Motivation of health surveillance assistants in Malawi: A qualitative study
Motivation of health surveillance assistants in Malawi: A qualitative study
复制标题
DOI：
10.4314/mmj.v28i2.2
复制
发表时间：
2016-06-01
影响因子：
0.8
通讯作者：
Theobald, Sally
中科院分区：
文献类型：
--
作者：
Chikaphupha, Kingsley R.;Kok, Maryse C.;Theobald, Sally
背景卫生工作者的积极性是绩效的关键组成部分，受多种因素影响。本研究探讨马拉维健康监察助理(HSA)动机的影响因素，目的在于找出可应用于提高HSA动机与绩效的干预措施。方法在Salima和Mchinsi两个地区进行了一项定性研究，了解有意选择的参与者的观点。参与者包括卫生协会、卫生管理人员和各种社区成员。通过焦点小组讨论(n=16)和深入访谈(n=44)收集数据。研究样本包括112名女性和65名男性。结果我们的分析确定了影响HSA动机的五个关键主题：工资、住宿、人力资源管理、用品和物流以及社区联系。其中每一个都在不同的层面上发挥作用--个人、家庭、社区和组织--既有积极的影响，也有消极的影响。消极因素主要与组织层面有关，而激励因素更多地与个人、家庭和社区层面有关。缺乏财政奖励以及基本用品和材料短缺是阻碍HSA积极性的关键因素。监督通常被认为是不支持、不协调和自上而下的。大部分民政事务局局长均投诉工作量繁重。许多卫生行政人员感受到了卫生部的进一步认可和支持，明确的职业道路将提高他们的积极性。结论影响卫生行政人员动机的因素是复杂的和多层次的，一个层面的经历将影响其他层面。需要采取干预措施来加强HSA的动机，包括加强监督系统，发展职业发展途径，并确保明确和透明的激励措施。HSA有独特的经验，需要倾听和解决这些问题，以使HSA能够更好地应对其工作条件的挑战。
BackgroundMotivation of health workers is a critical component of performance and is shaped by multiple factors. This study explored factors that influence motivation of health surveillance assistants (HSAs) in Malawi, with the aim of identifying interventions that can be applied to enhance motivation and performance of HSAs.MethodsA qualitative study capturing the perspectives of purposively selected participants was conducted in two districts: Salima and Mchinji. Participants included HSAs, health managers, and various community members. Data were collected through focus group discussions (n = 16) and in-depth interviews (n = 44). The study sample was comprised of 112 women and 65 men. Qualitative data analysis was informed by existing frameworks on factors influencing health worker motivation.ResultsOur analysis identified five key themes shaping HSA motivation: salary, accommodation, human resource management, supplies and logistics, and community links. Each of these played out at different levels-individual, family, community, and organisational-with either positive or negative effects. Demotivating factors related primarily to the organisational level, while motivating factors were more often related to individual, family, and community levels. A lack of financial incentives and shortages of basic supplies and materials were key factors demotivating HSAs. Supervision was generally perceived as unsupportive, uncoordinated, and top-down. Most HSAs complained of heavy workload. Many HSAs felt further recognition and support from the Ministry of Health, and the development of a clear career pathway would improve their motivation.ConclusionsFactors shaping motivation of HSAs are complex and multilayered; experiences at one level will impact other levels. Interventions are required to enhance HSA motivation, including strengthening the supervision system, developing career progression pathways, and ensuring clear and transparent incentives. HSAs have unique experiences, and there is need to hear and address these to better enable HSAs to cope with the challenging conditions they work in.