Abstract
BackgroundFinancial incentives are widely used in performance-based financing (PBF) schemes, but their contribution to health workers’ incomes and job motivation is poorly understood. Cambodia undertook health sector reform from the middle of 2009 and PBF was employed as a part of the reform process.ObjectiveThis study examines job motivation for primary health workers (PHWs) under PBF reform in Cambodia and assesses the relationship between job motivation and income.DesignA cross-sectional self-administered survey was conducted on 266 PHWs, from 54 health centers in the 15 districts involved in the reform. The health workers were asked to report all sources of income from public sector jobs and provide answers to 20 items related to job motivation. Factor analysis was conducted to identify the latent variables of job motivation. Factors associated with motivation were identified through multivariable regression.ResultsPHWs reported multiple sources of income and an average total income of US$190 per month. Financial incentives under the PBF scheme account for 42% of the average total income. PHWs had an index motivation score of 4.9 (on a scale from one to six), suggesting they had generally high job motivation that was related to a sense of community service, respect, and job benefits. Regression analysis indicated that income and the perception of a fair distribution of incentives were both statistically significant in association with higher job motivation scores.ConclusionsFinancial incentives used in the reform formed a significant part of health workers’ income and influenced their job motivation. Improving job motivation requires fixing payment mechanisms and increasing the size of incentives. PBF is more likely to succeed when income, training needs, and the desire for a sense of community service are addressed and institutionalized within the health system.
Highlights
The poor quality of health services continues to impede progress toward improving both access to and the use of essential public health services in low- and middle-income countries (LMICs) [1]
This study examines job motivation for primary health workers (PHWs) under performance-based financing (PBF) reform in Cambodia and assesses the relationship between job motivation and income
This study explores what drives job motivation for primary health workers (PHWs) in Cambodia and assesses whether and by how much job motivation is affected by income and the financial incentives used in the PBF reform
Summary
The poor quality of health services continues to impede progress toward improving both access to and the use of essential public health services in low- and middle-income countries (LMICs) [1]. Health workers may be motivated by several factors They may, for example, be motivated because they have been trained for the job and feel they have the ability to perform well, and/or they expect a return either monetary, such as financial incentives or income, or non-pecuniary, such as trust or reputation. Structures, processes, resources, relationships with peers, and institutional rules may affect motivation and the ability to deliver a service. This includes the sense of belonging and justice within the International License (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix, transform, and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license. PBF is more likely to succeed when income, training needs, and the desire for a sense of community service are addressed and institutionalized within the health system
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