The online version of this article (doi:10.1186/1475-2875-11-48) contains supplementary material, which is available to authorized users.
The authors declare that they have no competing interests.
All the listed co-authors commented substantially on the paper and were part of the design of the research proposal and research instruments. GMM was the principal investigator in the study that was part of his PhD training in health sciences with a specialty in the health economics, management, planning, and policy systems related to IPTp for malaria that was carried out under the Faculty of Health Sciences at the University of Copenhagen in Denmark. GMM has since 1996 been working the National Institute for Medical Research (NIMR) in Tanzania until now. All authors read and approved the final manuscript.
Since its introduction in the national antenatal care (ANC) system in Tanzania in 2001, little evidence is documented regarding the motivation and performance of health workers (HWs) in the provision of intermittent preventive treatment of malaria during pregnancy (IPTp) services in the national ANC clinics and the implications such motivation and performance might have had on HWs and services' compliance with the recommended IPTp delivery guidelines. This paper describes the supply-related drivers of motivation and performance of HWs in administering IPTp doses among other ANC services delivered in public and private health facilities (HFs) in Tanzania, using a case study of Mkuranga and Mufindi districts.
Interviews were conducted with 78 HWs participating in the delivery of ANC services in private and public HFs and were supplemented by personal communications with the members of the district council health management team. The research instrument used in the data collection process contained a mixture of closed and open-ended questions. Some of the open-ended questions had to be coded in the form that allowed their analysis quantitatively.
In both districts, respondents acknowledged IPTp as an essential intervention, but expressed dissatisfaction with their working environments constraining their performance, including health facility (HF) unit understaffing; unsystematic and unfriendly supervision by CHMT members; limited opportunities for HW career development; and poor (HF) infrastructure and staff houses. Data also suggest that poor working conditions negatively affect health workers' motivation to perform for ANC (including IPTp) services. Similarities and differences were noted in terms of motivational factors for ANC service delivery between the HWs employed in private HFs and those in public HFs: those in private facilities were more comfortable with staff residential houses, HF buildings, equipment, availability of water, electricity and cups for clients to use while taking doses under direct observed therapy than their public facility counterparts. Employees in public HFs more acknowledged availability of clinical officers, nurses and midwives than their private facility counterparts. More results are presented and discussed.
The study shows conditions related to staffing levels, health infrastructure and essential supplies being among the key determinants or drivers of frontline HWs' motivation to deliver ANC services in both private and public HFs. Efforts of the government to meet the maternal health related Millennium Development Goals and targets for specific interventions need to address challenges related to HWs' motivation to perform their duties at their work-places.
Authors’ original file for figure 112936_2011_2009_MOESM1_ESM.doc
National Bureau of Statistics, ICF Macro: Tanzania Demographic Health Survey: Preliminary Report. 2010, Dar Es Salaam
Mubyazi G, Bloch P, Byskov J, Hansen K, Olsen Ø, Magnussen P: Economic and other contextual determinants of the acceptability and viability of intermittent preventive treatment for malaria during pregnancy in Tanzania. MIM-GM-6048. ActaTropica, MIM Conference Abstracts. 2005, 95S: S1-S506 p252.
Mubyazi GM, Magnussen P, Goodman C, Bygbjerg IC, Kitua AY, Olen ØE, Bloch P: Implementing intermittent preventive treatment for malaria in pregnancy: review of prospects, achievements, challenges and agenda for research. Open Trop Med J. 2008, 1: 92-100. 10.2174/1874315300801010092. PubMedCentralCrossRefPubMed
Ernst ME, Messmer PR, Franco M, Gonzalez JL: Nurses' job satisfaction, stress and recognition in pediatric settings. Pediatr Nus. 2004, 30: 219-227.
Franco LM, Bennett S, Kanfer R, Stubblebine P: Determinants and consequences of health worker motivation in hospitals in Jordan and Georgia. SocSci Med. 2004, 58: 343-355. 10.1016/S0277-9536(03)00203-X. CrossRef
Hanson , Goodman CG, Lines J, Meek S, Bradley D, Mills A: The economics of malaria control interventions. Global Forum for Health Research. 2004, Geneva
Mubyazi GM, Bloch P, Magnussen P, Olsen Øystein, Byskov Jens, Hansen Kristian, Bygbjerg IC: Women's experiences and views about costs of seeking malaria chemoprevention and other antenatal services: a qualitative study from two districts in rural Tanzania. Malar J. 2010, 9: 54-10.1186/1475-2875-9-54. PubMedCentralCrossRefPubMed
Wooldridge JM: Introductory econometrics: a modern approach International Student Edition. Thompson, South-Western, USA. 2006
Mubyazi GM, Bygbjerg IC, Magnussen P, Olsen ǾE, Byskov J, Hansen KS, Bloch P: Prospects, achievements, challenges and opportunities for scaling up malaria chemoprevention in pregnancy in Tanzania: the perspective of national level officers. Malar J. 2008, 7: 135-10.1186/1475-2875-7-135. PubMedCentralCrossRefPubMed
Mubyazi G, Bloch P, Kamugisha M, Kitua A, Ijumba J: Intermittent preventive treatment of malaria during pregnancy in Tanzania: a qualitative study of knowledge, attitudes and perceptions of district health managers, antenatal service staff and pregnant women in Korogwe district, northeastern Tanzania. Malar J. 2005, 4: 31-10.1186/1475-2875-4-31. PubMedCentralCrossRefPubMed
Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, Fee E, Habte D, Hanvoravongchai P, Jacobs M, Kurowski C, Michael S, Pablos-Mendez A, Sewankambo N, Solimano G, Stilwell B, de Waal A, Wibulpolprasert S: Human resources for health: overcoming the crisis. Lancet. 2004, 364: 1984-1990. 10.1016/S0140-6736(04)17482-5. CrossRefPubMed
Filippi V, Ronsmans C, Campbell OMR, Graham WJ, Mills A, Borghi J, Koblinsky M, Osrin D: Strategies for reducing maternal mortality: getting on with what works. Lancet. 2006, 368: 1284-1290. 10.1016/S0140-6736(06)69381-1. CrossRef
Kovner C, Brewer Wu YW, Cheng Y, Suzuki M: Factors associated with work satisfaction of registered nurses. J NursScholarsh. 2006, 38: 71-79. CrossRef
Gardulf A, Siderstrom IL, Arton ML, Eriksson LE, Arnetz B, Nordstrom G: Why do nurses at a university hospital want to quit their jobs?. J NursManag. 2005, 13: 329-337.
Fochsen G, Sjogren K, Josephson M, Lagerstrom M: Factors contributing to the decision to leave nursing care: a study among Swedish nursing personnel. J NursManag. 2005, 13: 338-344.
Begat I, Ellefsen B, Severinsson E: Nurses' satisfaction with their work environment and the outcomes of clinical nursing supervision on nurses' experiences of well-being-a Norwegian study. J NursManag. 2005, 13: 221-230.
Salem B, Beattle KJ: Facilitative supervision: a vital link in quality reproductive health service delivery. AVSC International. 1996, 18- http://www.engenderhealth.org/pubs/workpap/wp10/wp_10.html (accessed: 15th January, 2012)
Hosmer DW, Lemeshow S: Applied logistic regression analysis. 2000, John Willey & Sons Inc., USA, 2 CrossRef
URT: National Public-Private-Partnership Policy. 2009, Prime Minister's Office, Dar Es Salaam, Tanzania
- Supply-related drivers of staff motivation for providing intermittent preventive treatment of malaria during pregnancy in Tanzania: evidence from two rural districts
Godfrey M Mubyazi
Ib C Bygbjerg
Kristian S Hansen
- BioMed Central
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