the conflict which arose as a consequence of the policies.


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