Background
Theories on health worker motivation
Indian context
Methods
Results
Demographics of health workers
STATE (AP) | STATE (UP) | |||
---|---|---|---|---|
Public
|
Private
|
Public
|
Private
| |
n = 290 | n = 331 | n = 875 | n = 420 | |
Sex
| ||||
Male | 55.2% | 57.7% | 66.7% | 58.6% |
Female | 44.8% | 42.3% | 33.3% | 41.4% |
Age
| ||||
< 30 Years | 10.7% | 23.9% | 5.6% | 20.7% |
30-45 Years | 68.6% | 50.5% | 69.0% | 58.3% |
> 45 Years | 20.7% | 25.7% | 25.4% | 21.0% |
Position
| ||||
Doctor | 82.4% | 74.0% | 65.2% | 79.1% |
Nurse | 17.6% | 26.0% | 34.8% | 21.0% |
Identification of main factors of job characteristics
Rotated component matrix | ||||
---|---|---|---|---|
Component correlation
| ||||
1
Job content &
work environment
|
2
Extrinsic
benefits
|
3
Autonomy &
security
|
4
Transparency
| |
Challenging work |
0.714
| -0.028 | 0.095 | 0.039 |
Training opportunities |
0.680
| 0.158 | -0.064 | -0.007 |
Tools to use skills on the job |
0.667
| 0.202 | 0.131 | 0.137 |
Good working relationship with colleagues |
0.602
| 0.177 | -0.025 | -0.053 |
Good physical conditions |
0.591
| 0.203 | 0.028 | 0.072 |
Knowing what you are expected to do |
0.511
| 0.280 | 0.156 | 0.079 |
Good employment benefits | 0.171 |
0.748
| 0.128 | -0.040 |
Good income | 0.013 |
0.644
| 0.048 | 0.142 |
Opportunity to advance | 0.360 |
0.617
| 0.125 | -0.043 |
Time for family life | 0.089 |
0.563
| -0.093 | 0.039 |
Based in good location | 0.343 |
0.520
| 0.082 | -0.082 |
Keeping job as long as you want | 0.081 | 0.148 |
0.735
| 0.078 |
Independence from interference | 0.046 | 0.017 |
0.727
| -0.174 |
Not having work influenced by political decisions | 0.002 | 0.038 | -0.270 |
0.666
|
Not having to pay bribes to get what you want | 0.099 | -0.020 | 0.107 |
0.787
|
Superior who recognized work | 0.351 | 0.488 | 0.228 | -0.015 |
Trusted by clients | 0.460 | 0.147 | 0.335 | 0.378 |
Importance ratings for ideal job characteristics
INDICATOR | STATE(AP) | STATE(UP) | ||
---|---|---|---|---|
Public
|
Private
|
Public
|
Private
| |
Job content & work environment
| ||||
Challenging work | 88.6 | 83.9 |
93.3
|
91.6*
|
Training opportunities |
90.3
|
81.5**
| 96.0 | 93.2 |
Tools to use skills on the job | 83.4 | 84.2 |
96.8
|
93**
|
Good working relationships with colleagues | 93.8 | 90.6 | 98.7 | 97.8 |
Good physical conditions | 90.7 | 90.6 | 93.5 | 94.2 |
Knowing what you are expected to do |
83.0
|
72.3**
| 92.3 | 89.6 |
Extrinsic benefits
| ||||
Good employment benefits |
76.2
|
53.3***
|
94.0
|
65.8***
|
Good income | 74.4 | 66.5 |
82.1
|
73.4***
|
Opportunity to advance | 72.0 | 65.3 |
94.3
|
77.7***
|
Time for family life | 77.9 | 75.8 |
93.9
|
85.5***
|
Based in good location |
83.1
|
72.5**
|
93.8
|
84.3***
|
Autonomy & security
| ||||
Keeping job as long as you want | 57.2 | 52.7 | 70.2 | 73.3 |
Independence from interference | 58.9 | 49.7* | 56.0 | 61.6 |
Transparency
| ||||
Not having to pay bribes to get what you want | 75.5 | 74.1 | 85.5 | 87.9 |
Not having work influenced by political decisions | 80.3 | 79.5 |
74.0
|
85.9***
|
Other
| ||||
Trusted by clients | 70.6 | 74.4 | 94.8 | 93.2 |
Superior who recognizes work |
74.7
|
60.7***
|
92.9
|
68.8***
|
Ratings of actual presence of characteristics in current job
INDICATOR | STATE(AP) | STATE(UP) | ||
---|---|---|---|---|
Public
|
Private
|
Public
|
Private
| |
Job content & work environment
| ||||
Challenging work | 61.4 | 62.3 |
54.0
|
74.0***
|
Training opportunities | 41.3 | 52.3 |
29.3
|
49.0***
|
Tools to use skills on the job |
34.8
|
55.3***
|
37.6
|
75.5***
|
Good working relationships with colleagues | 83.4 | 79.0 |
80.5
|
90.1***
|
Good physical conditions | 54.2 | 61.5 |
43.6
|
78.7***
|
Knowing what you are expected to do | 61.2 | 62.1 |
63.4
|
79.5***
|
Extrinsic benefits
| ||||
Good employment benefits |
43.1
|
22.5***
|
45.3
|
22.2***
|
Good income | 34.6 | 39.7 | 43.5 | 45.2 |
Opportunity to advance | 33.7 | 36.5 |
34.1
|
41.4*
|
Time for family life | 32.9 | 38.5 |
47.4
|
55.0*
|
Based in good location |
47.8
|
56.9*
|
35.2
|
78.7***
|
Autonomy & security
| ||||
Keeping job as long as you want | 45.5 | 50.5 |
49.3
|
71.7***
|
Independence from interference | 37.4 | 41.8 |
39.6
|
49.9***
|
Transparency
| ||||
Not having to pay bribes to get what you want | 72.8 | 72.7 |
70.0
|
89.1***
|
Not having work influenced by political decisions |
70.2
|
79.8**
|
42.8
|
89.0***
|
Other
| ||||
Trusted by clients |
56.7
|
69.3**
|
78.5
|
91.5***
|
Superior who recognizes work |
50.3
|
43.6*
|
53.0
|
43.4*
|
Discordance between importance and actual presence of job characteristics
INDICATOR | STATE (AP) | STATE (UP) | ||
---|---|---|---|---|
Public
|
Private
|
Public
|
Private
| |
Job content & work environment
| ||||
Challenging work
|
31.8%
|
26.3%
|
41.1%
|
20.0%***
|
Training opportunities
|
51.0%
|
33.4%***
|
67.7%
|
46.9%***
|
Tools to use skills on the job
|
54.3%
|
35.4%***
|
59.8%
|
22.2%***
|
Good working relationships with colleagues
|
13.8%
|
16.8%
|
19.0%
|
9.2%***
|
Good physical conditions
|
39.2%
|
31.2%
|
51.2%
|
18.0%***
|
Knowing what you are expected to do | 29.1% | 16.4%*** | 31.5% | 16.7%*** |
Extrinsic benefits
| ||||
Good employment benefits | 39.2% | 34.6% | 50.0% | 47.2%** |
Good income | 44.8% | 33.6%* | 44.8% | 36.3%*** |
Opportunity to advance | 43.9% | 34.0%** | 61.4% | 42.2%*** |
Time for family life | 47.8% | 42.6% | 49.2% | 35.3%*** |
Based in good location | 39.8% | 21.9%** | 60.2% | 13.9%*** |
Autonomy & security
| ||||
Keeping job as long as you want | 23.4% | 16.6%** | 26.1% | 15.1%*** |
Independence from interference | 32.2% | 19.2%** | 28.1% | 23.5%* |
Transparency
| ||||
Not having to pay bribes to get what you want | 10.5% | 6.0%* | 20.5% | 4.7%*** |
Not having work influenced by political decisions | 16.6% | 8.0%** | 37.5% | 5.2%*** |
Other
| ||||
Trusted by clients | 18.4% | 11.0%** | 18.4% | 7.1%*** |
Superior who recognizes work | 34.6% | 24.8%** | 41.4% | 31.6%** |
Discussion
Main factors describing health worker satisfaction
Differences in employment environment between the two states
Differences in employment environment between private and public sector
Which health workers have the biggest gap in expectations?
What are the limitations of this study?
Conclusions
-
Improvements in training opportunities for skill development and availability of equipment for effective use of existing professional skills have the greatest promise to raise health worker satisfaction in both states. The public sector in particular needs to focus attention on this aspect of their health sector human resource management, since the level of discordance on this aspect was significantly more in the public sector compared to the private sector.
-
Whereas a large number (41%) of public sector health workers in both states had discordant views about their work location, the problem appears to be particularly acute in UP. Some useful interventions in this area may be: (a) reorganization of health worker cadres into smaller geographical entities, so that potential candidates can self select geographic cadres according to their personal preferences, (b) transparent, responsive and reliable transfer and posting policy.
-
Even though the financial package was rated as lower in importance compared to non-financial incentives related to job content and work environment, employers are well advised to not ignore the incomes of health workers. Overall between 40 to 50% of health workers did not realize their salary expectations.
-
The organizational culture requires attention. Training and motivation of supervisory personnel to promptly recognize good work, and foster an environment that encourages autonomy will improve health worker satisfaction and motivation. Here again the need appears greater for the public sector institutions. About 41% of public sector health workers in UP reported discordance due to inadequate recognition of their work. In AP about 35% of public sector health workers longed for supervisors who would recognize their work.
-
For health workers engaged in the public sector, the effect of corruption on their day to day working may need closer analysis. It provides further incentive to policy-makers and managers to take steps to reduce corruption, though this may not be always easy. Trying to reduce the effect of corruption on the morale of workers may be an approach to follow. This would entail involving workers in identifying problems with non-transparency and its impact on them, and working with them to reduce its effects.