Motivation: The Key to Improving the Performance of Frontline Health Workers

31 August 2021, by Ha Anh PHAM

For several months, the COVID-19 pandemic has resulted in frontline health workers’ non-stop physical and emotional burnout, especially those in low- and middle-income countries (LMICs). As health workers are constantly responding to changes in their environment, they need motivation to take actions in the face of fluctuating circumstances. It is crucial for health leaders to have a closer look at health workers’ motivation that ultimately impacts their performance.

Why Is Motivation Important?

Health worker shortage, along with poor working conditions, limited remuneration and incentives, has brought renewed attention to the health worker crisis in terms of improving performance and motivation to meet high and growing demands. Much research has found that clear job expectations, up-to-date knowledge and skills, adequate equipment, supplies, and constructive feedback are the main enablers of FHW’s performance[1]. However, it is inevitable that very few countries’ health systems have all enablers. In developing countries and different regional areas, health workers often struggle with low resource availability, poor hospital infrastructure, fewer opportunities to continue education, and lack of personal recognition or appreciation[2]. Psychology theories state that during times of challenge, change and uncertainty, individuals need motivation to buffer its negative effects. Indeed, in the case of FHWs, highly motivated individuals can overcome constraints such as poor working conditions, personal safety concerns and inadequate equipment.

|As one constantly responds to changes in our environment, they need motivation to take corrective action in the face of fluctuating circumstances. |[3]

The Three Components of Motivation

Fundamentally, motivation is generally defined as the internal (intrinsic) and external (extrinsic) factors that promote and sustain effort toward a goal. Given the complexity of motivation, healthcare leaders are making effort to create conditions within which intrinsic and extrinsic motivation can flourish. Research has identified three main components of motivation[1]:

Perceived importance of the work (Valance). It refers to the value someone puts on the tasks that they are being asked to perform.
Perceived chances for success (Self-Efficacy). It refers to the extent to which we believe we can be successful at our work.
Expectation for personal reward (Expectancy). It is our anticipation of what will happen to us if the work goal is reached. In all cases, work tasks involve some effort on the part of workers. Workers expect something in return. Motivation is likely to suffer when workers think that their hard work will go unnoticed.

Key Strategies to Motivate Health Workers in LMICs

The importance of FHWs motivation shows that taking deliberate steps to enhance one’s task valance, self-efficacy and expectancy is vital to strengthen health workers’ performance and productivity.

Valance

To increase health workers’ perceived importance of task, the impact of the work and how the community and society at-large will benefit should be clearly communicated. Increased perceived importance of task also facilitates health workers’ willingness to further develop their skills and knowledge.

In fact, several GaneshAID’s innovations have incorporated a Community of Practice for institutional discussion in forums of various specific immunization domains. This features not only strengthens the interaction between colleagues, but also allows for the exchange of ideas among them, which ultimately strengthens the value they place on each of their tasks.

Self-Efficacy

For health workers in developing countries, low self-efficacy in health workforce can stem from working long hours in under-staffed and under-resourced conditions with inadequate support from higher-level staffs. To increase a health worker’s belief that they can succeed at a task, they need to be equipped with the required skills and knowledge. Interventions to improve health workers’ motivation should have a great focus on their continuous professional development[4]. Continuous professional development is important for health workers to stay current with the latest research and technologies, emerging health issues and new treatment programs.

One of the popular approaches to this issue is supportive supervision. However, due to time and money consuming nature of supervisory visits, much of supportive supervision does not live up to expectation. Thus, in leveraging supportive supervision, GaneshAID proposed the supportive supervision 2.0, through the application Coach2PEV, which virtually connects the health workers with a supervisor as well as comprises many different helpful features. Remote feedback and two-way communication with their coach mitigates the negative effect of work overload and psychological distress of the coachee. The solution has greatly fostered the competencies of users by providing access to m-learning capsules, up-to-date knowledge library for constant gain of knowledge and a performance measurement tool for self-assessment.

Expectancy

Of the three main motivational factors, expectancy is by far the easiest to impact. In numerous studies, incentive systems, both tangible and intangible have been shown to improve and sustain performance. Examples of tangible rewards include money, prizes, increased benefits such as time off and additional training. Intangible rewards include formal recognition systems and respect from supervisors, peers, and clients.

It is important to note that even though tangible reward might be crucial, it alone cannot affect motivation. FHWs are likely to be demotivated if there is a lack of recognition from the supervisors, peers and communities; as well as limited opportunities for personal growth and career advancement[5]. Therefore, it is important for health workers to be provided with a clear rewards mechanism. For example, in Kyrgyzstan, public posting of performance data paired with supervisory recognition improved FHW’s performance in counselling on sexually transmitted infections[6]. Acknowledging the importance, many solution providers have considered recognition and rewards as one essential aspect when developing solutions. Indeed, all GaneshAID’s capacity building and learning solutions enables performance acknowledgement through ranking and championship, as well as giving end-of-capsules badge and end-of-course certificate for users as a way of recognizing users’ hard work.

Conclusion

The global shortage calls for health leaders to consider whether they are sufficiently optimizing their health workforce to respond to the pandemic and to contribute to longer-term health system resilience. It is crucial that health workers’ motivation components such as valence, self-efficacy, and expectancy are positioned at the heart of every intervention designed to improve performance. At GaneshAID, we believe that the key to a strong health system is a motivated, skilled, and supported health workforce. Indeed, a hallmark of success at GaneshAID are our innovations in digital health learning and mobile application to improve health workforce preparedness and resilience. With the goal of building a well-trained, well-supervised, and well-resourced health workforce, we have developed:

What do you think about the impact of motivation on FHW’s performance? What do you think will be the future initiatives to strengthen FHW’s performance? Please share with us what you think in the comment section below!

Sources:

[1] Increasing the Motivation of Health Care Workers , Marc Luoma, 2006

[2] Motivation and retention of health workers in developing countries: a systematic review, Mischa Willis-Shattuck et al., 2008

[3] The Vital Importance and Benefits of Motivation, Beata Souders, 2021

[4] Job satisfaction and motivation of health workers in public and private sectors: cross-sectional analysis from two Indian states, David H Peters, Subrata Chakraborty, Prasanta Mahapatra & Laura Steinhardt, 2010

[5] Factors Affecting Job Motivation among Health Workers: A Study From Iran, Daneshkohan, et al., 2015

[6] The effects of the public posting of performance data on healthcare workers in Kyrgyzstan, Luoma, M., 2014.