IFGH 2012: The Relative Importance of Different Motivational Determinants for Different Categories of Health Workers in South Africa, Tanzania and Malawi

January 30, 2012

Authors: Blaauw D.1, Ditlopo P.1, Maseko F.2, Chirwa M.2, Mwisonga A.3, Bidwell P.4, Thomas S.4, Normand C.4

Author Affiliations:1Centre for  Health Policy, University of the Witwatersrand, Johannesburg, South Africa, 2 College of Medicine, University of Malawi, Blantyre, Malawi, 3National Institute for Medical Research, Dar es Salaam, Tanzania, 4Centre for Global Health, Trinity College, University of Dublin, Dublin, Ireland

Option 1– Scientific / Empirical Research Findings Presented as – Oral Presentation


Improving health worker motivation is critical to improving the performance of health systems in low- and middle-income countries. The list of factors that influence health worker motivation has been well researched but little is known about the relative importance of these factors. There are also few formal comparisons of the preferences of different cadres in different countries. As part of the Motivation Project this study used a Discrete Choice Experiment (DCE) to measure the relative importance of motivational determinants for different health worker categories in South Africa, Tanzania and Malawi.


Multi-level stratified sampling strategies, customized for each country, were used to select a representative sample of health workers. A DCE was designed to quantify the relative importance of different motivational factors, namely: salary, staffing levels, availability of drugs and equipment, training opportunities, promotion opportunities, recognition from management, and community respect. Mixed logit models were used for analysis. Differences between sub-groups were formally tested by including interaction terms in the models.



A total of 2,221 questionnaires were analyzed (717 from South Africa, 937 from Malawi, 567 from Tanzania). Training opportunities, job location and salary were key motivational determinants. However, the relative importance of determinants varied between countries, cadres and individuals. For example, a 75% salary rise increased the odds of being motivated 2.4 [95%CI: 2.2-2.6] times in South Africa and 2.7 [95%CI: 2.3-3.1] times in Malawi, while training increased the odds of being motivated 5.1 [95%CI: 3.0-6.4] times in Malawi and 1.5 [95%CI: 1.4-1.6] times in Tanzania. There was significant individual heterogeneity for many motivational determinants, and significant differences between different cadres and socio-demographic groups.

Discussion/conclusions/ implications:

DCEs can provide interval data on the relative importance of different motivational determinants. Such data is essential for the development of more targeted human resource policy interventions to improve health worker motivation and performance.




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