Determinants of Motivation among Healthcare Workers in the East African Community between 2009-2019: A Systematic Review.

Rose Nabi Deborah Karimi Muthuri,Flavia Senkubuge,Charles Hongoro

doi:10.3390/healthcare8020164

Rose Nabi Deborah Karimi Muthuri, Flavia Senkubuge + Show 1 more

Open Access

https://doi.org/10.3390/healthcare8020164

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Abstract

Healthcare workers are an essential element in the functionality of the health system. However, the health workforce impact on health systems tends to be overlooked. Countries within the Sub-Saharan region such as the six in the East African Community (EAC) have weak and sub-optimally functioning health systems. As countries globally aim to attain Universal Health Coverage and the Sustainable Development Goal 3, it is crucial that the significant role of the health workforce in this achievement is recognized. In this systematic review, we aimed to synthesise the determinants of motivation as reported by healthcare workers in the EAC between 2009 and 2019. A systematic search was performed using four databases, namely Cochrane library, EBSCOhost, ProQuest and PubMed. The eligible articles were selected and reviewed based on the authors’ selection criteria. A total of 30 studies were eligible for review. All six countries that are part of the EAC were represented in this systematic review. Determinants as reported by healthcare workers in six countries were synthesised. Individual-level-, organizational/structural- and societal-level determinants were reported, thus revealing the roles of the healthcare worker, health facilities and the government in terms of health systems and the community or society at large in promoting healthcare workers’ motivation. Monetary and non-monetary determinants of healthcare workers’ motivation reported are crucial for informing healthcare worker motivation policy and health workforce strengthening in East Africa.

Highlights

The health workforce is vital to the core functionality of a health system, yet it tends to be overlooked as a key element of upgrading health systems [1]
The reasons for exclusion at the full-text screening stage included studies that assessed a different construct such as satisfaction, efficiency, health system performance and reported motivation (n = 5); a similar study with less detail than the one reviewed with more detail (n = 1); and a study that focused on students, not healthcare workers (n = 1)
To understand the level of support available, and the capacity and motivation of community health workers to deliver these expanded services, we interviewed community medicine distributors (CMDs), who had been involved in the home-based management of fever (HBMF) programme in Tororo district, shortly before integrated community case management (ICCM) was adopted

Summary

Introduction

The health workforce is vital to the core functionality of a health system, yet it tends to be overlooked as a key element of upgrading health systems [1]. 2006 report Working Together for Health, 57 countries reported experiencing critical health workforce shortage [3]. According to WHO, the African region is experiencing both the greatest burden of disease and the lowest density of health workers at 2.2 health workers per 1000 population of healthcare professionals [5]. In the WHO 2006 report, 36 Member States, some of which are part of the East African Community (EAC), were and still are experiencing a critical shortage of human resource for health [3]. Health workforce shortage crisis impedes the performance and quality of healthcare provided, contributing to sub-optimal functionality of health systems. Borghi and colleagues [6] state that the ability of a health system to deliver quality healthcare among the current workforce is partly dependent on healthcare workers’ motivation

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